135 The conceptualization of a Challenging Rehabilitation Environment Discussion In this study, relevant stakeholders in rehabilitation assembled the components of three previous studies on CRE into an evidence-based conceptualization of CRE using concept mapping.6-8 This has led to a broadly supported conceptualization of CRE, which combines evidence-based, expert-based, and experience-based knowledge. One of the strengths of using concept mapping is that it combines the individual input of relevant stakeholders, without participants influencing each other.10,11 The result is the conceptualization of CRE in five clusters: goals, rehabilitant and informal caregiver, staff aspects, environmental aspects, and exercise and peer support. The complex intervention of a CRE was conceptualized with the input of relevant stakeholders. Involving relevant stakeholders from the start of the development of such an intervention is helpful for identifying needs and priorities and understanding the problem. This supports the implementation of evidence-based knowledge in practice.17,18 The conceptualization achieved in this study describes all components relevant to a CRE. The involvement of the relevant stakeholders in this process results in a widely supported conceptualization. Implementing CRE according to the conceptualization achieved in this study may lead to broader support. Although the subgroup analysis in this study resulted in an almost similar division into clusters, there were some differences between the stakeholders regarding the mean rating of the statements. First, the rehabilitants and informal caregivers ranked priority for the top 10 statements with the overall highest ranking statements very differently. Second, this subgroup’s range in rating the clusters and statements was narrower than the professionals. These results show that the three stakeholder groups conceptualize CRE in a similar way, but that there are differences in the value they attach to the different aspects of CRE. A recent scoping review by Lubbe et al. identified the rehabilitants’ perspective on the quality of GR and confirmed differences between professionals and rehabilitants regarding their perspectives on GR.19 Therefore, in order to create an optimal 5
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