The experience of two world wars, numerous smaller-scale armed conflicts of the last century and no less bloody wars and conflicts of the first quarter of the twenty-first century (in which Ukraine was involved) has led to the rapid development of rehabilitation systems for military personnel in many countries of the world [1]. According to current data from the International Research and Exchanges Board (IREX), more than 70 per cent of veterans have sought medical care to restore their physical or psychological health after completing military service [2]. Today, this negative trend is only growing due to the ongoing and largest war in Europe, and increases the demand for quality and effective rehabilitation services in Ukraine [3, 4].
NATO countries have developed medical rehabilitation in accordance with the current recommendations of the World Health Organization, which is characterized by a comprehensive approach taking into account the specifics of rehabilitation and care for servicemen and women injured in military conflicts [5, 6].
Full restoration of functioning, improvement of vital activity and return to quality of life are integral components of effective rehabilitation of servicemen and women during all periods of rehabilitation care. The issues of organising the outpatient stage of post-acute and long-term rehabilitation periods remain extremely relevant.
The aim of the study is to improve the effectiveness of rehabilitation care for servicemen in the post-acute and long-term rehabilitation periods in outpatient settings by creating and implementing local rehabilitation programmes.
According to modern principles of rehabilitation care, the outpatient stage is one of the stages of the rehabilitation route. Individual and multidisciplinary approaches to the provision of rehabilitation care in outpatient settings, in particular for military personnel, are the basic components of rehabilitation programmes for this patient population [7, 8].
Local rehabilitation programmes for servicemen in outpatient settings are based on the principle of patient-centredness, have a reasonable stage and sequence, which allows for the development of a local individual patient route. The individual approach involves not only an individual sequence of application of forms, methods and means of rehabilitation according to the rehabilitation needs of the patient, but also takes into account the pathogenetic mechanisms of the pathological process, clinical manifestations and rehabilitation prognosis [8, 9].
The rehabilitation programmes are based on the relevant regulations approved by the Ministry of Health of Ukraine on the organisation of rehabilitation care in the healthcare sector, clinical guidelines, treatment protocols, including international ones, WHO recommendations, and national classifications, in particular, the International Classification of Functioning, Disability and Health.
According to the Order of the Ministry of Health of Ukraine No. 2083 of 16.11.2022 ‘On Approval of the Procedure for Organising Rehabilitation Care on Rehabilitation Routes’, rehabilitation routes include: rehabilitation route for spinal cord injuries, brain injuries, burns, amputations, and complex skeletal injuries. These are the most common rehabilitation routes for military personnel, so local outpatient rehabilitation programmes should be based on these routes.
The rehabilitation programme has a structure that is formed in accordance with the principles of creating an individual rehabilitation plan. Rehabilitation tools are also involved in the initial and final diagnostic examination, the formation of an individual rehabilitation route, including those listed in Annex 6 to Order of the Ministry of Health of Ukraine No. 2083 of 16.11.2022 ‘On Approval of the Procedure for Organising the Provision of Rehabilitation Care “Functional Assessment Tools Required for Deciding on Referral of a Patient to the Next Stage of Rehabilitation Care”. Functional assessment tools are used not only to assess the patient's condition, but also to assess the effectiveness of rehabilitation measures as the final stage of the rehabilitation programme.
Evaluation of the effectiveness of rehabilitation assistance determines the effectiveness of the local rehabilitation programme.
Thus, the complexity, phasing, and social focus of local rehabilitation programmes used at the outpatient stage during the post-acute and long-term rehabilitation of servicemen are aimed at regenerating and compensating for impaired functions, and improving the quality of life of this patient population. Rehabilitation programmes are an integral part of rehabilitation medicine and help to structure and objectify the rehabilitation process.
References:
1. Shvets AV, Maltsev OV, Kyselov SM, Kaplyuk OB. Peculiarities of the rehabilitation management process among combatants: world experience. Ukrainian Journal of Military Medicine. 2024;5(3), 39-49. https://doi.org/10.46847/ujmm.2024.3(5)-039
2. IREX. Veterans Reintegration Program. Аnalytical report from 14/06/2021. https://www.irex.org/sites/default/files/Veterans%E2%80%99%20Benefits%20Utilization %20and%20Experiences%20%E2%80%93%20Ukrainian.pdf
3. Zabolotna IВ, Gushcha SG, Babova IK, Dmitrieva GA, Polshchakova TV. Оrganization of rehabilitation of the military with post-traumatic stress disorder: analysis of foreign approaches and domestic experience. Аctual Рroblems of Тransport Medicine. 2021;2(64):32-42. https://kurort.gov.ua/wp-content/uploads/2021/08/zabolotna_aptm_2021.pdf
4. Shvets AV, Horishna OV, Kikh AY, Ivantzova GV, Gorshkov OO, Richka OV. Peculiarities of the organization of psycho-medical rehabilitation of servicemen in NATO member countries and partnership for peace countries. Ukrainian Journal of Military Medicine. 2021;2(4), 26-39. https://doi.org/10.46847/ujmm.2021.4(2)-026
5. Landmark resolution on strengthening rehabilitation in health systems. Word Health Organization. 2023. https://www.who.int/news/item/27-05-2023-landmark-resolution-on-strengthening-rehabilitation-in-health-systems
6. Walter Reed National Military Medical Center. Military Advanced Training Center (MATC). 2023. https://walterreed.tricare.mil/Health-Services/Specialty-Care/Amputee-Car
7. Webster J, Scholten J, Young P, Randolph BJ. Ten-Year Outcomes of a Systems-Based Approach to Longitudinal Amputation Care in the US Department of Veteran Affairs. Fed Pract. 2020 Aug;37(8):360-367. doi: 10.12788/fp.0024
8. Zabolotna IB, Gushcha SG, Balashova IV, Bezverhnyuk TM. Рroblem issues of medical and psychological rehabilitationof military servicemen in Ukraine. Bulletin of problems in biology and medicine. 2023;2(169):64- 74. doi: 10.29254/2077-4214-2023-2-169-64-74.
9. Basko AV, Sobakar AO, Myroniuk SA. Methods of rehabilitation of military personnel, status of functioning and development of implementation centers as one of the directions of activity of local government bodies. Rehabilitation & Recreation. 2024;18(1):78-93. doi: 10.32782/2522-1795.2024.18.9
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