A progress report on planetary health, environmental and sustainability education in physiotherapy – Editorial

Australian allied health professionals' perspectives on current practice, benefits, challenges, and opportunities in nature-based approaches

PURPOSE

To guide the effective use of nature-based approaches (NBAs), we aimed to determine current practice, challenges and proposed solutions concerning the use of these approaches by allied health professionals (AHPs). We also investigated the signs, symptoms and conditions AHPs believe NBAs may prevent and/or manage, as well as the perceived impact of the COVID-19 pandemic.

MATERIALS AND METHODS

Allied health professionals (physiotherapists, occupational therapists, exercise physiologists, psychologists, social workers and speech pathologists) who used or wanted to use NBAs in Australia were invited to complete an online questionnaire. Qualitative data were analysed through inductive coding and categorisation, and paired with descriptive statistics for the quantitative data to develop our understandings.

RESULTS

Allied health professionals indicated that exposure to nature could prevent and/or manage a range of physical and mental health, social and developmental outcomes. In addition to using NBAs with patients/clients, AHPs were also engaged with advocacy for or involvement in the provision of natural spaces indicating the broader roles in which AHPs work and utilise NBAs. Perceived challenges were identified, which related to the patients/clients, AHPs themselves, and external factors. Recommended solutions included increasing education for AHPs and the general public about NBAs, advancing related research, implementing relevant governance changes, and legitimising the role(s) of these approaches to allied health practice.

CONCLUSIONS

Increasing awareness of and evidence about NBAs among AHPs across sectors - particularly those involving policy, education, funding, and health management - will support their legitimacy and potential benefit of NBAs across a range of populations.

Green Environments and Healthy Aging: Analyzing the Role of Green Infrastructure in the Functional Well-Being of Seniors-A Pilot Study

Health professionals have slowly integrated the environment and green areas into their prescriptions to connect patients with nature and outdoor activities. The World Health Organization recommends that everyone reside within 300 m of green regions to improve well-being and physical and mental health. The study aimed to explore the effects of urban and rural green areas on multiple physiological and functional variables, as well as evaluate the perception of individuals regarding the ease of use of these same spaces. Participants walked twice a week for six weeks, covering 1.6 km. Heart rate (HR), blood pressure (BP), oxygen saturation (SpO2), physical capacity analysis (IPAQ), risk of falls (Morse Fall Scale), Mini Mental State Examination, physical performance test (PPT), and perception of accessibility (Pedestrian Accessibility Perception Scale for adults over 65 years old) were evaluated/administered. Variables such as noise, temperature, and air quality were also measured during the outdoor activities. Twenty-four individuals divided into two groups participated in the study: group 1 (urban route) and group 2 (rural route). We found impacts on body weight (p = 0.021), SpO2 (p = 0.033), and Mini Mental State Examination (p = 0.041) scores in group 1 and SpO2 and PPT scores in group 2. This study highlights the importance of incorporating green infrastructure in urban planning to support healthy aging and improve accessibility for older adults, and shows that outdoor activities provide various health benefits (physical, mental, and social well-being) and that walking in urban and rural environments seems to impact the health of elderly individuals positively and should be considered in physical therapy by health professionals.

Advancing the deliberate implementation of the concept of sustainability and its alternatives in physical therapy research, practice, and education

BACKGROUND

Sustainability has become a ubiquitous imperative across all sectors of society, including healthcare. Building on the broader discourse on sustainable development, sustainability is used in relation to social, ecological, and economic concerns with varying degrees of emphasis and often related to a sense of durability.

OBJECTIVE

To provide a detailed analysis of the concept of sustainability in current physical therapy literature and advance its deliberate future implementation.

METHODS

Setting out from a critical exposition of prevalent models of sustainability, we conducted a critical discourse analysis to (1) examine the implementation of the concept of sustainability in physical therapy academic literature and (2) critically evaluate its hitherto use in light of the broader discourse surrounding sustainability.

RESULTS

Our analysis identified a focus on the cost-effectiveness of healthcare interventions, and the use of so-called "weak" and "strong sustainability" models in the physical therapy literature. Other models and the broader critical discourse surrounding sustainability are only gradually finding their way into physical therapy literature.

CONCLUSION

Physical therapy lacks comprehensive exploration of both general and profession-specific understandings of sustainability. Nuanced engagement with sustainability and its alternatives is necessary to ensure its meaningful implementation in physical therapy research, education, and practice.

Australian and New Zealand nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices: A descriptive survey study

AIM

To explore Australian and New Zealand nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices.

DESIGN

A cross-sectional survey design.

METHODS

An online survey was sent to Australian and New Zealand nursing and midwifery educators across the 45 Schools of Nursing and Midwifery between July and September 2023. The online survey consisted of 29 open- and closed-ended questions about nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices.

RESULTS

There was a total of 127 responses to the first open-ended question. A total of 97 nursing and midwifery educators then completed the remaining questions. While educators had mostly positive views about integrating planetary health into their teaching, they lacked the knowledge and/or confidence to do so effectively.

CONCLUSION

Australian and New Zealand nursing and midwifery educators acknowledge that planetary health should be included in nursing and midwifery curricula, but most reported a deficit in knowledge and/or confidence to integrate these complex concepts into their teaching. When considering planetary health, most educators focussed on climate change, which demonstrates their limited understanding of the concept of planetary health.

IMPLICATIONS FOR THE PROFESSION

All nurses and midwives need to understand how the health of the planet and human civilization are interconnected and be prepared to address complex global health challenges now and in the future. Across the world, key healthcare organizations have called upon nursing and midwifery educators to prepare the healthcare workforce to practice in a more sustainable way, including supporting decarbonization of healthcare. However, our study has demonstrated that nursing and midwifery educators do not feel ready to respond due to a lack of required knowledge and/or confidence.

REPORTING METHOD

We used the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Fostering the discussion of planetary health in occupational therapy and physiotherapy

INTRODUCTION

Occupational therapists and physiotherapists aim to promote health, prevent various diseases and help people in their rehabilitation processes. So far, there is a paucity of understanding of the big picture of how the new paradigm of planetary health (PH) is connected to the education and practice of these professionals.

METHODS

This research aimed to address this gap by investigating and deploying a bibliometric analysis to elucidate the pivotal role of occupational therapists and physiotherapists in addressing PH challenges. The ultimate goal is to construct a comprehensive framework crosschecking the bibliometric analysis and the collection of 10 case studies selected by experts to outline how best practices in occupational therapy and physiotherapy, related to the three pillars of sustainability and the UN's Sustainable Development Goals (SDGs), can contribute to increasing PH.

RESULTS

The bibliometric analysis revealed four major research strands: 1) enhancing patient care and quality of life; 2) integrating sustainability in health care and rehabilitation; 3) professional development and clinical competence; and 4) evidence-based practice and quality improvement. Moreover, further temporal analysis revealed how the topic evolved, from advancing evidence-based practice and clinical effectiveness, exploring the strengthening of health care and person-centred practices, to connecting the topic to aspects also predicted by the SDGs, such as integrating environmental and climate concerns in therapy and addressing psychological and self-care impacts on health. The case studies confirmed this trend, and a framework of PH in occupational therapy and physiotherapy through the lens of the SDGs was developed to support future research and practitioners in advancing this research field.

CONCLUSIONS

Occupational therapists and physiotherapists are essential players in public health and can integrate sustainability at every level of practice, from using resources during therapy sessions to advocating for more sustainable lifestyles.

Time to Rethink Intended Learning Outcomes for Sustainable Development? A Qualitative Exploration and Reflection of Course Syllabuses in Swedish Undergraduate Physiotherapy Education

OBJECTIVE

Several calls to action for the implementation of education for sustainable development in health profession education have been put forth during the last few years. The aim was therefore to explore and describe sustainability-focused intended learning outcomes (SD-ILOs) in curricula of undergraduate physiotherapy education in Sweden.

METHODS

Using a deductive, descriptive, and qualitative approach, SD-ILOs in programs (n = 8) and course syllabuses (n = 143) from eight higher education institutions providing physiotherapy undergraduate education in Sweden were analyzed. SD-ILOs were described based on the subject content or condition, level of cognitive processes, sustainability learning dimensions, and key sustainability competencies.

RESULTS

Six of the eight physiotherapy programs provided course syllabuses with SD-ILOs. However, only 3% (n = 36) of all ILOs were sustainability-focused. A larger part of the SD-ILOs, 78% (n = 28) was described within the cognitive dimension of learning, and 80% (n = 27) were linked to either the cognitive process 'understanding' or 'analyzing'. The most frequently identified key competency in the SD-ILOs was 'systems-thinking' n = 10 (28%), and 30% (n = 11) lacked key competency.

CONCLUSION

There is an urgent need for rapid initiatives to enhance sustainable development education in Swedish undergraduate physiotherapy education. Pedagogical approaches that cover not only cognitive dimensions of learning for sustainable development but also socio-emotional and behavioral dimensions, as well as more complex cognitive learning processes must also be developed. The current lack of key sustainability competencies further emphasizes the necessity to enrich physiotherapy curricula with action-oriented learning to develop powerful future sustainability agency within healthcare and the public health arena.

Physiotherapy and ecosystem services: improving the health of our patients, the population, and the environment

INTRODUCTION

The relevance of ecosystems to physiotherapy has traditionally been overlooked, despite its potential for health impacts relevant to conditions often managed by physiotherapists.

PURPOSE

The purpose of this article is to introduce the concept of ecosystem services to physiotherapists, and to discuss how understanding ecosystem services may improve patient care, and population and planetary health.

DISCUSSION AND CONCLUSION

Physiotherapists with an understanding of ecosystem services may improve patient care by value-adding to management through patient education, empathy, advocacy, and broader population health approaches. Physiotherapists are also well placed to promote the conservation and restoration of ecosystem through participation, advocacy, and the development of public health measures, to the benefit of global sustainability and population health. Further research is required into how physiotherapists currently use nature-based interventions, and the barriers and enablers to their use. To be adequately prepared to meet the challenges that climate change and environmental degradation pose to patient care, population health and health systems, both current and future physiotherapists need to take a broader view of their practice. By including consideration of the potential role of the environment and green space exposure in particular on their patient's health, physiotherapists can ultimately contribute more to population and planetary health.

The environmental impact of health care for musculoskeletal conditions: A scoping review

BACKGROUND

Health care has significant environmental impact. We performed a scoping review to map what is known about the environmental impact of health care for musculoskeletal conditions.

METHODS

We included published papers of any design that measured or discussed environmental impact of health care or health support services for any musculoskeletal condition in terms of climate change or global warming (e.g., greenhouse gas emissions it produces). We searched MEDLINE and Embase from inception to 2 May 2022 using keywords for environmental health and musculoskeletal conditions, and performed keyword searches using Google and Google Scholar. Two independent reviewers screened studies. One author independently charted data, verified by a second author. A narrative synthesis was performed.

RESULTS

Of 12,302 publications screened and 73 identified from other searches, 122 full-text articles were assessed for eligibility, and 49 were included (published 1994 to 2022). Of 24 original research studies, 11 measured environmental impact relating to climate change in orthopaedics (n = 10), and medical aids for the knee (n = 1), one measured energy expenditure of laminar versus turbulent airflow ventilation systems in operating rooms during simulated hip replacements and 12 measured waste associated with orthopaedic surgery but did not relate waste to greenhouse gas emissions or environmental effects. Twenty-one editorials described a need to reduce environmental impact of orthopaedic surgery (n = 9), physiotherapy (n = 9), podiatry (n = 2) or occupational therapy (n = 1). Four narrative reviews discussed sustainability relating to hand surgery (n = 2), orthopaedic surgery (n = 1) and orthopaedic implants (n = 1).

CONCLUSION

Despite an established link between health care and greenhouse gas emissions we found limited empirical data estimating the impact of musculoskeletal health care on the environment. These data are needed to determine whether actions to lower the carbon footprint of musculoskeletal health care should be a priority and to identify those aspects of care that should be prioritised.

South African Healthcare Professionals' Knowledge, Attitudes, and Practices Regarding Environmental Sustainability in Healthcare: A Mixed-Methods Study

Climate change, biodiversity loss and large-scale environmental degradation are widely recognized as the biggest health threats of the 21st century, with the African continent already amongst the most severely affected and vulnerable to their further progression. The healthcare system's contribution to climate change and environmental degradation requires healthcare professionals to address environmental issues urgently. However, the foundation for context-relevant interventions across research, practice, and education is not readily available. Therefore, we conducted a convergent mixed-methods study to investigate South African healthcare professionals' knowledge, attitudes, practices, and barriers to environmental sustainability. Healthcare professionals participated in a cross-sectional questionnaire (n = 100) and in-depth semi-structured focus group discussions (n = 18). Data were analyzed using descriptive statistics and thematic analysis, respectively, and integrated to provide holistic findings. Our results confirm overwhelmingly positive attitudes and a high degree of interest in education, implementation, and taking on more corresponding responsibility, but a lack of substantial knowledge of the subject matter, and only tentative implementation of practices. Identified barriers include a lack of knowledge, resources, and policies. Further research, education, and policy development on overcoming these barriers is required. This will facilitate harnessing the extant enthusiasm and advance environmental sustainability in South Africa's healthcare practice.