155 The CREATE-tool: A self-evaluation tool for a Challenging Rehabilitation Environment The CREATE-tool and current study focused on the perspectives of professionals regarding CRE on their rehabilitation ward, and rehabilitants and informal caregivers were therefore not part of the study. A recent scoping review by Lubbe et al. revealed that including the perspectives of rehabilitants on the rehabilitation process is important for improving the effectiveness of the rehabilitation. (18) In addition, the tool tested in this study also states that rehabilitants and informal caregivers must be part of the rehabilitation team, and their perspectives were included in the development of the current tool. (10) Therefore, it is advisable to develop a method for rehabilitants and informal caregivers to assess CRE, in addition to or concurrently with the CREATE-tool. In this way a CRE on a rehabilitation ward can be a co-creation between rehabilitants, informal caregivers, and professionals. Limitations Not all participants were aware of the short descriptions provided for each statement, which resulted in different interpretations by participants. If the CREATE-tool is implemented, a clear interface must be provided so that participants automatically see the short description of the statements. Some participants mentioned that due to their professional role, they were not involved in all aspects of the rehabilitation process, making it difficult for them to answer all questions. This resulted in them estimating some answers, which may lead to differences within the team. For future use of the CREATE-tool, we recommend adding an answer category “I don’t know”. At the start of the team meeting the participants received the statement level team results, visualized with the median and range. The range of answers at the statement level was very broad, which hampered the discussion, especially because some participants had difficulties answering some questions, which led to more unclear answers. For further use of the CREATE-tool, we therefore advise to visualize the team results using the mean and IQR. Strengths One of the strengths of this study is the diversity of participants’ professional backgrounds. The participants represented all relevant professionals in geriatric 6
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