CURRENT STATE OF MEDICAL SUPPORT FOR PSYCHOSOMATIC REHABILITATION IN UKRAINE

Authors:

Abstract:

The purpose of the study was to provide a comprehensive analysis of modern legal and ethical challenges that constitute the medical basis of psychosomatic rehabilitation in modern Ukrainian realities. A systematic analysis of studies from 2020 to 2025, taken from the medical databases of V.I. Vernadsky National Library of Ukraine, PubMed, Web of Science, and SCOPUS, outlines main properties of court-ready rehabilitation: main complaints and history, basic clinical and functional status, intervention type, methods of treatment, dose and frequency, time-stamped re-assessments, functional and participation outcomes, adverse events. The authors focus attention on studies published in Ukrainian because they widely showed those aspects that have become extremely relevant in connection with the full-scale war, the changing structure of public demands, and the transformation of the system of medical and psychological care. The authors state that the issue of recognizing the results of psychosomatic rehabilitation as judicial evidence in Ukraine remains a complex interdisciplinary challenge in which legal, clinical, and ethical aspects are intertwined. The main legal conflicts stem from the lack of clear procedural standards for rehabilitation documentation, unresolved issues of admissibility and relevance, insufficient standardization of the form and content of conclusions, and the gap between clinical and forensic practice. Ethical dilemmas center on balancing the right to privacy and the public interest, protecting patient confidentiality, the need for informed consent to disclose rehabilitation results, and maintaining professional standards and the limits of professionals' competence. Insufficient attention to these issues not only reduces the effectiveness of judicial protection of victims, but also undermines trust in the healthcare, rehabilitation, and justice systems in general. The authors conclude that the priority of following actions should concentrate on medical standardization: a unified template with a minimum clinical dataset; mandatory use of validated assessment tools; time-stamped repeated measures; multidisciplinary sign-off; and auditable data trails, with endpoints anchored in clinical significance (pain, function, participation, quality of life).

Keywords:

psychosomatic rehabilitation legal and ethical provisions medical support ethical framework patients affected by war

References:

1. Anpleev AB. Psykholohichna pidtrymka viyskovosluzhbovtsiv u protsesi sotsialno-psykholohichnoyi adaptatsiyi pislya boyovykh diy. Visnyk Mizhnarodnoho ekonomiko-humanitarnoho universytetu imeni akademika Stepana Demyanchuka. 2026; 1: 17-22. doi: https://doi.org/10.32782/3041-2021/2026-1-2 [in Ukrainian].
2. Babov KD, Khomenko IP, Tertyshny SV, Babova IK, Vastyanov RS. Orhanizatsiya etapnoyi reabilitatsiyi viyskovosluzhbovtsiv z vohnepalnymy defektamy myakykh tkanyn na rivnyakh nadannya medychnoyi dopomohy. Medychni perspektyvy. 2021; 26(4): 188-195. doi: https://doi.org/10.26641/2307-0404.2021.4.248228 [in Ukrainian].
3. Bozhuk BS, Markova MV, Strelnikov MO, Lashko OM, Markov AR, Piontkovska OV et al. Biopsykhosotsialna paradyhma reabilitatsiyi uchasnykiv boyovykh diy: obgruntuvannya, struktura ta rezultaty pilotnoho vprovadzhennya informatsiyno-koordynatsiynoyi modeli. Psykhiatriya, nevrolohiya ta medychna psykholohiya. 2025; 12(5): 561–575. doi: https://doi.org/10.26565/2312-5675-2025-31-01 [in Ukrainian].
4. Klymenko IS, Galadza MV, Bondarchuk AG, Pisarenko TV, Shlyonska OO. Tilesno-oriyentovana psykhoterapiya v roboti z dysotsiatyvnymy rozladamy u viyskovosluzhbovtsiv. Psykhiatriya, nevrolohiya ta medychna psykholohiya. 2024; 11(4): 399–410. doi: https://doi.org/10.26565/2312-5675-2024-26-05 [in Ukrainian].
5. Klymenko IS, Bovtun OV, Horlachuk YO, Deputatov VO, Galadza MV. Otsinka potreby u psykholohichniy dopomozi sered viyskovosluzhbovtsiv ta baryery zvernennya. Psykhiatriya, nevrolohiya ta medychna psykholohiya. 2025; 12(4): 490–503. doi: https://doi.org/10.26565/2312-5675-2025-30-05 [in Ukrainian].
6. Klymenko IS, Galadza MV, Pisarenko TV. Dokazova praktyka v korotkotryvalykh psykhoterapevtychnykh interventsiyakh. Psykhiatriya, nevrolohiya ta medychna psykholohiya. 2025; 12(1): 81–90. doi: https://doi.org/10.26565/2312-5675-2025-27-07 [in Ukrainian].
7. Klymkiv RI, Kulmatytskyi AV, Bilobryn MS. Posttravmatychnyy stresovyy rozlad u veteraniv: innovatsiyni metody terapiyi ta profilaktyky. Psykhiatriya, nevrolohiya ta medychna psykholohiya. 2025; 12(1): 37–47. doi: https://doi.org/10.26565/2312-5675-2025-27-03 [in Ukrainian].
8. Kunev YuD. Informatsiyni prava patsiyentiv iz psykhichnymy rozladamy v Ukrayini: pravovyy analiz. Yurydychnyy naukovyy elektronnyy zhurnal. 2025; 3: 714-717. doi: https://doi.org/10.32782/2524-0374/2025-3/173 [in Ukrainian].
9. Lebedeva S, Ovsyannikova Y, Pokhilko D. Psykholohichna dopomoha ta reabilitatsiya uchasnykiv zbroynykh konfliktiv ta fakhivtsiv ryzykonebezpechnykh profesiy: svitovyy dosvid. Habitus. 2023; 45: 139–145. doi: https://doi.org/10.32782/2663-5208.2023.45.23 [in Ukrainian].
10. Kostyuk YuV. Pravo na reabilitatsiyu osib z invalidnistyu: teoretyko-pravovyy analiz. Analitychno-porivnyalʹne pravoznavstvo. 2025; 2: 1318-1323. doi: https://doi.org/10.24144/2788-6018.2025.02.200 [in Ukrainian].
11. Petrushenko V. Terminolohichni ta definityvni problemy paradyhmalnoho pidgruntya yurydychnoyi psykholohiyi. Psykholohichnyy chasopys. 2026; 12(5): 7–22. doi: https://doi.org/10.31108/1.2026.12.5.1 [in Ukrainian].
12. Puzyryov EV, Berezynets TYu. Osoblyvosti provedennya sudovo-psykholohichnoyi ekspertyzy v tsyvilnykh i administratyvnykh spravakh Ukrayiny. Vcheni zapysky TNU imeni V.I. Vernadskoho. Seriya: Psykholohiya. 2025; 36(5): 162-165. doi https://doi.org/10.32782/2709-3093/2025.5/25 [in Ukrainian].
13. Sinyakova VB, Velichko PO, Bereznikov KO, Lomakina IYu, Efremova II. Sotsialno-psykholohichni predyktory profesiynoyi efektyvnosti pratsivnykiv komertsiynykh orhanizatsiy v umovakh voyennoho stresu. Psykhiatriya, nevrolohiya ta medychna psykholohiya. 2026; 13(2): 289–301. doi: https://doi.org/10.26565/2312-5675-2026-34-05 [in Ukrainian].
14. Tsilmak OM, Kuznetsova LV. Osnovy sudovo-psykholohichnoyi ekspertyzy. Odesa: NU «Odeska yurydychna akademiya», 2025. 36. [in Ukrainian].
15. Chaban OS, Haustova OO. Medyko-psykholohichni naslidky dystresu viyny v Ukrayini: shcho my ochikuyemo ta shcho potribno vrakhovuvaty pry nadanni medychnoyi dopomohy? Ukrayinskyy medychnyy chasopys. 2022; 4: 1–11. doi: https://doi.org/10.32471/umj.1680-3051.150.2322975. [in Ukrainian].
16. Yaremko O, Shafransky V. Pravo osib z psykhichnymy rozladamy na sotsialni posluhy u konteksti pravovoyi realnosti Ukrayiny. Aktualni problemy pravoznavstva. 2022; 3(31): 90–94. doi: https://doi.org/10.35774/app2022.03.090 [in Ukrainian].
17. Aggarwal NK. Accountability for Forensic Psychiatrists and Psychologists in U.S. Intelligence Settings. J Am Acad Psychiatry Law. 2022; 50(3): 346-350. doi: 10.29158/JAAPL.220052-22
18. Atkinson-Graham M, Mior S, Bakaa N, Konstantinidis T, Wong J, Arienti C. et al. Governance arrangements for rehabilitation services in health systems: an overview of systematic reviews. Cochrane Database Syst Rev. 2025; 11(11): CD016309. doi: 10.1002/14651858.CD016309.
19. Badura-Brzoza K, Główczyński P, Tatar D, Dębski P. Youth in times of polycrises: the role of social support in connection with the depression and anxiety symptoms among young people in polish secondary schools during the COVID-19 threat and the outbreak of war in Ukraine. Front Psychol. 2025; 16: 1591218. doi: 10.3389/fpsyg.2025.1591218
20. Bolton D. A revitalized biopsychosocial model: core theory, research paradigms, and clinical implications. Psychological Medicine. 2023; 53(16): 7504–7511. doi: https://doi.org/10.1017/S003329172300266011.
21. Card AJ. The biopsychosociotechnical model: a systems-based framework for human-centered health improvement. Health Systems (Basingstoke, England). 2022; 12(4): 387–407. doi: https://doi.org/10.1080/20476965.2022.2029584
22. Escolà-Gascón Á, Dagnall N, Drinkwater K. Bias analysis in forensic and non-forensic psychiatric assessments. Int J Law Psychiatry. 2023; 88: 101891. doi: 10.1016/j.ijlp.2023.101891.
23. Flinn RE, Estevez R, Terepka A, Boot-Haury J, Abreu RL, Dewey JM. et al. Transaffirmative psychological practice is ethical practice: Leveraging the American Psychological Association's Ethical Principles of Psychologists and Code of Conduct in practice and advocacy. J Couns Psychol. 2025; 72(5): 552-566. doi: 10.1037/cou0000811.
24. del Furia MJ, Minozzi S, Battel I, Cordani C, Arienti C, Atkinson-Graham M. et al. Delivery arrangements for rehabilitation services in health systems: an overview of systematic reviews. Cochrane Database Syst Rev. 2026; 4(4): CD016348. doi: 10.1002/14651858.CD016348.
25. Gimigliano F, Liguori S, Arienti C, Paoletta M, Butzbach O, Iolascon G. et al. Financial arrangements for rehabilitation services in health systems: an overview of systematic reviews. Cochrane Database Syst Rev. 2026; 2(2): CD016327. doi: 10.1002/14651858.CD016327.
26. Houlding C, Barnett BM, Colton S, Houlding E, Schmidt F, Konkolý Thege B. Ethics and action pathways for psychologists in a time of climate crisis. Front Psychol. 2026; 17: 1770041. doi: 10.3389/fpsyg.2026.1770041.
27. Huda AS. The medical model and its application in mental health. Int Rev Psychiatry. 2021; 33(5): 463-470. doi: 10.1080/09540261.2020.1845125.
28. Jawad MJ, Abbas MM, Jawad MJ, Hassan SM, Hadi NR. Mental health and psychosocial considerations post COVID-19 outbreak. Wiad Lek. 2021; 74(12): 3156-3159. doi: 10.36740/WLek202112106
29. Karatzias T, Shevlin M, Ben-Ezra M, McElroy E, Redican E, Vang ML. et al. War exposure, posttraumatic stress disorder, and complex posttraumatic stress disorder among parents living in Ukraine during the Russian war. Acta Psychiatrica Scandinavica. 2023;147(3):276–85. doi: https://doi.org/10.1111/acps.13529
30. Khoroshun EM, Makarov VV, Nehoduiko VV, Tertyshnyi SV, Titov YeV, Ryzhenko AP. et al. Peculiarities of liver severe gunshot wounds pathomorphosis. World of Medicine and Biology. 2025; 2(92): 197-201. doi: 10.26724/2079-8334-2025-2-92-197-201
31. Khoroshun EM, Khomenko IP, Negoduiko VV, Shipilov SA, Bunin YuV, Tertyshnyi SV. et al. Modern strategies for surgical treatment of combat chest and abdominal injuries in wartime conditions in Ukraine. The Ukrainian Journal of Clinical Surgery. 2026; 93(1): 3-11. doi: 10.26779/2786-832X.2026.1.03
32. Leonardi M, Lee H, Kostanjsek N, Fornari A, Raggi A, Martinuzzi A. et al. 20 Years of ICF-International Classification of Functioning, Disability and Health: Uses and Applications around the World. Int J Environ Res Public Health. 2022; 19(18): 11321. doi: 10.3390/ijerph191811321.
33. Lushchak O, Velykodna M, Bolman S, Strilbytska O, Berezovskyi V, Storey KB. Prevalence of stress, anxiety, and symptoms of post-traumatic stress disorder among Ukrainians after the first year of Russian invasion: a nationwide cross-sectional study. The Lancet Regional Health – Europe. 2024;36:100773. doi: https://doi.org/10.1016/j.lanepe.2023.100773
34. Markova MV, Aliieva TA, Markov AR, Korop OA, Lisovaya EV, Babych VV. et al. Disorders of adaptation of combatants and their medical and psychological rehabilitation at the sanatorium stage of treatment. Wiad Lek. 2022; 75(2): 444–450. doi: https://doi.org/10.36740/WLek202202121
35. Nehoduiko VV, Tertyshnyi SV, Khomenko IP, Ryzhenko AP, Ocheretnyi SL, Vastyanov RS. Peculiarities of liver foreign bodies (metal fragments) removal of gunshot origin depending on their location. Paediatric Surgery (Ukraine). 2025; 3(88): 63-70. doi: 10.15574/PS.2025.3(88).6370
36. O'Donohue W, Fisher JE. Are illiberal acts unethical? APA's Ethics Code and the protection of free speech. Am Psychol. 2022; 77(8): 875-886. doi: 10.1037/amp0000995.
37. Potter K, Miller S, Newman S. Environmental Factors Affecting Early Mobilization and Physical Disability Post-Intensive Care: An Integrative Review Through the Lens of the World Health Organization International Classification of Functioning, Disability, and Health. Dimens Crit Care Nurs. 2021; 40(2): 92-117. doi: 10.1097/DCC.0000000000000461.
38. Roberts A. The biopsychosocial model: Its use and abuse. Med Health Care Philos. 2023; 26(3): 367-384. doi: 10.1007/s11019-023-10150-2.
39. Uher J, Arnulf JK, Barrett PT, Heene M, Heine JH, Martin J. et al. Psychology's Questionable Research Fundamentals (QRFs): Key problems in quantitative psychology and psychological measurement beyond Questionable Research Practices (QRPs). Front Psychol. 2025; 16: 1553028. doi: 10.3389/fpsyg.2025.1553028.
40. Zaina F, Côté P, Cancelliere C, Di Felice F, Donzelli S, Rauch A. et al. A Systematic Review of Clinical Practice Guidelines for Persons With Non-specific Low Back Pain With and Without Radiculopathy: Identification of Best Evidence for Rehabilitation to Develop the WHO's Package of Interventions for Rehabilitation. Arch Phys Med Rehabil. 2023; 104(11): 1913-1927. doi: 10.1016/j.apmr.2023.02.022.

Publication:

«World of Medicine and Biology» Vol. 22 No. 97 (2026), pp. 236-242
UDC 616.89-008.441.13-036.66

DOI:

https://doi.org/10.26724/2079-8334-2026-3-97-236-242