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70 The environmental impact of health care for musculoskeletal conditions: a scoping review
  1. Bayden McKenzie1,
  2. Romi Haas1,
  3. Giovanni Ferreira2,
  4. Chris Maher2,
  5. Rachelle Buchbinder1
  1. 1Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia
  2. 2The University of Sydney, Sydney Musculoskeletal Health, Sydney, Australia


Objectives To map what is known about the environmental impact of health care for musculoskeletal conditions.

Method We searched MEDLINE, Embase, Google and Google Scholar from inception to 2 May 2022 using keywords for environmental health and musculoskeletal conditions. We included published papers of any design that measured or discussed the environmental impact of healthcare or health support services for any musculoskeletal condition. This could include the impacts of the care (e.g., hospital visits, surgery, imaging and pharmaceuticals) on indices of climate change or global warming. We did not impose date or language restrictions. 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 48 were excluded. Forty-nine publications were eligible for inclusion. All included papers were published from 1994 to 2022, with the majority (n=36, 73%) published since 2019. Twelve original studies investigated the environmental impact of health care for musculoskeletal conditions using life cycle assessment or carbon footprinting methods. Twelve studies measured waste associated with orthopaedic surgery. Of 19 included editorials; nine described a need for the physiotherapy profession to address environmental impacts of care, and 10 discussed sustainability practices related to orthopaedic surgery (n=8), occupational therapy (n=1) and podiatry (n=1). Four publications were literature reviews.

Conclusions Despite an established link between healthcare and greenhouse gas emissions we found limited data on the environmental impact of care for musculoskeletal conditions, particularly for well-recognised contributors such as imaging and pharmaceuticals. Further data are needed to determine whether actions to lower the carbon footprint of musculoskeletal health care should be a priority and identify aspects of care that should be prioritised.

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