COMPREHENSIVE AND MULTIDISCIPLINARY REHABILITATION IN THE TIME OF CRISIS

Comprehensive and multidisciplinary rehabilitation is gaining momentum as a useful strategy that aims to improve physical, psychological, and social components of health in subjects affected by violence, trauma, and mental distress. Previous and current wars have prioritized essential diagnostic and rehabilitative services to civil subjects and military servicepersons which can be delivered by skilled physiatrists and allied specialists. Stratifying subjects in need of various rehabilitative procedures and offering them psychological support, balanced nutrition, musculoskeletal care, and socialisation in a safe and relaxing atmosphere may improve their mental and functional capacities and resolve numerous health issues. The choice of comprehensive rehabilitative procedures depends on their availability and understanding of complementary effects of various interventions.

The current global crisis affects all spheres of human life and activities. The consequences of intense and lasting psychological stress caused by the ongoing COVID-19 pandemic, war in Europe, use of unconventional weapons, mass killings, violence, migration, and desperation will affect the health of millions and result in new outbreaks of chronic clinical conditions in the years and decades to come [1][2][3][4]. Although there are no definite estimates of the scale of the health crisis, it is obvious that the global population will face a new syndemic that drives aging and triggers agingrelated diseases. Such a grim prospect will accelerate the spread of social diseases such as tuberculosis and sexually transmitted infections and affect mental health of most vulnerable population groups [5][6][7]. The worsened environmental factors will further accelerate aging and worsen fertility prospects [8].
In view of the catastrophic consequences of unjustified and self-destructive human activities, health specialists must loudly voice their concerns and act to curb the issue of accelerated aging, particularly in most vulnerable groups. Experimenting with various rehabilitative strategies aiming to improve all health-related components and achieving a "state of complete physical, mental, and social well-being" is the most desirable goal at the current stage. Although such a goal seems idealistic, its realization is possible by complementing physical rehabilitation with well-organized psychological help [9]. Stratifying psychologically and physically traumatized subject groups for tailored complex procedures by multidisciplinary rehabilitation teams may be the optimal strategy. In fact, the vast experience gained during previous wars in Europe suggests that the efficiency of rehabilitation is subjected to priority setting and stratifying health consumer groups [10]. Orthopedics, balneology, and climatology constitute the essence of rehabilitation in war which is inaccessible to most due to the lack of appropriate facilities and shortage of specially trained physiatrists. On the other hand, it is well known that the main rehabilitation procedures delivered in specially designed facilities allow improving the functional parameters of the musculoskeletal system which are critical for military servicepersons and civilians in the face of war [11].
The war in Ukraine has once again highlighted the importance of comprehensive and multidisciplinary rehabilitation by specialists supported with modern assistive technologies [12,13]. Experts have underscored the role of advancing physiotherapists' and allied specialists' skills, employing early and comprehensive rehabilitation procedures, and prioritizing services to subjects with disabilities and those requiring pain-relieving interventions [14,15]. Psychosocial help and humanitarian support turned the most needed services to the most vulnerable subjects who flee the war, experience sexual violence, witness family separation and human losses, and suffer in an unusual sociocultural environment [16,17].
The expected rise of aging diseases such as type 2 diabetes and their dreadful complications due to the inaccessibility of antidiabetic agents necessitates the awareness campaigns among predisposed subjects who should be trained to monitor blood glucose, correct their diet, and ensure their self-care as a part of comprehensive rehabilitation care [18,19]. Given the high risk of neuropathic and vascular affections of limbs and feet in young subjects involved in military conflicts, extra efforts are needed to avoid delays with rehabilitation of combatants and civilians with impaired glucose metabolism and traumas [20].
Accumulating evidence suggests that telerehabilitation with timely examination, stratification, and planning of rehabilitative procedures may help avoid delays in musculoskeletal rehabilitation of subjects undergoing surgical interventions. In fact, virtual inspection and range of motion evaluation in postoperative subjects experiencing pain, depression, and anxiety help to choose costeffective complementary and integrative therapies such as online yoga [21].
Subjects experiencing mental health issues, substance abuse, and social isolation may benefit from golf which is gaining global popularity as an option of psychological and physical therapy for groups [22,23]. Golf activities improve focus and concentration, reduce mental burden, ameliorate musculoskeletal fitness, and positively influence social well-being (Fig. 1, 2). New relations and strong feelings of social identity and importance develop as a result of group interactions and communication [23]. Unsurprisingly, golf has become the most popular form of all-year physical activity in US-based military veterans, particularly those with increasing age (above 35 years) [24]. Regular golfing as a moderate physical activity has been associated with improved muscular strength, body composition, glucose metabolism, and lipids profile all of which contribute to longevity [25]. In the time of the pandemic, golf therapy has emerged as a safe rehabilitative option in COVID-19 survivors, particularly those with cardiac and cerebrovascular risks [25].
In conclusion, comprehensive rehabilitation by use of advanced technologies and well-equipped facilities is becoming a pressing health priority in the time of pandemic, war, and socioeconomic crisis. The current crisis with its numerous threats requires complex approaches to timely diagnosing infections, metabolic disorders, disbalanced nutrition, substance abuse, and posttraumatic stress disorder. Consequently, diagnostic workup may guide the planning of rehabilitative procedures by multidisciplinary teams to treat diseases, alleviate pain, improve musculoskeletal functional capacity, and quality of life of subjects facing numerous threats and taking part in civil and military actions (Fig. 3, 4). The vast experience of previous wars suggests that comprehensive rehabilitation may help to recover combatants' health, psychological, and physical capacities [26,27]. The most vulnerable civilians undergoing complex rehabilitation may also improve their psychological functioning and quality of life. Planning and realizing comprehensive rehabilitation in post war conditions should also be planned to continue recovering stress-coping reserves and ensuring quality of life of all subjects surviving threats and horrors of the ongoing pandemic, war, and crisis.