Life cycle assessment of a chronic low back pain physiotherapy plan

Background: Chronic low back pain (CLBP) is a common, disabling condition often requiring long-term physiotherapy. With growing attention to sustainability in healthcare, there is a need to understand the environmental impacts of physiotherapy treatments. This study applies Life Cycle Assessment (LCA) to a CLBP treatment plan, based on an adapted published case, to identify improvement areas and promote eco-responsible practices. Sustainability considerations in physiotherapy remain underexplored, and this analysis addresses a gap by quantifying treatment-related ecological burdens. Methods: A case-specific LCA was conducted using the ISO 14040 framework. The functional unit was 20 physiotherapy sessions over six months in Switzerland, targeting a 40 % pain reduction (NRPS) and an ODI score ≤ 20. The system boundaries excluded medications and focused on the clinical setting. The Ecoinvent database and IMPACT 2002 + method were used to assess four indicators: climate change (CO₂), human health, ecosystems, and non-renewable resources. Key elements examined included material use (reusable vs. single use), patient transport, and waste management. Data were modelled to reflect typical outpatient rehabilitation practices. Sensitivity analyses were conducted to compare material choice and transport scenarios. Results: Patient transport was the main environmental burden: car use accounted for 71 % of CO₂ emissions, 91 % of impacts on human health, 85 % on ecosystems, and 86 % on resource use. Alternative transport (carpooling, public transport) significantly reduced the footprint. Single-use material production contributed notably to resource depletion, highlighting the benefits of reusable, repairable products. However, reused materials posed end-of-life challenges, mainly through waste management processes. Transport distance and frequency were also key drivers of environmental variation. Conclusion and implications: LCA identified key sustainability levers in physiotherapy: reducing transport emissions, preferring reusable materials, and improving waste strategies. Future research should compare physiotherapy with other CLBP treatments, such as surgery or medication, to integrate environmental criteria into health policy and clinical guidelines. This case study offers practical guidance for physiotherapists aiming to minimize ecological impacts. Understanding treatment life cycles helps make informed choices in daily practice. Results support the inclusion of environmental considerations in future physiotherapy protocols and sustainability frameworks. Training and awareness-raising among clinicians may further support environmentally responsible clinical decision-making.