Fysioterapeuten 4-2021

54 FYSIOTERAPEUTEN 4/21 FAGARTIKKEL © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions (https://crea- tivecommons.org/licenses/by-nc/4.0/) . Published by Fysioterapeuten. Abstract 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 environ- mental reasoning can inform future clinical reasoning in physiotherapy practice. Main part : Environmental sustainability in physiothe- rapy 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 physio- therapy 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 sustai- nability 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 imple- mentation of sustainability considerations. Keywords : environmental sustainability, clinical reaso- ning, physiotherapy. Filip Maric , Ph.D., Lecturer, Physiotherapy studies, Department of Health and Care Sciences, UiT The Arctic University of Norway. filip.maric@uit.no. Karen Synne Groven, Ph.D., Professor, Oslo Metropolitan University & VID Specialized University. Srishti Banerjee, Master’s of physiotherapy, Assistant Professor, LJ Institute of Physiotherapy. Tone Dahl Michelsen, Ph.D., Associate Professor, Oslo Metropolitan University. This article (“fagartikkel”) has been peer-reviewed according to Fysioterapeuten’s guidelines, and was accepted on 4 March 2021. No conflicts of interest stated. The article was first published at www.fysioterapeuten.no. Introduction Climate change, biodiversity loss, the disruption of bio- geochemical cycles, air, water and plastic pollution and the widespread degradation of land and sea are fundamentally changing the environmental conditions that support hu- man life on earth (1). The destruction of our global natural environment has been recognised as the largest threat to human health and flourishing in the 21st century and is already affecting the health of people around the world. Recognised health impacts expected to increase over the coming years include non-communicable disease, exposu- re to infectious and vector-borne disease, threats to human nutrition and food crops, as well as mental and physical trauma and injury due to extreme weather events, climate migration and other environment- and resource-related displacement and conflicts (2). In light of the ubiquity and severity of todays intercon- nected environmental and health crises, it has been recog- nised that addressing them means working towards more sustainable futures and requires resolute action across all sectors of society, from multi-national endeavours to indi- vidual action in daily life. This is clearly stated in the UN Agenda 2030 Sustainable Development Goals (SDGs) ex- plicit call for the ‘mobilisation of all available resources, participation of all countries, all stakeholders and all peo- ple’ and many other resonant publications (3). For the health care professions, this represents a clear call for the inclusion of sustainability considerations into all aspects of professional practice, research and education (4,5). Looking towards clinical practice in particular, cli- nical reasoning has been a cornerstone of physiotherapy for the last few decades and is deeply embedded in phy- Essentials for sustainable physiotherapy: Introducing environmental reasoning into physiotherapy clinical decision-making