Environmentally Sustainable Approaches to Musculoskeletal Rehabilitation: An Umbrella Review of Practices With Potential Carbon Efficiency

Background Healthcare systems significantly contribute to carbon emissions, prompting a shift towards sustainable practices. Physiotherapy interventions, particularly those minimising travel, hospitalisation, and pharmaceuticals, offer promising low carbon strategies for musculoskeletal care (MSK). Objective To synthesise evidence from systematic reviews and meta‐analyses on 5 physiotherapy intervention domains—telerehabilitation, prehabilitation, self‐management strategies, comparisons with NSAIDs and group exercises in adults aged ≥ 18 years with non‐traumatic musculoskeletal disorders. Methods An umbrella review was conducted following PRISMA guidelines. A search across five physiotherapy intervention domains, four electronic databases from date of inception till may 2025: Pubmed, Cochrane, PEDro and Epistemonikos. Acute to chronic MSK conditions were included. Intervention duration varied across studies ranging from short term (2–6 weeks) to long term upto 12 months. AMSTAR 2, ROBIS and GRADE were used to assess study quality, bias and certainty of evidence. Primary outcomes were pain intensity and physical function. Secondary outcomes included functional capacity, adherence, healthcare utilisation/cost, quality of life, and adverse events. Results Telerehabilitation and prehabilitation improved pain, function and hospital stay. Exercise‐based physiotherapy showed benefits comparable to NSAIDs with fewer side effects, while self‐management and group exercise demonstrated scalable but low certainty. Conclusion Although sustainability was not a primary selection, all included interventions aligned with low carbon healthcare principles, underscoring their potential for integration into future climate conscious care models. Building on findings, future research should integrate sustainability metrics to support the routine adoption of low carbon physiotherapy in MSK care.