Essentials for sustainable physiotherapy: Introducing environmental reasoning into physiotherapy clinical decision-making

Introduction: Global environmental changes require the provision of sustainable health care and the decisive inclusion of sustainability considerations into all aspects of health care professional practice. In this article we illuminate how environmental sustainability might be positioned in physiotherapy and how environmental reasoning can inform future clinical reasoning in physiotherapy practice. Main part: Environmental sustainability in physiotherapy relates to a two folded mandate of sustainable healthcare: to improve the sustainability of health care systems and services and contribute to the broader societal transition to sustainable futures. We suggest that measuring the environmental footprint of physiotherapy interventions should become a regular element of physiotherapy intervention research. This will enable the inclusion of an environmental layer to clinical reasoning in physiotherapy that we term environmental reasoning: The ability to include environmental sustainability considerations - based on relevant evidence of the environmental impact of physiotherapy services - into the collaborative clinical decision-making process shared by therapists and patients. Conclusion: In this article we indicate a key pathway for introducing environmental sustainability into clinical decision-making via the measurement of physiotherapy intervention environmental footprint. This suggests an extensive research agenda with much to be explored, clarified and adapted as the physiotherapy profession makes first advances toward the inclusion and implementation of sustainability considerations.