Objective spinal parameters did not differ significantly between third- and fourth-year physiotherapy students despite marked differences in school-based standing and sitting exposure, while trunk length was independently associated with trait anxiety and sleep quality after multivariable adjustment.
Fourth-year physiotherapy students had different school-based postural exposure than third-year students, with longer standing and shorter sitting durations.
Fourth-year students had lower trait anxiety and burnout scores and higher walking activity than third-year students.
No statistically significant between-group differences were found in trunk length, kyphotic angle, or lordotic angle between third- and fourth-year students.
Higher trait anxiety was independently associated with shorter trunk length in the fully adjusted model.
Poorer sleep quality (higher PSQI) was independently associated with shorter trunk length.
The final hierarchical regression model explained 68.4% of the variance in trunk length.
Exploratory mediation analysis found a significant indirect association between emotional exhaustion and trunk length through sleep quality.
The authors conclude the findings are associations rather than causal or temporal relationships and suggest training should go beyond ergonomics.
This study looked at 132 healthy physiotherapy students, 70 in their third year and 62 in their fourth year, to see whether the spine's shape differed between the two groups. Fourth-year students spent more time standing and less time sitting at school, and reported lower trait anxiety and burnout and more walking. Even so, 3D scans of the back showed no statistically significant differences in trunk length or in the curvature of the upper and lower spine. The upper-back curve was somewhat lower in fourth-year students, but this was just short of statistical significance. Within the whole group, students with higher trait anxiety and poorer sleep quality tended to have shorter trunk length, even after accounting for body size, academic year, standing and sitting time, and physical activity. An exploratory analysis also suggested that emotional exhaustion was linked to trunk length indirectly, through its link with sleep quality. This research suggests that psychological stress and sleep may be related to objectively measured spinal features, and that how long students sit or stand at school may not be the whole story. Because the study captured a single point in time, it cannot show that anxiety or poor sleep changes the spine, or the reverse. The authors suggest that training programs could consider mental and recovery-related factors alongside ergonomics.
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Upload Your LabsNumanoğlu E, Arık A, Pamukçu E, Tanımlı Y, Ergit B. (2026). Academic-year differences and psychophysiological associations with objective spinal parameters in physiotherapy students: a cross-sectional DIERS formetric 4D study.. BMC medical education. https://doi.org/10.1186/s12909-026-10505-2