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Adult learning theory in action

Physiotherapists don’t just teach, they structure, support and facilitate learning. Knowles’ (1988) adult learning theory, also known as andragogy, provides valuable insights into how adults best learn. Knowles outlined key principles that shape adult learning and these include:

  • Adults need to know why learning matters. Patients are more engaged in the learning process when they understand how education applies to their own unique situation.
  • They learn best when they take ownership of their learning. Active participation in the learning process and even collaborating with the professional leads to better understanding and more engagement in their own management.
  • Prior experiences shape new learning. Patients interpret new information through the lens of past experiences.
  • Readiness to learn increases with perceived relevance. Patients engage more when education is immediately applicable to their circumstances and when they understand how it will help.
  • Learning is most effective when it applies to real-life situations. Practical, hands-on education with real world examples leads to better learning and better retention.
  • Internal motivation drives learning. Patients are more likely to follow through when education aligns with their personal goals and when they are ready to learn.

This is no different to how you might find your own learning. Just as patients learn best when education is relevant and practical, you likely have found in your own studies that you seem to learn better when information and learning activities have practical relevance and real-world application (World Health Organization, 2013).

In physiotherapy, these principles highlight why individualised education matters. Patients are more engaged when learning aligns with their personal experiences, needs, and health goals. So what does this mean for us? We should assess patient readiness, explain why information matters, and encourage active participation where we can (Chesbro & Davis, 2002).

Adult learning theory principles in action

Let’s look at a brief case example of how we might use these principles in patient education:

Sam, a 45-year-old office worker, has been struggling with persistent low back pain for over six months. They have tried various treatments with little success and feel frustrated about their condition. Following their assessment, the physiotherapist determines that Sam is likely to benefit from a management approach that includes an exercise program. Rather than just prescribing the exercises, the physiotherapist considers how they can apply adult learning principles to ensure the education they provide around the exercise program is relevant and engaging.

Explaining the “why”

Instead of simply telling Sam to exercise, the physiotherapist frames the graduated exercise plan as a tool for managing pain and improving function. They explain in clear, relatable terms how exercise can specifically help Sam’s condition. This can help build understanding and buy-in.

Example: “Sam, I want to show how these exercises can help you move more easily and help you feel more in control of your pain. We’re not just trying to treat your symptoms, but build your strength and flexibility through the exercises to get you back to the things you enjoy.”

Encouraging responsibility

The physiotherapist involves Sam in the decision-making process, asking about their routine, what exercise they have enjoyed in the past and preferred approaches to exercise. By co-designing the exercise plan, Sam feels ownership over their recovery, increasing their motivation.

Example: “What kinds of movement or physical activity do you usually do? Are there times in your day when you feel most able to fit something in? We want to create an exercise plan that works with your day to day schedule.”

Building on prior experiences

The physiotherapist explores Sam’s previous encounters with pain and exercise, identifying any misconceptions and barriers (for example, fear of movement, or beliefs about structural damage). Addressing these potential barriers early on helps reframe Sam’s understanding of their condition and makes education more personally relevant.

Example: “You mentioned you stopped exercising because it made your back pain worse last time. Can you tell me more about that? Sometimes our body can feel pain even when there’s no damage happening. Let’s discuss what happened and figure out how to avoid that experience again.”

Making it relevant

Instead of generic advice, the physiotherapist links the exercise program to Sam’s personal goals, such as being able to lift up their children and help with tasks at home. This connects education to meaningful activities, reinforcing its importance. Over time the physiotherapist shows Sam how the exercise has helped improve outcomes and led to them achieving goals.

Example: “We discussed that one of your goals is to be able to lift your toddler without worrying about your back. That’s exactly what these strengthening exercises are going to help you achieve. We can continue to monitor your progress based on this goal and not just on how your back is feeling day to day.”

Applying learning to real-life situations

Rather than prescribing abstract or complex exercises, the physiotherapist demonstrates and practices movements in the context of Sam’s daily routine. For example, the exercise program is integrated into times of the day when Sam is able to do it and involves movements that are relevant to what Sam has difficulty doing.

Example: “You mentioned Sam that your back gets stiff after sitting all morning at work. What if we added a short movement break at 11am with a stretch you can do at your desk? That way, you’re applying the exercises into your routine and not just at the gym or clinic.”

Tapping into internal motivation

The physiotherapist contextualises the idea of “fixing pain” within a broader goal of restoring function and quality of life, emphasising that movement will help Sam return to the activities that matter most to them, whether that’s playing with their child, hiking, or working comfortably.

Example:  “I know you said being involved more actively with your children on the weekends is something you really value. These exercises are designed to help you move more comfortably and build the confidence to do just that. Let’s use this goal to guide your progress.”

By incorporating adult learning principles, this approach changes what could have been passive instruction or just simple delivery of information around exercise into an opportunity for active, patient-driven learning.

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Patient Education Essentials for Physiotherapy Copyright © 2025 by The University of Queensland is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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