Conceptual Foundations of Social Medicine in Rehabilitation: Evolution of Scientific Paradigms and Their Adaptation to Armed Conflict Contexts
Social medicine paradigms in rehabilitation
DOI:
https://doi.org/10.33700/jhrs.5.2.231Keywords:
social medicine, rehabilitation, armed conflict, biopsychosocial model, International Classification of Functioning, evidence-based rehabilitation, patient-centred care, UkraineAbstract
Introduction: Since February 2022, the full-scale war in Ukraine has sharply increased the need for rehabilitation and exposed conceptual and organisational weaknesses of the national system.
Objective: To analyse the evolution of conceptual approaches in social medicine related to rehabilitation, identify major paradigm shifts, and propose a framework adapted to wartime conditions in Ukraine.
Methods: This study was designed as a structured conceptual review, combining theoretical, comparative-historical, and contextual analysis of literature and policy documents published between 1948 and 2025, including WHO materials, Cochrane reviews, and Ukrainian regulatory sources. A structured search of four bibliographic databases returned 612 records, from which a focused corpus of foundational, conceptual, and policy sources was synthesised; the study does not constitute a systematic or scoping review.
Results: Five major paradigm shifts were identified: from the biomedical to the biopsychosocial model; from the medical to the social model of disability; from ICIDH to ICF; from empirical to evidence-based rehabilitation; and from paternalistic to patient-centred care. In Ukraine, implementation remains constrained by institutional fragmentation, workforce shortages, and incomplete ICF adoption. An integrative concept of rehabilitation resilience is proposed as the system’s capacity to absorb shocks, adapt, and restore access, quality, and equity of services under armed conflict.
Conclusions: Contemporary rehabilitation should be understood as a medico-social strategy rather than a narrowly clinical intervention. The rehabilitation resilience framework can support evidence-informed policy, organisational reform, and recovery planning in Ukraine.
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Copyright (c) 2026 Maksym Lytvynenko, Igor Verbitskiy, Rostyslav Dovbenko, Oleksiy Domoratskiy, Nataliia Serohina
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