Escape Room-Based Learning in a Neurological Rehabilitation Course: Academic Achievement, Performance, and Student Experience

This single-group quasi-experimental mixed-methods educational study will evaluate the effects of an escape room-based learning activity implemented within the Neurological Rehabilitation course for third-year undergraduate physiotherapy and rehabilitation students at Lokman Hekim University.

The study aims to investigate the effects of escape room-based learning on academic achievement, practical performance, clinical problem-solving, clinical decision-making, teamwork, communication, time management, student satisfaction, and learning experiences. The qualitative component will explore students' perceptions, evaluations, and recommendations regarding the escape room learning experience through semi-structured individual interviews.

Students who voluntarily agree to participate will be assigned to teams of approximately seven students. Each team will participate in a structured educational escape room activity consisting of three phases: prebriefing, gameplay, and debriefing.

During the prebriefing phase, students will receive information about the purpose of the activity, rules, time limit, team roles, safety procedures, and their right to withdraw from the activity at any time. The gameplay phase will consist of six neurological rehabilitation stations. Students will work collaboratively to solve puzzles and complete practical tasks involving identification of neurological conditions, interpretation of clinical findings, use of the ASIA Impairment Scale, sensory assessment, selection and use of walking aids, matching disease-specific assessment methods, and clinical decision-making.

The escape room activity will be conducted in a university laboratory arranged to provide a standardized educational environment for each group. Students will have a limited time to complete the stations. Performance indicators will include completion time, number of completed stations, number of solved puzzles, hints received, errors made, and station-specific rubric scores.

After completing the escape room, each group will participate in a debriefing session. The debriefing will allow students to reflect on their decisions, communication, teamwork, errors, successful strategies, and learning outcomes. Temporary video recordings may be used only during the same-day debriefing session to facilitate reflection and discussion. These recordings will not be used as research data, shared, archived, or retained; they will be permanently deleted immediately after the debriefing session.

Quantitative assessments will include course academic performance, escape room performance measures, and satisfaction with the activity. Academic achievement, including midterm grades, final grades, and overall course grades, may be compared with data from students who completed the same course in the previous academic year, when the same instructor, course content, sequence, and assessment approach were used. Student satisfaction will be evaluated using an eight-item Likert-type questionnaire and two open-ended questions.

For the qualitative component, approximately 8 to 12 volunteer students representing different levels of academic achievement and different teams will participate in semi-structured individual interviews. Interviews will explore overall learning experience, emotional responses during the activity, teamwork, time pressure, perceived contribution to clinical reasoning, challenges, and suggestions for improving the intervention. Interviews will be audio-recorded, transcribed, and analyzed using thematic or content analysis.

Participation in the study will be voluntary and will not affect academic grades or course evaluation. Students who do not wish to participate in the research will not be disadvantaged. All research data will be anonymized, stored securely, and used only for scientific purposes. No medical intervention, physical examination, biological sample collection, or clinical treatment will be involved.

• Student Satisfaction with Escape Room-Based Learning [Time frame: Immediately after the escape room activity]
• Qualitative Student Learning Experience [Time frame: 16 weeks]