169 General discussion This thesis describes the results of the CREATE study (Challenging REhAbiliTation Environment). The overall aim of the CREATE study was to conceptualize a challenging rehabilitation environment, and to develop a tool to support rehabilitation wards in improving this. The CREATE study is the first study which positions the concept of a (socio) therapeutic climate in Geriatric Rehabilitation. A (socio)therapeutic climate is a well secured concept in psychiatry and this broad perspective on treatment has proven its added value in this field.1-3 The combination of the social, physical, and organizational environment is also used to achieve therapeutic goals in nursing home residents with dementia.4 These positive outcomes gave inspiration to apply the broad approach of a (socio)therapeutic climate in the rehabilitation of older persons as a challenging rehabilitation environment (CRE). The concept of CRE contains more than only the contact or therapy moments lead by therapists. Therefore, in this thesis the name “challenging rehabilitation environment” is used. As the concept describes a broad approach aimed at challenging rehabilitants to achieve optimal rehabilitation results, this name describes the concept best. To achieve the above-mentioned aim of this thesis, 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? In this final chapter of this thesis, the main research findings are presented and critically discussed. Hereafter, implications and recommendations for clinical practice, future research and education are presented. 7
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