Brych V. Medical and social reasoning of the rehabilitation care system for the adult population with the consequences of injuries and disorders of the musculoskeletal system at the regional level

The thesis is devoted to the solution of topical scientific and practical problem – the organization of a system of rehabilitation care for the adult population with the consequences of injuries and disorders of the musculoskeletal system – through medical and social reasoning and the development of a model aimed at solving the problem at the regional level, taking into account the processes of reforming the national health care system. The work analyses global and national experience in the organization of rehabilitation care and proves the gradual strengthening of the rehabilitation component of health care system of Ukraine in the regulatory, educational, and organizational spheres while maintaining limited opportunities to provide high-quality rehabilitation care for the adult population with the consequences of injuries and disorders of the musculoskeletal system at the regional level. A comprehensive study in Transcarpathian region established the regional prerequisites for the development of a model of the rehabilitation care system for the adult population with the consequences of injuries and disorders of the musculoskeletal system: the indicated nosologies hold consistently high the third and fourth places among the causes of disability, the network and staffing were slowly being rearranged to the new principles of the organization of rehabilitation care, predictors of adherence of patients with injuries of the musculoskeletal system to rehabilitation care, a high level of rehabilitation specialists' readiness to use modern information and communication technologies in the process of rehabilitation of patients with injuries, insufficient role of primary medical care in providing rehabilitation care. Based on the results of a comprehensive study, a model of the system of rehabilitation care for the adult population with the consequences of injuries and disorders of the musculoskeletal system at the regional level was scientifically substantiated and developed. The following innovative elements were introduced: integration of rehabilitation into primary medical care by creating rehabilitation offices staffed by rehabilitation specialists on the basis of primary medical care centers; creation of separate rehabilitation centers and offices with rehabilitation specialists and involvement of public health specialists to provide rehabilitation care in territorial communities; regional information and communication network of rehabilitation care and virtual professional communities of rehabilitation specialists connecting into a single information space the activities of primary and specialized medical care health care facilities and specialists of the region related to the provision of rehabilitation care to target groups of the population. The proposed model became the basis for the development of functional and organizational models of providing rehabilitation care to the adult population with the consequences of injuries and diseases of the musculoskeletal system in the conditions of primary medical care and at the level of united territorial communities. It also influenced the development of the online tool of the regional information and communication network of rehabilitation care, the creation of a regional coordination study room for rehabilitation assistance for musculoskeletal injuries, the formation of a virtual professional community of rehabilitation specialists, methodical recommendations and improvement of the educational process of higher education graduates of the field of knowledge 22 "Health care" on issues, related to providing rehabilitation assistance to the adult population with consequences of injuries and diseases of the musculoskeletal system. The proposed model of the system of rehabilitation care for the adult population with the consequences of injuries and disorders of the musculoskeletal system at the regional level received appreciation of highly qualified independent experts – from 4.65 ± 0.59 to 4.95 ± 0.22 points for individual characteristics – according to a five-point scale, which confirmed its effectiveness and allows it to be recommended for implementation in other regions of Ukraine. Key words: rehabilitation; physical and rehabilitation medicine; physical therapy; injuries; diseases of the musculoskeletal system; musculoskeletal system; information and communication support; health care system.