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Many people constantly use their smartphones in all kinds of situations. Often smartphones are used in a meaningful and targeted way, but frequently they are used as a pastime without any purpose. This also applies to patients and therapists in treatment situations.
The aim of this study was to investigate how purposeful smartphone use compared with recreational smartphone use (by a physiotherapist or by a patient) influenced the perception of a physiotherapeutic treatment situation. We examined the impact of smartphone use during a physiotherapy session on the perception of the physiotherapist, evaluation of attentiveness, and evaluation of smartphone use in physiotherapy in general.
Members of various music and sports clubs were invited to participate in an online randomized controlled trial. Participants were randomly assigned to one of four conditions. They watched a video in which a physiotherapeutic treatment was shown and in which a smartphone was used or not used in the following four different ways: (1) therapeutically purposeful use, (2) recreational use by the physiotherapist (looking at the phone from time to time with no therapeutic purpose), (3) recreational use by the patient, and (4) no smartphone use (control condition). After watching the video, the participants indicated their perception of the physiotherapist’s professional competence, social competence, and empathetic behavior. They also rated the physiotherapist’s and patient’s attentiveness and evaluated the usage of smartphones generally in physiotherapy.
The analysis included 118 participants (63 women and 55 men). When the physiotherapist used the smartphone in a purposeful way, the physiotherapist was perceived as more professionally competent (
Smartphones are only appropriate for therapists and patients if they are used directly for a therapeutic purpose. Otherwise, it is better not to use smartphones during treatment.
AsPredicted (aspredicted.org) #24740; https://aspredicted.org/blind.php?x=vv532i
Smartphones and other mobile devices are ubiquitous. They enable their users to complete a large number of tasks with little effort. They can be used not only for all kinds of everyday tasks, but also expressly for medical diagnostics [
Checking behavior refers to people’s habit of constantly inspecting their smartphones. This includes receiving messages from other people and reports of news through websites or social media. Habits are repetitive procedures and activities in certain situations. This checking habit is a kind of ritual for many people, which mostly happens unconsciously [
In physiotherapy, new exercises are often shown to build up muscles or train balance and body awareness. One technique that is often used to support such learning processes is learning through observing one’s own behavior or the behaviors of human role models [
Through video self-modeling (ie, a video recording of the patient herself/himself during the implementation of a motor movement sequence), visual evidence is produced. This differs from the video exercise instruction, which shows a film excerpt with the motion sequence being performed by an expert or professional. Many studies have confirmed the usefulness of video feedback to improve athletic performance [
The interaction between therapists and patients is a complex construct. The therapeutic relationship between therapists and patients is an important factor for the success of physiotherapy. In this type of relationship, aspects, such as social and professional competence and empathy, are particularly important [
In order to ensure a positive effect of the therapeutic relationship,
In addition to professional competence,
Adequate empathetic behavior by therapists is also important to promote a positive therapeutic relationship and treatment success. Through
As an open research question, we examined whether the assumed differences in perceived professional competence, perceived social competence, and perceived empathetic behavior occur owing to the fact that (1) purposeful use of the smartphone leads to a
In order to be able to ensure successful therapy, a good working atmosphere must be created. One factor that can positively influence the working atmosphere is attention. It is important not to be distracted in order to be able to focus one’s full attention on something [
In this context, it is also relevant to investigate how the concrete use of smartphones in the physiotherapeutic treatment situation affects how the participants evaluate the use of smartphones in general. We state the following hypothesis (hypothesis 5): The way the smartphone is used has an impact on participants’ evaluation of smartphone use in physiotherapy in general. Smartphone use in physiotherapy will be rated as more positive if the smartphone is used in a purposeful way than if physiotherapists or patients look at it from time to time with no therapeutic purpose.
As an open research question, we examined whether the assumed differences are owing to the fact that (1) purposeful use of the smartphone leads to a
This study was approved by the Ethics Committee of the Leibniz-Institut fuer Wissensmedien (Tuebingen, Germany; approval number: LEK 2019/025).
The data for this study were collected in an online survey. The survey contained several questionnaires and a video that differed depending on the experimental condition. We used a video presentation, because this allowed for standardized manipulation of the conditions. The video clips lasted about 2 minutes. They showed a physiotherapeutic treatment with different types of smartphone use, involving a female physiotherapist and a female patient, who were both portrayed by actresses. The first and the last scenes of the video were identical in all of the conditions. First, the patient was greeted and asked about the current back pain. In the following part, the physiotherapist provided instructions for an exercise with a Pezzi ball. Here, the physiotherapist demonstrated the exercise and the patient imitated it. In this part, the conditions differed only with regard to smartphone use (
Experimental conditions.
A power analysis for analysis of variance (ANOVA) with α=.05, an intended power of 95%, and a large effect size of 0.40 revealed a required sample size of 112. Members of various music and sports clubs in Germany (Federal State of Baden-Wuerttemberg) were invited via the clubs’ internal email distribution lists to participate from June to July 2019 in an online study. This was a relevant sample as both athletes and musicians often need physiotherapy [
Flow diagram for study participants.
Initially, the participants provided information about their age, gender, current occupation, and daily smartphone usage. Thereafter, they were asked to imagine that they were undergoing physiotherapy for back pain. After that, the participants were randomly assigned to one of the four experimental conditions equally and they watched the appropriate video. Randomization was carried out by using Qualtrics software (Qualtrics). All participants were blinded to group allocation.
After watching the video, we conducted a manipulation check to ensure that the participants recognized the experimental treatment. They then indicated their perception of the professional competence, social competence, and empathetic behavior of the physiotherapist. They also rated the physiotherapist’s and patient’s attentiveness and evaluated the usage of smartphones in physiotherapy in general. Finally, the participants were debriefed. They were given the investigators’ contact information, and a link was provided to enable them to take part in a raffle for Amazon vouchers (two vouchers of €50 (USD 60) each and five vouchers of €20 (USD 23) each). Participation in the study took about 20 to 30 minutes.
The online study was created using the Qualtrics software. The questionnaire of Willson and McNamara was used to measure
Unprofessional (1) to professional (9)
Experienced (1) to inexperienced (9)*
Not thorough (1) to thorough (9)
Careful (1) to careless (9)*
Incompetent (1) to competent (9)
Trained (1) to untrained (9)*
Not appealing (1) to appealing (9)
Confident (1) to unconfident (9)*
Friendly (1) to unfriendly (9)*
Impolite (1) to polite (9)
Attentive (1) to not attentive (9)*
Unkind (1) to kind (9)
Pleasant (1) to unpleasant (9)*
Not nice (1) to nice (9)
Caring (1) to not caring (9)*
Insensitive (1) to sensitive (9)
Sympathetic (1) to unsympathetic (9)*
1: The physiotherapist behaved in such a way that the patient felt comfortable around her.
2: The physiotherapist was caring and showed compassion to the patient.
3: The physical therapist really listened to the patient.
4: The physiotherapist encouraged the patient.
5: The physiotherapist explained everything to the patient in an understandable way.
We measured
-The therapist seemed to be distracted during the therapy.*
-The therapist’s attention was completely focused on the therapy.
-The therapist showed great interest in the progress of the therapy.
-The patient seemed to be distracted during the therapy.*
-The patient’s attention was completely focused on the therapy.
-The patient showed great interest in the progress of the therapy.
We also measured how participants evaluated the use of smartphones in physiotherapy in general (
1: A smartphone is mainly distracting in physiotherapy.*
2: A smartphone interferes during physiotherapy.*
3: A smartphone stands in the way of good physiotherapy.*
4: It is very useful to use a smartphone in physiotherapy.
5: The use of a smartphone in physiotherapy is very supportive.
6: Using a smartphone in physiotherapy entails advantages.
Data analysis was performed using IBM SPSS 25 statistics (IBM Corp) for Windows. To test our hypotheses and answer the open research questions, we performed contrast analysis. Contrast analysis allows for testing specific hypothesized patterns of mean differences by defining lambda coefficients while increasing statistical power and avoiding issues of multiple testing, which would arise with pairwise comparisons using
We provide mean, SD, and R as an indicator of effect size for significant results. According to a previous report [
There were no significant differences among the four experimental conditions regarding participants’ sex (
All of the outcome variables (professional competence:
In hypothesis 1, we assumed that the professional competence of the physiotherapist would be perceived as more pronounced if the physiotherapist used the smartphone in a purposeful way than if the physiotherapist looked at it from time to time with no therapeutic purpose. A contrast analysis supported this assumption (t112=2.53,
Hypothesis 4a was supported by the data as well. When the physiotherapist used the smartphone in a recreational way, the physiotherapist was perceived as being less attentive than in all of the other conditions (t105=5.15,
In line with hypothesis 5, we found that the way the smartphone was used had an impact on participants’ evaluation of smartphone use in physiotherapy in general. If the physiotherapist used the smartphone in a purposeful way, smartphone use in physiotherapy was rated more positively compared with the conditions in which the physiotherapist or the patient looked at the smartphone from time to time with no therapeutic purpose (t102=7.01,
Means and CIs for the outcome variables professional competence and social competence in the four experimental conditions. ns: nonsignificant. *
Means and CIs for the outcome variables empathetic behavior, attentiveness of the physiotherapist, attentiveness of the patient, and smartphone use in the four experimental conditions. ns: nonsignificant. *
As further contrast analyses showed, differences in perceived professional competence, perceived social competence, and perceived empathetic behavior occurred owing to the fact that the checking behavior of the physiotherapist led to a lower rating than no smartphone use (professional competence: t112=3.12,
Purposeful use of the smartphone did not lead to a higher rating of perceived professional competence (
This study examined to what extent smartphone use in a physiotherapeutic treatment session impacted the perceived competence and empathy of the physiotherapist, the perceived attentiveness of the physiotherapist and the patient, and the overall evaluation of the use of smartphones in physiotherapy. To our knowledge, this is the first empirical investigation into the effects of different kinds of smartphone usage in physiotherapeutic treatment situations. By examining the difference between purposeful use of smartphones and the often unconsciously occurring checking (or phubbing) behavior, we aimed to contribute to the highly socially relevant discussion about new interaction phenomena induced through the omnipresence of smartphones.
As expected, our results indicated that purposeful use of a smartphone by a physiotherapist was assessed differently from recreational smartphone use regarding the rating of the physiotherapist’s professional and social competence and empathetic behavior. Interestingly, this was the case because the checking behavior of the physiotherapist led to a lower rating than no smartphone use and not because of the superiority of purposeful smartphone use. It seems that the smartphone used as a treatment tool was accepted, but it did not lead to any more positive perceptions of the therapist. It is therefore particularly important to use a smartphone in therapy only in a targeted manner; otherwise, it can have a negative impact on the physiotherapist-patient relationship, which is important for treatment success [
Overall, the results of our study are in line with other research findings demonstrating that smartphone use in social situations can have negative effects on social interactions [
Our research has some limitations worth noting. First, the experiment conducted here only relied on video material of a physiotherapeutic treatment situation. While videos can be a great format for illustrating processes, they are only an imitation of real treatment situations. Owing to the exact scripting of the video, we had the advantage of creating standardized experimental material, but the disadvantage of a reduced level of realism. In addition, the participants acted as observers and not as patients or therapists. We cannot know conclusively whether actual interaction partners in situations like the one in the video would perceive the situation in the same way. Moreover, this study cannot make a statement about whether a certain level of smartphone use is necessary to achieve certain effects, whether there must be a minimum threshold of smartphone use, or whether more smartphone use leads to stronger effects. The findings of this study only allow conclusions to be drawn about whether a certain type of use in general caused the effects investigated. Another limitation was the relatively small sample size. As the power analysis showed, we could only determine rather large effects. Large effects are also more relevant to clinical practice. Owing to the sample size, we cannot draw any conclusions on specific participant characteristics, such as gender and age. This should be addressed in further studies. It would also be interesting to examine different characteristics (eg, gender, age, and digital competence) of the therapist in further studies. Finally, we considered only one physiotherapeutic treatment situation. Generalization to other treatments or medical conditions is therefore not possible. We advise researchers to examine the effects of different kinds of smartphone uses in real clinical settings in the future.
This research showed that the frequently reported negative effects of smartphone use in social (face-to-face) interactions were not perceived as such by our participants if the smartphone was used in an obviously purposeful way. In this kind of usage, participants even see the positive potential of smartphone use in physiotherapy. In summary, we recommend that practitioners use smartphones in a medical treatment situation only as actively integrated supportive tools for the purpose of treatment. Otherwise, a smartphone should be used with great awareness, and checking behavior should be avoided as often as possible.
CONSORT checklist.
analysis of variance
The research reported here was supported by budget resources of the Leibniz-Institut fuer Wissensmedien (Tuebingen, Germany).
None declared.