119 The conceptualization of a Challenging Rehabilitation Environment Introduction Geriatric Rehabilitation (GR) was recently defined as “a multidimensional approach of diagnostic and therapeutic interventions, the purpose of which is to optimize functional capacity, promote activity and preserve functional reserve and social participation in older people with disabling impairments.”1 With the ageing of the population, the demand for GR in Europe has increased.2,3 In the Netherlands, for example, 54,910 persons were referred to GR in 2021.4 In a Challenging Rehabilitation Environment (CRE), GR is offered in a multidimensional and structured approach. It is, however, a relatively new concept.5-8 To date, there is no official definition of CRE and there are considerable differences between rehabilitation wards in their interpretation and execution of CRE. Despite these differences, professionals who work in a CRE assume CRE to be an effective and efficient way to offer GR and to stimulate rehabilitants to actively participate in their rehabilitation process.7 The aim of the CREATE study (Challenging REhAbiliTation Environment) is to develop an evidence-based conceptualization of CRE and to study empirical evidence for the added value of CRE for rehabilitants.9 In prior studies, i.e., a narrative review and two qualitative studies regarding the perspectives of professionals, rehabilitants and informal caregivers, components for the conceptualization of a CRE were identified. Identified components included the manner in which therapy is offered, the involvement of informal caregivers, nutrition, eHealth, environmental aspects and staff aspects.6-8 The aim of the present study is to generate consensus among stakeholders and to assemble these components into an evidence-based conceptualization of CRE using the Concept Mapping method. This method was specifically developed to combine evidence-based knowledge with the collective judgement of stakeholders. We used advanced statistical methods to construct an evidence-based concept.10,11 5
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