VETERANS AS A SPECIAL CATEGORY OF CONSUMERS OF REHABILITATION SERVICES: CLINICAL-FUNCTIONAL CHALLENGES AND MULTIDISCIPLINARY APPROACH

Abstract

The article presents a clinical-functional and multidisciplinary analysis of war veterans as a special category of rehabilitation service consumers in the context of full-scale war and the transformation of the Ukrainian healthcare system in line with World Health Organization approaches. The authors argue that veterans constitute a clinically, functionally and psychosocially unique group whose needs are not met by standard rehabilitation protocols and require an integrated biopsychosocial approach. The substance of Law No. 1053-IX on rehabilitation in healthcare is examined as a paradigm built upon the category of limitations of daily functioning under the International Classification of Functioning, Disability and Health (ICF), together with the leading role of the multidisciplinary rehabilitation team headed by a physician of physical and rehabilitation medicine. The grounds for the veteran-consumer's particularity are shown through the clinical severity of combat trauma (polypathology, high and multiple amputations, mine-blast injuries with vascular complications, post-traumatic stress disorder, traumatic brain injuries) and the need for a long-term, stepwise rehabilitation pathway. Particular attention is paid to the client-oriented perspective of rehabilitation (person-centred care), shared goal-setting, informed consent and the measurement of functional outcomes through validated scales (FIM, Barthel Index, SF-36). The institutional architecture in Ukraine (Ministry of Veterans Affairs, National Health Service of Ukraine, healthcare institutions, adaptive physical culture centres, local self-government) is considered in connection with the scale of demand (1.3 million veterans and a forecast of 5–6 million people together with families) and the funding volumes of the Medical Guarantees Programme. Based on a comparative analysis of the US (Veterans Health Administration), UK (Veteran Aware, Op COURAGE and Op RESTORE) models and the WHO Rehabilitation 2030 initiative, the authors formulate a position on transitioning from quantitative scaling of procedures to outcome-based rehabilitation with standardisation of multidisciplinary teams and systemic integration of adaptive physical culture as an indispensable component of the rehabilitation pathway.