12 Chapter 1 ages can partly be explained by which activities are counted as therapeutic (e.g. mealtimes, communication, activities of daily living). Similar results were found for rehabilitants with orthopedic problems of the lower extremities in the inpatient rehabilitation, who were able to walk independently or with support. This group of rehabilitants walked on average only 8 min/day and none of them achieved 10 mins of moderately intensive physical contiguous activity.23 This low activity level of these rehabilitants is worrying, because more therapy time appears to be associated with positive outcomes such as return home, functional recovery and a shorter length of stay, and an decrease of therapy time is associated with return to hospital or death.17,23-35 Towards a challenging rehabilitation environment (Socio-) therapeutic climate is a common concept in psychiatry since the nineteen eighties and focusses among other things on therapeutic goals related to the ability to re-adapt to the home situation, on group processes within a treatment group, on problem orientated approach, and on the influence of staff characteristics.36-38 This broad perspective on treatment is well secured in psychiatry. The combination of the social, physical, and organizational environment is also used to achieve therapeutic goals in nursing home residents with dementia.39 These positive outcomes give inspiration to apply this broad approach in other fields. This broad perspective on treatment was brought to geriatric rehabilitation in the Netherlands by Marieke Terwel in 2011 with the publication of the book: “Everything is rehabilitation: rehabilitation after a stroke in the Laurens therapeutic climate”. 40 This book described e.g. the importance of shared rehabilitation goals, methods for interdisciplinary group training, functional training moments during daily activities (task-oriented training), and methods to encourage rehabilitants to work independently on their rehabilitation. Rehabilitation wards in the Netherlands adapted this concept enthusiastically and the concept is no longer only used for stroke rehabilitants.41-44 Although a scien-
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