Environmental Physiotherapy: Knowledge, Attitudes, and Practices Among Physiotherapists in Iceland

Steinunn A Olafsdottir ^1* Lilja Salome H Petursdottir ²

• ¹ University of Iceland, Reykjavik, Iceland
• ² National University Hospital of Iceland, Reykjavik, Capital Region, Iceland

With growing concerns about climate change and the healthcare sector's carbon footprint, integrating sustainable practices into physiotherapy could not only reduce this impact but also enhance patient outcomes. This study explores the knowledge, attitudes, and practices of physiotherapists in Iceland regarding climate change and their role in promoting sustainability.A cross-sectional survey was distributed to active members of the Icelandic Physiotherapy Association and a total of 114 physiotherapists participated (17.1% response rate). The survey consisted of 21 questions across four themes: knowledge, attitudes, behavior, and obstacles. Majority of participants (56.6%) reported intermediate knowledge of climate issues and 38.1% considered their knowledge advanced or rather advanced. While 84.1% believed climate change affects health in Iceland, 97.3% believed it has global health impacts. Commonly cited effects included respiratory diseases due to air pollution, disruptions to food and water security, and mental health challenges such as climate anxiety. Additionally, 83% agreed on the need to limit healthcare's environmental impact, and 66.7% felt physiotherapists should raise public awareness of climate change's health effects. Active transportation, waste reduction, and eco-friendly practices were highlighted as key opportunities for action, though barriers such as lack of knowledge (56%) and material resources (49%) were noted. Guidelines (63%) and education (57%) were the most desired supports for implementing eco-friendly practices.This study highlights the potential for physiotherapists to contribute significantly to the healthcare sector's sustainability goals. The respondents' desire to enhance their environmental practices suggests an opportunity for professional associations and educational institutions to provide targeted training and support. By fostering greater environmental literacy, physiotherapists could not only contribute to reducing the healthcare sector's carbon footprint but also promote sustainable health behaviors in patients.Environmental physiotherapy is an under-explored yet promising area for integrating sustainability into healthcare. While Icelandic physiotherapists are beginning to embrace environmental considerations in their practice, further research and the development of educational resources are needed to empower them in mitigating climate change. Enhanced knowledge and support could help physiotherapists become key contributors to sustainability in healthcare.