Effectiveness of various pedagogical tools to enhance clinical reasoning in physiotherapy: a systematic review

BACKGROUND: Developing clinical reasoning is a critical component of physiotherapy education. Active strategies such as simulation- and digital-based learning have been proposed to enhance these skills. However, their effectiveness, but also the best modalities remain largely unknown. Therefore, this systematic review aimed to evaluate the effectiveness of various educational strategies on clinical reasoning among physiotherapy students and clinicians. METHODS: A systematic search of PubMed, Scopus, PsycINFO, and ProQuest Central was conducted for studies published between January 1, 2015 and February 28, 2026. Eligible designs included randomized controlled trials, controlled before - after studies, pre - post studies, and quasi-experimental designs. Methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI) for quantitative studies and the Mixed Methods Appraisal Tool (MMAT) for qualitative or mixed-methods studies. Data were narratively synthesized by grouping studies into three pedagogical categories: (i) simulation- and digital-based learning, (ii) active and case-based learning methods, and (iii) structured educational programs and training. RESULTS: = 3,048 participants) of moderate-to-high methodological quality were included in this study. Participants ranged from entry-level physiotherapy students to licensed clinicians. Simulation- and digital-based approaches, such as standardized patients, virtual reality, mobile applications, and computer-assisted learning, showed consistent improvements in clinical decision-making and performance, as well as gains in self-efficacy and motivation. Active and case-based learning strategies, including problem-based learning and concept mapping, were associated with increased satisfaction, reflective practice, and usability. Structured programs, such as residencies, workshops, and mentorship models, produced notable benefits in decision-making, self-efficacy, and professional attitudes. Overall, simulation-, digital-based and structured programs demonstrated the most consistent evidence of effectiveness across studies. CONCLUSION: Simulation, digital technologies, active learning, and structured programs effectively foster clinical reasoning in physiotherapy education. Simulation-based and active approaches appear particularly impactful. Future research should emphasize high-quality randomized trials and long-term outcomes, including patient-related measures.