Investigation of physical playfulness in physiotherapy students
BMC Medical Education volume 23, Article number: 651 (2023)
Physiotherapists show a positive attitude towards playing games in order to be a role model for pediatric patients and to increase the success of therapy. The aim of the present study is to investigate the physical playfulness of physiotherapy students and the relationship of physical playfulness and individual and environmental factors.
The sociodemographic data, regular physical activity habits of the students were examined as well as their computer game playing status and duration. “Attitudes of 18–22 Age Adults for Playing Games That Contain Physical Activity” scale was used for assessing playfulness.
A total of 268 students participated in the study. Among the game proneness scale subsections, the highest score was obtained in the Social Adjustment while the lowest scores were obtained in the “Desire to Play Game” and “To take pleasure from playing game” subsections. Male students scored higher in “Risk Taking and “To take pleasure from playing game” in comparison with the female students. There was a statistically significant difference between physical activity habits and “Game Compassion”, “Risk Taking”, “Social Adjustment” and “To take pleasure from playing game scores”.
Physiotherapy students were found to be more playful, particularly in terms of social adaptation. Men take more risks in the plays and also play the games more enjoyable. Students with regular physical activity habits were more playful overall. The present study suggests that monitoring physical activity levels, computer games types might be beneficial for evaluating the playfulness.
From a biopsychosocial point of view, one of the features that support the social aspect of human is playing and being playful [1, 2]. Buytendijk (1933) defines the game as a certain type of playful movement with rules . Plays are a variety of activities promoting the maturation and development of necessary skills in chilhood [4, 5]. Games enable the development of their communication and motor skills as well as they increase emotional skills and social interactions [1, 6]. Games has a crucial role in maximizing independence and expanding relevant individual goals in children. Accordingly, games also have a positive effect on the treatment process of children who are functionally dependent [4, 5].
Many types of games are available and one of them is physical activity games . Such games present a higher intensity of physical activity than resting metabolic rate (running, jumping, etc.) . Playfulness is defined as “an individual difference variable that allows the person to frame or reframe everyday situations in such a way that they experience them as entertaining, and/or intellectually stimulating, and/or personally interesting” . Playfulness has a number of psychological and physiological benefits including problem solving, physical activity, and imagination [1, 9].
In recent years, it was stated that the participation in physical activity among university students has decreased with the intensive use of technology such as mobile phones and computer games [10,11,12]. Physical activity has an important place in the process of maintaining health and preventing diseases. In order to develop healthy behaviors, barrier and facilitator factors affecting physical activity participation are currently investigated. The fact that funny activity is considered among the factors that increase physical activity participation [13,14,15]. On the other hand, game increases the motivation of the individual when combined with physical activity because it is funny . It has been emphasized in the current publications that use of exergaming (virtual exercise training game) increases the compliance of individuals to treatment of various diseases such as obesity, dementia and respiratory problems [17,18,19].
In physiotherapy training, some movements may be painful or create tension . The fact that repetitive compulsory activities such as exercise is boring for children diagnosed with acute and chronic diseases and it may be difficult for these children to focus on treatment. Making these therapeutic activities enjoyable increases the success of the treatment [21, 22]. In a study, a group of patients with CP who received physiotherapy since childhood were asked about the factors that facilitated their participation in treatment. The patients stated that the fun of the treatment increased their motivation and participation in the treatment . Furthermore, physiotherapists strengthen their communication with the child while transforming the activity to the game compatible with their purpose [2, 3, 21, 22,]. There is a need for integrating physical activity games with therapy for children receiving physiotherapy and rehabilitation services to be able to perform functional activities in an independent manner. Physiotherapists are one of the professional groups that observe children most frequently in their career [23,24,25,26]. Therefore, it is important for physiotherapists to show a positive attitude towards playing games both in order to be a role model for pediatric patients and to increase the success in the therapy .
An important factor in physical activity games is the intensity of the activity changing moderate to vigorous . There are many individual and environmental factors that may affect intensity. One of them is that individuals need an ability to regulate their body temperature during the game. According to this hypothesis, children play games requiring less-intense physical activity in hot weathers . In addition, gender has shown as a factor that will affect the severity of physical activity. The studies show that boys prefer games with more physical activity intensity because they spend more time with their fathers .
Therefore, the aim of our study is to investigate the playfulness of physiotherapy students and the relationship of playfulness and individual with environmental factors.
Physiotherapy and Rehabilitation Department students with an age range of 18–22 years participated in the present descriptive study. Microsoft Forms program was used for creating voluntary consent form which contains information about the study, data registration form used in the evaluation and Attitudes of 18–22 Age Adults For Playing Games That Contain Physical Activity Scale. The students were informed about the study before participation. Students who volunteered to participate were asked to fill in the evaluation form that was provided via a link. It was assured by form design that all questions had to be answered and it was not possible to change a given answer and each student could log in to the form only once by using a username and password that is created uniquely for themselves.
Study participants were the first, second, third and fourth-year students of physiotherapy and rehabilitation department at Faculty of Health Sciences, Manisa Celal Bayar University. The voluntary students between the ages of 18–22 years were included in the study.
The forms of the students who were informed about the study and were voluntary participation, was reviewed. The forms of students under 18 and over 22 years are excluded (n = 12 students).
Data Registration Form
The data form consisted of questions regarding age, gender, height, weight, geographic region of residence, regular physical activity habits, and computer game playing status of the participants. The daily time (hours) spent for playing computer games was asked to the students who play computer games. We questioned only whether the students had regular physical activity habits in accordance with physical activity recommendations for the 18–64 age group . We calculated body mass index (BMI) that is calculated by person’s weight in kilograms divided by the square of height in meters .
Game proneness scale: attitudes of 18–22 age adults for playing Games that Contain Physical Activity
The scale consists of 5 sub-dimensions and 25 questions as follows: game compassion (questions 9,10,13,14,15,16), risk taking (questions 3, 4, 8, 19, 20), social adjustment (questions 6, 7, 11, 17, 18, 22), desire to play game (questions 1, 2, 5, 12) and taking pleasure (questions 21, 23, 24, 25). Items in the scale are evaluated with a five-point Likert-type scale as 1 point indicating “I strongly disagree” and 5 points “I strongly agree”. The validity and reliability study was performed by Hazar 2015. The Cronbach’s alpha coefficients of the sub-dimensions are 0.83, 0.86, 0.79, 0.72 and 0.81 for game compassion, risk taking, social adaptation, desire to play game and taking pleasure from playing game, respectively .
Sample size calculation
Epi InfoTM 188.8.131.52 software was used to calculate sample size. A 95% confidence interval was used for determining the number of participants needed. It was calculated that the minimum sample size should include 242 participants. Population size (for finite population correction factor or fpc) (N): 650. Hypothesized % frequency of outcome factor in the population (p): 50%+/-5 and confidence limits as % of 100 (absolute +/- %)(d): 5%. Sample size n= [DEFF*Np(1-p)]/ [(d2/Z21-α/2*(N-1) + p*(1-p)].
SPSS software (version 25.0) was used for performing statistical analyses. Analytical methods (Kolmogorov-Smirnov/Shapiro¬Wilk tests) were used to examine the distribution normality of the variables. The descriptive analyses were presented as mean ± standard deviation and descriptive statistics of categorical data were calculated as frequency and percentage values. In continuous data, t-test was used to compare independent groups with normal distribution. One-way ANOVA analysis was used for comparison between more than two groups and also post-hoc test Bonferroni analysis was performed. Pearson’s correlation test was used to examine the relationship between variables (age, BMI and daily time spent playing computer games) and scores. The results with a p-value below 0.05 were considered statistically significant.
Of totally 652 department students, 366 (56.13%) were not included in the study because they did not answer the online form and 6 (0.92%) ticked the option “I do not volunteer to participate in the study”. Twelve of the 280 volunteer students were excluded because they did not meet the criteria for the age range of 18–22 years. As a result, 268 department students participated in the study and filled out the online form. Since no missing data was found in the filled forms, all forms were considered to be valid. The average time to fill out the form was 8 min and 29 s.
The Cronbach’s α value of our study was found 0.89. Cronbach’s α value of sub-dimension scale ranged 0.78 to 0.62 (Game Compassion = 0.78, Risk Taking = 0.71, Social Adjustment = 0.75, Desire To Play Game = 0.70, Taking Pleasure = 0.62). These values were acceptable.
76.5% (n = 205) of the students were female and 23.5% (n = 63) were male. The mean age was 20.8 ± 1.2 years and the mean body mass index was 22.1 ± 3.8 kg/m2. It was seen that most of the students (46.6%) were living in the Aegean Region followed by Marmara by 22.0%, Mediterranean by 9.0%, Central Anatolia by 8.2%, Black Sea by 6.0%, Eastern Anatolia by 4.5% and Southeast Anatolia by 3.7%. While 55.2% of the participant group stated that they did regular physical activity, 44.8% of them were not doing. Of the students, 34.7% (n = 93) stated that they played computer games averagely 2.4 ± 2.1 h (See Table 1).
On the basis of mean score, it was found in the sub-dimensions of the game proneness scale that the participants gained the highest score in the sub-dimension of social adjustment (25.2 ± 3.1), followed by “risk taking” (15.0 ± 3.7), “game compassion” (14.8 ± 2.5), “desire to play game” (13.6 ± 3.7) and “to take pleasure from playing game” (13.6 ± 2.4), respectively (See Table 2). It was found that male scores in the dimensions of “risk tasking” (p = 0.005) and “to take pleasure from playing game” (p = 0.008) were significantly higher than those of females. The scores obtained from the dimensions of game compassion (p < 0.001), risk taking (p < 0.001), social adjustment (p = 0.001), to take pleasure from playing game (p < 0.001) by those with physical activity habits were significantly higher than those without physical activity habits.
The scores from the dimensions of game compassion (p = 0.008), risk taking (p = 0.005), to take pleasure from playing game (p = 0.001) were found to be significantly higher in the computer game players than those who were not players (See Table 3).
No correlation was found between subscore variables of student age and game proneness (game compassion: r = 0.030 and p = 0.623; risk taking: r= -0.085 and p = 0.167; social adjustment: r= -0.115 and p = 0.061; desire to play game: r= -0.029 and p = 0.641; to take pleasure from playing game: r = 0.012 and p = 0.846) (See Table 4).
There was no correlation between subscores of student BMI and game proneness (game compassion: r = 0.030 and p = 0.625; risk taking: r = 0.072 and p = 0.242; social adjustment r = 0.072: and p = 0.239; desire to play game: r = 0.095 and p = 0.120; to take pleasure from playing game: r = 0.112 and p = 0.067) (See Table 4).
In addition, there is no correlation between the subscores of duration of playing computer games and game proneness of the students either (game compassion: r = 0.018 and p = 0.867; risk taking: r= -0.159 and p = 0.135; social adjustment: r= -0.037 and p = 0.726; desire to play game: r = 0.122 and p = 0.250; to take pleasure from playing game: r = 0.161 and p = 0.130) (See Table 4).
The present study was carried out to evaluate the game proneness attitude of undergraduate students of the Department of Physiotherapy and Rehabilitation. The results showed that students had high scores in terms of game compassion, risk taking while playing, social adjustment in the game, desire to play, and taking pleasure of playing the game. Males took higher risks and enjoyed the game more than females. In all aspects, those were doing regular physical activity showed more game proneness attitude than those who were not doing. It was observed that the students who were playing computer games had more game compassion and risk taking behavior in the game and they also took more pleasure from playing compared to those who were not playing computer games.
In the present study that we evaluated the students from the Physiotherapy and Rehabilitation Department, it was seen that our students adapted to the environment more, took more risks, showed more desire to play and took more pleasure while playing games compared to the study of Öztürk  conducted with the students of the Department of Coaching and Sports Management. In our study, it was observed that Physiotherapy Department students were better at social adjustment in terms of game proneness while their passion for playing games was lower; however, it was observed in Öztürk’s study  that the passion of the students for playing games was at a higher level in contrast with their their social adjustment skills. This study also reported that the students of the coaching department are better than those of the sports management department in terms of showing social adjustment and taking pleasure from playing . The fact that the coaching students were better in terms of social adjustment of our students may be resulting from the fact that they have to communicate with the children in both areas of profession. In terms of the passion for playing, the desire of physiotherapists to play games with children that include physical activity may be in order to include the children more in the rehabilitation program. We argue that this is the reason why our results were similar, because the students of the coaching department also work to involve the children in sports related to game compassion. Although high game proneness scores were mentioned in the study of Balcı et al.  conducted to evaluate preschool teachers, sufficient data could not be reached to compare with our group because the study was published as an abstract.
Since the questionnaire used in our study did not present normal values, it is also debatable how playful the physiotherapy students should be. In addition, there are many factors that affect playfulness such as gender, number of siblings, gender of siblings and the climate of their residence region [8, 28]. In our study, we only investigated the effect of gender and region of residence, 77.6% of our group lived in a region with a temperate climate in Turkey. Because of this reason, we concluded that there was no difference regarding the region of residence.
The present study showed that men scored higher in-game risk-taking behavior and taking pleasure from game. In Öztürk’s study conducted with Coaching and Sports Management students, no gender difference was found.11 On the other hand, in the study conducted by Kaya et al. with Physical Education students, it was stated that males were more willing to play games . An important point is that higher scores were usually seen more often in the male gender in game proneness studies conducted between the ages of 10–14 years [35, 36]. Hazar et al. (2017) stated that men were more directed to sportive activities in patriarchal societies and were more involved in out-of-school activities . Our results were similar, although the age groups are close to the play period. The results of the study supported that the male gender enjoys playing games in adulthood and takes risks while playing games. The studies on child development in the literature indicated that boys are more injured while playing. Among the reasons for this, it is shown that boys are different from girls in terms of muscle strength and coordination [8, 28]. The review of the studies in this area reveal that there are studies showing that boys or girls are more playful and the effect of gender is still discussed in the literature. However, regarding taking risks in the game as one of the sub-dimensions of playfulness, there are many studies stating that boys participate in games more actively and take more risks than girls . Similar to the results in the literature, we found that young male adults took more risks at the end of our study.
In addition, the present study demonstrated that students with a regular physical activity habit were better at all sub-dimensions of game proneness than those who have not. Although a previous study with pre-school teaching students  in the literature did not support our results, another study conducted with physical education students  obtained results supporting our results. As Akarçeşme et al. showed comparing team sports and sedentary athletes in the age group of 10–14 years, all game proneness sub-scores of those who do sports were better . It has been stated that people who take part in regular physical activity have a more positive, social and enjoyable personality and try to take part in different fun activities. It is also stated that people with this personality structure are more playful as a view supported by the results of our study as well .
While the studies we examined were students who were known to do sports, we only asked students if they did regular physical activity according to WHO recommendations. One of our limitations was that we did not examine the characteristics such as physical activity intensity and duration. In addition, the majority of our study subjects were female.
In conclusion, the present study shows that our physiotherapist candidate students have a good level of game proneness. It is also noteworthy that male students and those who do regular physical activity have more positive attitudes towards playing games.
Thus, we conclude that it is important to develop approaches to ensure that female physiotherapist candidates are monitored in terms of playing attitude and physical activity participation throughout their undergraduate education in order to obtain more effective results from the physiotherapy and rehabilitation programs which they will apply to the pediatric patient, because they will frequently observe pediatric patients in their professional lives.
In the future, a more homogeneous group should be studied to investigate the effect of gender. In terms of climate change, there is a need for studies that will involve patients groups from various climates.
Our study was carried out with physiotherapy and rehabilitation students. Our students were the students who had an idea about the role of play and the importance of physical activity in communication with the child. Beside our students, we conclude that it is necessary to investigate how playful physiotherapists are while working with patients in the future.
The datasets used and analysed during this study are included in this article and are available from the corresponding author on reasonable request.
Proyer RT, Gander F, Bertenshaw EJ, Brauer K. The positive Relationships of Playfulness with Indicators of Health, Activity, and physical fitness. Front Psychol. 2018;9:1440. https://doi.org/10.3389/fpsyg.2018.01440.
Tonkin A, Whitaker J. Play and playfulness for health and wellbeing: a panacea for mitigating the impact of coronavirus (COVID 19). Soc Sci Humanit Open. 2021;4(1):100142. https://doi.org/10.1016/j.ssaho.2021.100142.
Foss N, Bardsen A. Playful reflection: an investigation into the kindergarten project ‘Play in physiotherapy with children’. Action Learning: Research and Practice. 2013;10(2):107–23. https://doi.org/10.1080/14767333.2013.791808.
Lai NK, Ang TF, Por LY, Liew CS. The impact of play on child development-a literature review. Eur Early Child Educ Res J. 2018;26(5):625–43. https://doi.org/10.1080/1350293X.2018.1522479.
Kapkın G, Manav G, Karayağız Muslu G. Effect of therapeutic play methods on hospitalized children in Turkey: a systematic review. Erciyes Med J. 2020;42(2):127–31. https://doi.org/10.14744/etd.2019.94940.
Proyer RT. A new structural model for the study of adult playfulness: assessment and exploration of an understudied individual differences variable. Personal Individ Differ. 2017;108:113–22. https://doi.org/10.1016/j.paid.2016.12.011.
Anderson-McName JK, Bailey SJ. The importance of play in early childhood development. Mont State Univ Extention. 2010;4(10):1–4.
Pellegrini AD, Smith PK. Physical activity play: the nature and function of a neglected aspect of playing. Child Dev. 1998;69(3):577–98.
Gordon G. Well played: the Origins and Future of Playfulness. Am J Play. 2014;6(2):234–66.
Xiao W, Wu J, Yip J, Shi Q, Peng L, Lei Q, Ren Z. The relationship between physical activity and mobile phone addiction among adolescents and young adults: systematic review and Meta-analysis of Observational Studies. JMIR Public Health Surveill. 2022;8(12):e41606. https://doi.org/10.2196/41606.
Mei S, Hu Y, Wu X, Cao R, Kong Y, Zhang L, Lin X, liu Q, Hu Y, Li L. Health Risks of Mobile phone addiction among College students in China. Int J Ment Health Addiction. 2022. https://doi.org/10.1007/s11469-021-00744-3.
Bebetsos E, Antoniou P. University students’ differences on attitudes towards computer use. Comparison with students’ attitudes towards physical activity. Interact Educational Multimedia: IEM. 2008;20–8.
Martins J, Costa J, Sarmento H, Marques A, Farias C, Onofre M, Valeiro MG. Adolescents’ perspectives on the barriers and facilitators of physical activity: an updated systematic review of qualitative studies. Int J Environ Res Public Health. 2021;18(9):4954. https://doi.org/10.3390/ijerph18094954.
Nikolajsen H, Sandal LF, Juhl CB, Troelsen J, Juul-Kristensen B. Barriers to, and facilitators of, exercising in fitness centres among adults with and without physical disabilities: a scoping review. Int J Environ Res Public Health. 2021;18(14):7341. https://doi.org/10.3390/ijerph18147341.
Denford S, van Beurden S, O’Halloran P, Williams CA. Barriers and facilitators to physical activity among children, adolescents, and young adults with cystic fibrosis: a systematic review and thematic synthesis of qualitative research. BMJ Open. 2020;10:e035261. https://doi.org/10.1136/bmjopen-2019-035261.
Williams WM, Ayres CG. Can active Video Games improve physical activity in adolescents? A review of RCT. Int J Environ Res Public Health. 2020;17(2):669. https://doi.org/10.3390/ijerph17020669.
Zhao Y, Feng H, Wu X, et al. Effectiveness of exergaming in improving cognitive and physical function in people with mild cognitive impairment or dementia: systematic review. JMIR Serious Games. 2020;8(2):e16841. https://doi.org/10.2196/16841.
Comeras-Chueca C, Villalba-Heredia L, Perez-Lasierra JL, et al. Active Video Games improve muscular fitness and motor skills in children with overweight or obesity. Int J Environ Res Public Health. 2022;19(5):2642. https://doi.org/10.3390/ijerph19052642.
López-Liria R, Checa-Mayordomo D, Vega-Ramírez FA, García-Luengo AV, Valverde-Martínez M, Rocamora-Pérez P. Eff Video Games as Phys Treat https://doi.org/10.3390/s22051902.
Sandström K, Samuelsson K, Oberg B. Prerequisites for carrying out physiotherapy and physical activity-experiences from adults with cerebral palsy. Disabil Rehabil. 2009;31(3):161–9. https://doi.org/10.1080/09638280701850934.
Palmer EN, Pratt KJ, Goodway J. A review of play therapy interventions for chronic illness: applications to childhood obesity prevention and treatment. Int J Play Therapy. 2017;26(3):125–37. https://doi.org/10.1037/pla0000045.
Snowdon N, Booth S. Exploring the beliefs of young people with cerebral palsy and their families about sport and physical activity in relation to paediatric physiotherapy exercise. Association of Paediatric Chartered Physiotherapists Journal. 2019;10(2):20–32. http://shura.shu.ac.uk/26358/.
DeGangi GA, Wietlisbach S, Goodin M, Scheiner N. A comparison of structured sensorimotor therapy and child-centered activity in the treatment of preschool children with sensorimotor problems. Am J Occup Ther. 1993;47(9):777–86. https://doi.org/10.5014/ajot.47.9.777.
Ray D, Bratton S, Rhine T, Jones L. The effectiveness of play therapy: responding to the critics. Int J Play Therapy. 2001;10(1):85–108. https://doi.org/10.1037/h0089444.
Fujisawa DS, Manzini EJ. Professional training in physiotherapy: the use of play activities in the treatment of children. Revista Brasileira de Educação Especial. 2006;12(1):65–84. https://doi.org/10.1590/S1413-65382006000100006.
Schivinski CIS, Manna BC, Belém FJDM, Castilho T. Therapeutic blowing toys: does the overlap of ventilatory stimuli alter the respiratory mechanics of healthy schoolchildren? Revista Paulista de Pediatria. 2020;38:2018259. https://doi.org/10.1590/1984-0462/2020/38/2018259.
Simons-Morton BG, O’Hara NM, Parcel GS, Huang IW, Baranowski T, Wilson B. Children’s frequency of participation in moderate to vigorous physical activities. Res Q Exerc Sport. 1990;61(4):307–14. https://doi.org/10.1080/02701367.1990.10607492.
Barber N. Play and energy regulation in mammals. Q Rev Biology. 1991;66:129–47. https://doi.org/10.1086/417142.
Hazar M. A study of developing an Attitudes Scale of 18–22 age adults for playing Games that Contain Physical activity (improving the 18–22 age playing Games Scale). J Phys Educ Sport Sci. 2015;9(1):149–62.
Oztürk H. Attitudes of students studying in Coaching and Sport Management Department towards playing Games Involving Physical Activity. Gaziantep Univ J Social Sci. 2016;15(2):717–28. https://doi.org/10.21547/jss.256720.
Balcı S, Yaşar Ekici F. Okul Öncesi Öğretmen Adaylarının Fiziksel Aktivite İçeren Oyunları Oynamaya Yönelik Tutumları. Book of Abstracts of 3rd International Scientific Research Congress on Humanities and Social Sciences (IBAD-2018), July 9–11, 2018 Skopje-MACEDONIA.
Kaya DG, Filiz B, Yıldırım N. Determination of the Attıtudes of the Faculty of Sport Sciences students towards playing Games Involving Physical Activity (18–22 age. Spormetre The Journal of Physical Education and Sport Sciences. 2021;19(1):116–26.
Durhan TA, Koçak A, Karaküçük S. Playfullness and emotional intelligence relation in 10–14 age group. J Sport all Recreation. 2020;2(2):69–75. https://doi.org/10.1080/09720073.2015.11891856.
Akarçeşme C, Durhan TA, Yılmaz SH, Hazar M. Comparison of the playfulness levels of 10 to 14 Age Group of Team athletes with sedentary. Gaziantep Univ J Sport Sci. 2020;5(4):339–53. https://doi.org/10.31680/gaunjss.745122.
Hazar Z, Hazar K, Gökyürek B, Hazar M, Çelikbilek S. Investigation of the relationship between playfulness, digital game addiction and aggression levels of secondary school students in terms of various variables. J Hum Sci. 2017;14(4):4320–32. https://doi.org/10.14687/jhs.v14i4.5035.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
The authors declare no competing interests.
Ethics approval and consent to participate
The study started after permission was taken from the Manisa Celal Bayar University Faculty of Medicine Health Sciences Ethics Committee (11.11.2020/ 20.478,486). The study performed in accordance with the Declaration of Helsinki. All participants were informed. Participants were included in the study after the informed consent form was approved.
Consent for publication
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Karaali, H.K., Ozcan, O. Investigation of physical playfulness in physiotherapy students. BMC Med Educ 23, 651 (2023). https://doi.org/10.1186/s12909-023-04618-1
- Physical activity