118 Chapter 5 Abstract Objectives: A challenging rehabilitation environment (CRE) is a relatively new concept for offering geriatric rehabilitation (GR) and consists of multiple components. To date, there is no evidence-based conceptualization of CRE. Design: Concept mapping study Setting and participants: A total of 20 (para)medical staff, 11 nursing staff, and 15 rehabilitants and informal caregivers participated, all working or currently rehabilitating in GR. Methods: Statements regarding CRE were extracted from previous studies on CRE. Participants rated these statements according to importance for CRE and subsequently clustered all statements in a maximum of 10 clusters. The statistical procedure of concept mapping was performed in computer program Ariadne 3.0 and consisted of a multi-dimensional scaling procedure and a hierarchical cluster analysis. The multi-dimensional scaling procedure led to a point map showing the extent to which the statements are related according to all participants. The hierarchical cluster analysis subsequently led to a cluster solution which represents the concept of CRE. Results: A total of 70 statements were formulated to describe the concept of CRE. The statistical procedure resulted in five clusters: 1) goals (how they are formulated and guide the rehabilitation process), 2) rehabilitant and informal caregiver (factors concerning coping process, resilience and involvement in the rehabilitation process), 3) staff aspects (interdisciplinary collaboration and integrating rehabilitation in all daily activities), 4) environmental aspects (the design of the ward should be stimulating and challenging), and 5) exercise and peer support (how are exercise moments and peer support stimulated). Conclusions and implications: This study gives an evidence-based conceptualization of CRE, based on statistical consensus of three relevant stakeholder groups in the practice of GR. This conceptualization provides a basis for rehabilitation wards to organize their GR. Keywords Geriatric rehabilitation, challenging rehabilitation environment, concept mapping, post-acute care
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