143 The CREATE-tool: A self-evaluation tool for a Challenging Rehabilitation Environment Introduction With the ageing of the population, the demand for Geriatric Rehabilitation is high. (1) For instance, in the Netherlands it has led to the referral of 54.910 persons in 2021, which represents 1.5% of the Dutch population over 65 years. (2, 3) In a recent consensus statement by Grund et al., geriatric rehabilitation is 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.” (4) Despite this consensus definition there are international differences in the way geriatric rehabilitation is offered. There is general agreement that rehabilitation should be offered in a multidimensional setting with a structured approach that stimulates and challenges the rehabilitant to actively work on their recovery. Such a Challenging Rehabilitation Environment (CRE) is seen as a promising method for delivering high quality rehabilitation. (5) Since there was no standard for CRE, considerable differences between wards in the implementation of CRE arose. The aim of the CREATE study (Challenging REhAbiliTation Environment) is to develop a conceptualization of CRE and to study empirical evidence for the added value of CRE for rehabilitants. (6) To date, the CREATE study has led to an evidence-based, expert-based and experience-based conceptualization of CRE in five clusters: goals, rehabilitant and informal caregiver, staff aspects, environmental aspects, and exercise and peer support. (6-10) This conceptualization was the basis for developing a self-evaluation tool for CRE (‘the CREATE-tool’), which can help rehabilitation wards to improve CRE. Self-evaluation is a powerful instrument that uses the knowledge and experience of the professionals to assess the level of compliance with a concept. Moreover, it generates feedback for the organization, ward or team. In the literature, self-evaluation or self-assessment is defined as: “a comprehensive, systematic and regular review of an organisation’s activities and results. The self-evaluation process allows the organisation to discern clearly its strengths and areas in which improvements can be made. Also, improvement actions can be monitored for progress.” (11-13) 6
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