Variable levels of stress and anxiety reported by physiotherapy students during clinical placements: a cohort study

Published:December 17, 2021DOI:



      Healthcare students are at risk of high stress and anxiety, particularly during clinical placements. This study measured the stress and anxiety levels of physiotherapy students during clinical placements, how stress/anxiety changed over time, effect on academic performance, factors influencing stress/anxiety and coping strategies.


      A prospective cohort study using surveys collecting quantitative and qualitative data.


      Three sites where physiotherapy students from one university undertook clinical placements.


      109 students across 159 placements.

      Main outcome measures

      The State-Trait Anxiety Inventory (STAI [Y2]) provided a baseline measure of general stress level and propensity for anxiety. Perceived stress and anxiety were measured using visual analogue scales (VASs) at baseline and weekly over the 5-weeks duration of placements. A questionnaire sought students’ perceptions of factors affecting stress/anxiety and coping strategies.


      VAS stress/anxiety scores were highly variable between participants. Higher VAS scores were seen at Weeks 3 and 4 compared to Week 5 and placements earlier in the academic year. Baseline VAS scores were significantly associated with Weeks 1−5 VAS scores. Higher VAS scores were associated with poorer academic results. Stress/anxiety were affected by patient complexity, assessments, workload, poor health and family issues. Most participants felt supported by clinical educators/peers, and used coping strategies including exercise and taking breaks.


      Physiotherapy students demonstrated highly variable stress/anxiety levels during clinical placements, with higher levels negatively affecting academic performance. Baseline measures of perceived stress/anxiety could potentially highlight students at risk of high levels of stress/anxiety during clinical placements, allowing more targeted interventions.
      Australian New Zealand Clinical Trials Registry (ACTRN12618000302257).


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