The World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF, World Health Organization 2001), known as the ICF, describes integrating understanding of a health, assimilating the multidimensional elements of health, wellbeing, disease and functioning; models of healthcare; universality; and life context. The holistic approach of the ICF can assist health professionals on clinical reasoning, problem solving and goal setting. However, students and young professionals can find the ICF difficult to understand how multiple biological, psychological, and social factors associated with a persons’ health condition and other subjective factors, for example, their values, beliefs, cultural context, fears, worries, and hopes (Miles & Mezzich 2011).
During the last decades there has been a shift towards a biopsychosocial (BPS) paradigm in health care and has introduced concepts such as client-centered-practice, inclusion, shared decision making, coaching and self-management (Van de Velde et al., 2016). This has led to a switch from cure-oriented towards care-oriented practices. Yet, the implementation of the BPS model in rehabilitation has been slow, partly due to physiotherapists report lack of training and understanding of interventions according to the BPS in musculoskeletal health problems (Aleksanders et al., 2015), low back pain (Franca et al., 2019; Mescouto et al., 2020), and traumatology (Kaye et al., 2021). Also, in occupational therapy we see the introduction of the BPS model in rehabilitation to embrace a more integrated and holistic approach to practice (Gentry et al, 2018; Hubert, 1991).
Currently, Ukraine is one of the countries with high needs for rehabilitation services. The military conflict in the Donbass region since 2014 and the Russian large-scale invasion in Ukraine since February 24, 2022, has increased demands for acute and long-term rehabilitation services for many people injured in the war. According to the president of Ukraine, about 100 military personnel are killed every day and about 500 are wounded (Mack, 2022 ). In addition, there were multiple structural and political changes in rehabilitation system of Ukraine since 2015. For example, the physiotherapy profession did not exist until 2016. The Ministry of Health of Ukraine (MHU) established requirements to physiotherapist and physiotherapist assistant in 2018 (Ministry of Health of Ukraine, 2018) and master study programs of physiotherapy and occupational therapy were separated by the MHU (2018). Since 2016, the initial steps of ICF implementation have been done by the MHU (Special Directive of Acting Minister of Health number 183, 2016; Directive of Cabinet of Ministers of Ukraine number, 2017). The ICF has been translated to Ukrainian, Ukrainian legislation has been changed to enable implementation of the ICF across country and ICF basic knowledge has been included in pre and post graduate study programs of healthcare professionals (Golyk et al., 2021). Also, train-the-trainers workshops for practitioners and policy making stakeholders were organized on ICF on 2018 (MHU, 2018) followed by implementation of the ICF in the Central eHealth database of Ukraine on 2020 (Cabinet of Ministers of Ukraine, 2020). However, multiple challenges related to national policy and provision of rehabilitation services limited implementation of the ICF. For example, a biomedical approach still used in healthcare, professional recognition of physiotherapists and occupational therapists only since 2018, lack of multidisciplinary rehabilitation services and not available instruments to measure quality of rehabilitation services (WHO, 2021).
The noticeable factor of quality in health care systems is employee’s job satisfaction which further heavily influence the performance and clinical outcomes of patients. Information on job satisfaction among rehabilitation specialists in European countries is limited. Eker and collegues (2004) reported that leadership quality was one of the best predictors of job satisfaction among physiotherapists in Turkey. The other factors that showed strong relationship with job satisfaction were interpersonal relationships, income, opportunities for personal and professional growth, and professional advancement opportunities (Eker et al., 2004). Other research reported that equipment and technologies available in the working environment, expectation to receive support from the organization, positive leadership style provide important insight into the type of work characteristic those can affect job satisfaction among health professional, including physiotherapists (Alkassabi et al., 2018; Rodwell et al., 2009).
Several projects funded by the European Commission have been initiated to promote collaboration with international rehabilitation partners aiming implementation of European standards of training for rehabilitation professionals in Ukraine. For example, the REHAB project (nr. 598938-EPP-1-2018-1-LV-EPPKA2-CBHE-JP, http://rehabeukr.eu/) started in 2018 to address the three major goals related to development of innovative master programs in physiotherapy in Ukraine by: (1) building professional capacity of the academic and research staff, (2) development of the teaching/learning/assessment resources, and (3) providing specific educational infrastructure needed to implement the nationally new professional study program in physiotherapy. This project was committed to overcoming the traditional biomedical model, to promote biopsychosocial (BPS) approach and to promote implementation of the ICF in Ukrainian rehabilitation services linked with the REHAB project. The academic staff and students from the four project partner universities in Ukraine (National University of Ukraine on Physical Education and Sport, Ivan Bobersky Lviv State University Of Physical Culture, Sumy State University and I.Horbachevsky Ternopil National Medical University) received more than 20 traning sessions (webinars, seminars, onsite practical trainings and site visits) to learn a common language for describing physiotherapy as part of multidisciplinary rehabilitation system that involve different health professionals. The European project partners representing the v of Physical Education in Warsaw (Poland) and European Federation of Adapted Physical Activity have more than 20 years educational and research experience in rehabilitation field. More than one thousand bachelor and master students from physiotherapy programs and over one hundred academic and research staff from across Ukraine have been involved in the REHAB project training between 2018 – 2022.
Another project entitled Developing an Occupational Therapy study programme in Ukraine (nr. 609589-EPP-1-2019-1-BE-EPPKA2-CBHE-JP), financed by Erasmus+ Programme of the European Commission involves the three Ukraine higher education institutions (Drohobych Ivan Franko State Pedagogical University, Khmelnytskyi National University and Prydniprovsk State Academy) and European partners from Belgium (Vives University, Bruges) and Portugal (P.Porto). This particular project targets implementation of a new curriculum for occupational therapist according the standards of the World Federation of Occupational Therapy (WFOT). In the project, the focus is not only on training the teachers but also the staff from hospitals and rehabilitation centers (Caritas and Modrychi), because they have a crucial role as guides and coaches of the internship students. Also, the collaboration with governmental institutions of Ukraine is promoted since their support is needed in state funded rehabilitation centers.
Although the use of ICF as a unified language and framework for a BPS description of health in various domains is supported by Ukrainian health policy, there is no data on the perception and understanding of the rehabilitation professionals in Ukraine on how they understand and if they use a BPS model in their clinical practice. Also, to the authors knowledge, no monitoring to measure job satisfaction of rehabilitation professionals has been done in Ukraine.
This study aimed to explore the factors that impact the perception of rehabilitation professionals about the BPS model in Ukraine. In addition, the job satisfaction assessment was done to measure whether rehabilitation specialists in Ukraine fulfil their professional roles according to their expectations and values.