13 General introduction tific basis for this concept is lacking and there are differences in interpretation of aspects relevant for this concept. Aspects that are mentioned as being related to this concept concern for instance increasing therapy time, group training, patient-regulated exercise, family participation and task-oriented training. Because there is no conceptualization of the concept of therapeutic climate, it is not clear to what extent this contributes to effective and efficient rehabilitation. In this thesis we do not use the term ‘Therapeutic Climate’, but use the name “challenging rehabilitation environment” (CRE; Dutch: Uitdagend Revalidatieklimaat) for the described concept. As the concept contains more than the contact moment with therapists, we also want to recognize the work of other disciplines such as nurses in the rehabilitation process. The concept describes the whole environment in which the rehabilitation takes place, and it is intended to challenge rehabilitants to get the optimal rehabilitation results. Therefore, this name seems to describe the concept best. In this thesis we use the word rehabilitants when talking about persons/patients who are rehabilitating. These persons are trying to adapt to, and self-manage their current condition. In line with the ideas of Huber et al. on positive health, the term ‘rehabilitant’ is more appropriate.45 Aim and outline of this thesis This thesis describes the results of the CREATE study (Challenging REhAbiliTation Environment). The overall aim of the CREATE study was to conceptualize CRE, and to develop a tool to support rehabilitation wards in improving their CRE. For this purpose the following research questions were addressed: 1. Which aspects are important in a challenging rehabilitation environment and how can these be combined in a conceptualization? 2. To which extent is a team self-evaluation tool feasible to support rehabilitation wards by implementing a challenging rehabilitation environment? 1
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