Physiotherapists often lack sufficient training in SCI management during their education. To address this gap, a 5-week MOOC was developed in collaboration with the International Spinal Cord Society (ISCoS), offered in five languages. This study aimed to evaluate the MOOC's reach, effectiveness, participant reactions, and impact on clinical practice and teaching, using the RE-AIM and Kirkpatrick frameworks. The 2022 MOOC built upon previous iterations, significantly expanding its reach by offering the course in multiple languages and utilizing online platforms for learning and interaction. The paper then discusses the value and limitations of MOOCs as a method of education and training. The potential for MOOCs to address global health disparities by expanding access to education is highlighted. The authors acknowledge criticisms of MOOCs, such as low completion rates, and suggest that evaluating success should focus on the individual learner's goals and the impact on their knowledge and practice. The introduction concludes by stating the study's objective: to determine the learners’ experience and the impact of the 2022 MOOC.

The literature review examines the characteristics and effectiveness of MOOCs, focusing on their potential as a cost-effective and widely accessible educational tool. It references studies that explore the importance of community building in online learning environments, highlighting features that enhance engagement and knowledge retention. The authors also address criticisms regarding low completion rates and suggest alternative metrics for assessing MOOC success, emphasizing the individual learner's goals and self-reported changes in knowledge and practice. Previous MOOCs on SCI management run by the authors are referenced, highlighting the iterative development and refinement of the course design.

The 5-week MOOC was delivered online in English, Spanish, French, Portuguese, and Chinese. Data was collected from multiple sources: registration details, pre- and post-MOOC knowledge assessments, a post-MOOC evaluation, social media posts (Facebook and Weibo), and website analytics. The study used a mixed-methods approach, combining quantitative data (e.g., knowledge assessment scores, website usage statistics) and qualitative data (e.g., participant feedback from the evaluation and social media comments). The methodology section details data collection methods, outlining how each data source was used to address four research questions related to reach, effectiveness, participant reactions, and behavior change. Data analysis included descriptive statistics, text analysis of qualitative data to identify key themes and sentiments, and comparisons of pre- and post-MOOC knowledge scores. Ethical considerations are addressed, noting the University of Sydney’s Ethics Committee approval and waiver of consent.

Over 25,737 individuals from 169 countries registered for the MOOC. Participants completing the post-MOOC evaluation (n=2817) overwhelmingly rated the MOOC as “good” or “very good”. A substantial improvement in knowledge was observed, with a median (IQR) increase of 25% (10–45%) on the knowledge assessment (n=4016). Qualitative data revealed positive participant reactions, with many expressing enjoyment of the diverse learning materials (videos, case studies, online exercises), and indicating intentions to change clinical practice and teaching methods. Engagement varied across different MOOC components, with higher engagement observed in the early weeks. Attrition rates were observed, with a significant drop-off in participation towards the end of the course. Analysis of comments highlighted participants' positive overall impressions of the MOOC, and specific aspects they valued. Participants reported significant learning gains, improvements in confidence and intentions to alter their clinical practice based on MOOC content.

The study's findings demonstrate the significant reach and positive impact of the MOOC in upskilling physiotherapists in SCI management. The large number of participants, especially from regions with limited access to specialized training, highlights the MOOC's potential to address global health disparities. The high satisfaction rates and reported knowledge gains support the effectiveness of the chosen online learning format and pedagogical approaches. While the attrition rate warrants further investigation, the overall engagement levels and qualitative feedback suggest that the MOOC effectively met the learning objectives for a substantial proportion of participants. The discussion further explores the limitations of using knowledge assessments to measure effectiveness and suggests alternative approaches to quantify the impact on clinical practice. The relative success of the video content and the online exercise prescription platform is highlighted. The role of online forums in fostering a sense of community is discussed, suggesting potential improvements for future iterations of the MOOC.

The 2022 MOOC effectively increased physiotherapists' knowledge and confidence in managing SCI. Participants reported positive experiences and intentions to implement learned skills. The vast reach highlights the potential of MOOCs for global health education. Future research should focus on refining assessment methods to accurately capture changes in clinical practice and explore strategies to improve engagement and reduce attrition rates. Further work should aim to objectively assess the MOOC based on eleven key principles of adult learning.

The study's limitations include the potential for bias in the sample completing the knowledge assessments and evaluations. Attrition rates varied across data sources, making it challenging to determine the overall engagement level. The impact on clinical practice and teaching was primarily assessed through self-reported intentions, lacking objective measures. The analysis of qualitative data relied on text analysis of a subset of comments, potentially missing nuanced perspectives. The study acknowledges that not all participants completed all assessment components, potentially skewing results. The authors suggest paying participants to complete the post-MOOC evaluation to reduce bias. The lack of a control group also limits the ability to definitively attribute changes in knowledge and practice to the MOOC itself.