Assessment of the results of implementation of individual rehabilitation and habilitation programs by disabled persons in the Russian Federation

Authors:

Chernyakina Tatiana Sergeevna — Grand PhD in Medical sciences (Dr. Med. Sci.), Professor, Chief Researcher of the Department for Monitoring the Observance of the Rights of Disabled People, Albrecht Federal Scientific and Educational Center of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; Professor of the Department of Preventive Medicine and Health Protection of the I.I. Mechnikov North-Western State Medical University, 47 Piskarevsky Ave., 195067 St. Petersburg, Russian Federation; e-mail: maimulovt@mail.ru; https://orcid.org/0000-0002-2854-3248.

Fidarova Zalina Danilovna — PhD in Medical sciences (Cand. Med. Sci.), Associate Professor of Department of Therapy of the Institute of Additional Professional Education, doctor of Adult Department of Somatic Rehabilitation of the Clinic, Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: zalina-fidarova@yandex.ru.

Kolyuka Olga Evgenievna – Senior Researcher of the Department for monitoring the observance of the rights of disabled people of the Institute for Rehabilitation and Habilitation of Disabled People, Albrecht Federal Scientific and Educational Center for Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: problemkom@mail.ru; https://orchid.org/0000-0003-0199-4679.

Shestakov Vladimir Petrovich — Grand PhD in Medical sciences (Dr. Med. Sci.), Professor, Head of the scientific direction, Albrecht Federal Scientific and Educational Center of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: Schestakov.V.P@yandex.ru.

Annotation:

Introduction. Despite the ongoing reforms in the field of rehabilitation and habilitation of persons with disabilities and prevention of disability aggravation, there has been a slight increase in the number of people with disabilities of working age employed in the country’s economy, and therefore, a systematic assessment of the organization of the process of providing comprehensive rehabilitation or habilitation services to persons with disabilities and the results of habilitation and rehabilitation is an urgent task in order to improve the effectiveness of rehabilitation and habilitation measures.

Aim. The aim is to study the dynamics of the main results of rehabilitation and habilitation of people with disabilities aged 18 years and older in the Russian Federation.

Materials and methods. To assess the results of rehabilitation and habilitation of persons with disabilities aged 18 and older, data from the federal statistical observation on form 7-sobes “Information on the medical and social examination of persons aged 18 and older”, Updated reports on the implementation of the State Program of the Russian Federation “Accessible Environment” and its structural elements in 2019-2023 were used by the Ministry of Labor Russian Federation, the results of monitoring the implementation by state authorities of 86 subjects of the Russian Federation of measures to implement the provisions of the Convention on the Rights of Persons with Disabilities.
To achieve the purpose of the study, methods of descriptive statistics of expert rehabilitation reports on the implementation of individual rehabilitation programs, individual rehabilitation programs or habilitation of a disabled person during re-examination were applied. The calculation and comparative analysis of the parameters of the dynamic data series of expert rehabilitation reports on the implementation of individual rehabilitation and (or) habilitation programs by disabled people for 5 years (2018-2022) has been performed.

Results. An analysis of the data on the implementation of individual rehabilitation or habilitation programs (IRAP) measures for the re-examination of persons with disabilities aged 18 and over for the period from 2018 to 2022 showed that their number was 24.17% higher in 2022 than in 2018, of which there were 24.18% more with positive results of rehabilitation or habilitation. The share of conclusions on the implementation of individual rehabilitation or habilitation programs by disabled people during re-examination with positive results of rehabilitation or habilitation from all completed individual rehabilitation or habilitation programs in general in all areas of rehabilitation amounted to 48.99% in 2018, decreased to 45.35% in 2020 and then increased to 49.00% in 2022, there was an increase in the number of performed individual rehabilitation or habilitation programs in the areas of rehabilitation: restoration of impaired functions – by 25.78%, achievement of compensation for lost or missing functions – by 19.36%, restoration of socio-environmental status – by 28.54%, restoration of socio-psychological status – by 32.54%, restoration of sociohousehold status – by 34.58%, restoration of professional status – by 25.01%. Only in the rehabilitation area “restoration of socio-pedagogical status” there was a decrease in the number of conclusions on the implementation of individual rehabilitation or habilitation programs – by 15.75%.
An increase in the proportion of IRAP conclusions from all performed IRAP was found in terms of partial restoration of functions or status due to a decrease in the proportion of indicators: there is no complete restoration of functions or status and no positive results. The largest increase in the proportion of positive conclusions was noted in terms of partial restoration of socio-pedagogical status – by 13.23%, and the smallest in terms of partial restoration of socio-psychological status – by 3.05%.

Discussion. It is not possible to compare the results obtained by analyzing the data of expert rehabilitation reports on the implementation of individual rehabilitation programs, individual rehabilitation programs or habilitation of a disabled person during re-examination with selective or systematic studies by other authors, since there are no such studies. The report on the implementation of the subprogram “Improving the level of provision of rehabilitation and habilitation services for the disabled” of the State Program of the Russian Federation “Accessible Environment” and its structural elements lacks indicators indicating positive results in the rehabilitation of persons with disabilities aged 18 years and older.
The low, less than 50.0%, effectiveness of the implementation of IRAP, according to a number of authors, is due to the lack of rehabilitation specialists in the IRAP executive bodies who are able to develop a list of rehabilitation measures based on a scientific approach to the needs of a disabled person.
In this regard, it is necessary to consider the creation of a unified information and analytical system for recording personal appointments of IRAP activities and the results of its implementation, with an assessment of the results achieved in rehabilitation or habilitation in each area and with a comprehensive assessment. In order to improve the completeness and quality of rehabilitation or habilitation services provided, it is necessary to improve the organizational and methodological training and retraining of specialists who organize the implementation of IRAP, as well as the training of missing rehabilitation specialists in rehabilitation areas.

Conclusion. Based on the analysis of the data on the implementation of the IRAP and IPRA measures during the re-examination of persons with disabilities aged 18 and older for the period from 2018 to 2022, the low effectiveness of the rehabilitation measures carried out in general in all areas of rehabilitation was revealed, amounting to 45-49% of the conclusions with positive results from all conclusions on the implementation of IRAP by persons with disabilities in different years. It was found that the increase in the share of IPRA from all IRAP performed by disabled people in terms of partial restoration of functions or status in each area of rehabilitation was due to a decrease in the share of “full recovery” and “no positive results” indicators.

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