On February 27, the League of the Strong held a training session entitled “The first signs that a patient needs rehabilitation: how a doctor can restore a person’s functionality and life” in Ivano-Frankivsk. It brought together 20 primary care physicians, surgeons, neurologists, orthopedists, therapists, and hospital doctors.
The event was conducted by Iryna Lopushynska, head of the rehabilitation department at the St. Luke Clinic, a doctor of physical and rehabilitation medicine, and Khrystyna Soletska, an occupational therapist.
What was the training about?
Under martial law in Ukraine, there has been a significant increase in the number of military personnel, veterans, internally displaced persons, and civilians who require comprehensive rehabilitation after injuries. That is why the training participants focused on early signs indicating the need to refer a patient for rehabilitation, as well as on forming a common professional vision of the role of physical and rehabilitation medicine and occupational therapy in the recovery process.
The training focused on early detection of signs of functional loss in patients and timely referral for rehabilitation. They discussed how doctors of any specialty—from GPs to surgeons or neurologists—can recognize the first signs indicating the need for restorative intervention.
During the training, participants:
- discussed rehabilitation during wartime and new challenges;
- considered what should alert doctors and what early signs indicate a patient’s need for rehabilitation;
- analyzed how rehabilitation restores functionality;
- learned how a multidisciplinary team works and how to interact with it;
- examined and discussed real clinical cases.
Special emphasis was placed on the fact that rehabilitation is not a “post-hospital stage” but an integral part of treatment that begins as early as possible. Timely intervention gives the patient a chance not only to restore motor functions but also to return to independence, work, and active participation in life.
An important part of the event was the sharing of practical experience gained by the trainers during their internship at the rehabilitation department of the Don Calabria Clinic (Italy). The event provided an opportunity to integrate European approaches and rehabilitation standards into the Ukrainian context.
A sharp increase in diagnoses during the war
During the war, there was a sharp increase in the number of patients with various categories of diagnoses requiring rehabilitation intervention. First and foremost, these are injuries and combat wounds — mine-blast injuries, barotrauma, multiple injuries, traumatic amputations, as well as fractures of the spine, pelvis, and limbs. There has been a significant increase in cases of traumatic brain injury — from concussion to diffuse axonal injury and subdural and subarachnoid hemorrhages, with subsequent chronic consequences in the form of cognitive impairment, balance problems, and behavioral changes.
A separate group is made up of peripheral nervous system injuries — damage to the nerves of the limbs, plexopathy, and neuropathy after prolonged immobilization or the use of tourniquets. There has been an increase in the frequency of traumatic and orthopedic conditions, including long bone fractures, contractures, and tissue defects. Spinal injuries with the development of paraplegia, tetraplegia, or limb paresis are common.
Vascular conditions such as strokes, thrombosis, and heart failure are also more common. At the same time, there has been an increase in psychoneurological disorders, including PTSD, depression, anxiety disorders, and sleep disorders. At the same time, stress, displacement, and interruptions in treatment have exacerbated “peaceful” chronic conditions such as chronic back pain, arthrosis, dizziness, and diabetic neuropathy.
Rehabilitation is an integral part of treatment, not a “late stage”
The modern medical paradigm has changed: rehabilitation is no longer seen as something that begins “after everything else.” It starts within the first 24–48 hours after the patient’s condition has stabilized. Treatment and rehabilitation do not exist separately — they are parts of the same process.
It is important not to wait for the completion of drug therapy to begin recovery. If the patient has lost function, this is already a reason for rehabilitation intervention.
Rehabilitation does not end with discharge from the hospital. Discharge does not equal restoration of function. If functional deficits remain, the patient needs outpatient rehabilitation.
The key question for the doctor is simple: has the patient returned to their previous level of functioning? If not, this is a direct indication for rehabilitation.
Outpatient referral is appropriate after injuries and prolonged immobilization, after traumatic brain injuries and strokes, in cases of chronic pain with limited movement, instability and risk of falling, decreased endurance, cognitive or vestibular deficits.
International and national recommendations (WHO, NICE, ESPRM, Ministry of Health of Ukraine) emphasize early initiation of rehabilitation, multidisciplinary teamwork, and a functioning-based approach (MTF). This approach can reduce disability by 30–40%.
If a patient has lost function, he/she needs rehabilitation right now. And it is often the outpatient doctor who is the key point of departure for this process.
Basic principles of multidisciplinary rehabilitation team work
Effective rehabilitation is impossible without the coordinated work of a multidisciplinary team. Its activities are based on several key principles.
First and foremost is a patient-centered approach. The patient is an active participant in the process, not a passive object of treatment. Their personal goals, motivation, profession, lifestyle, and expectations are taken into account during planning. The rehabilitation plan is developed individually.
The second principle is the biopsychosocial model. Not only the diagnosis is assessed, but also functional limitations, psycho-emotional state, social factors, and professional risks. Thus, the focus shifts from the “disease” to the actual functioning of the person in everyday life.
Teamwork is an important component. Specialists from different fields coordinate their actions, exchange information, and work toward the common goal of restoring function.
Joint goal planning is of particular importance. Goals are formulated specifically and measured according to the SMART principle — they must be specific, measurable, achievable, relevant, and time-bound.
The rehabilitation process involves regular evaluation of results and adjustment of the plan as needed. Another principle is continuity: rehabilitation is not interrupted when moving between stages of treatment, but continues logically in accordance with the patient’s functional status.
The event is part of the Empower Ukraine project, which was created with financial support from the German Federal Foreign Office (GFFO), CBM, and the European Disability Forum.