170 Chapter 7 Main research findings The five studies presented in this thesis have jointly resulted in a conceptualization of CRE and an associated tool that can help rehabilitation wards implement CRE. The framework of the studies and chapters in this thesis has led to this conceptualization being a combination of evidence-based, expert-based, and experience-based knowledge. The conceptualization of a challenging rehabilitation environment Chapter 2 describes a narrative review into relevant literature concerning CRE. After a PubMed search, 51 articles were included, leading to seven relevant topics for CRE. These topics considered: 1) therapy time, 2) group training, 3) patient-regulated exercise, 4) family participation, 5) task-oriented training, 6) enriched environment, and 7) team dynamics. Because CRE is a relatively new concept, there was a possibility that the above-mentioned review had not examined all aspects important to CRE. Therefore, two qualitative studies were performed. In chapter 3 a qualitative study into the perspectives of rehabilitants and informal caregivers regarding CRE is described. And chapter 4 describes a qualitative study into the perspectives of professionals. The participants of both studies confirmed the importance of the topics that had emerged in the narrative review, but they also mentioned new topics. A total of 15 rehabilitants, six informal caregivers, and 180 professionals participated in both studies. Participants in both studies were unanimous about the topics of interest to CRE, but the emphasis placed on the topics was different. As a result, the professionals’ analysis led to 11 themes and the analysis of the rehabilitants and informal caregivers to 13 themes. The topics identified in both studies concerned 1) rehabilitant, 2) goals, 3) involving informal caregivers, 4) exercise, 5) daily schedule, 6) nutrition, 7) eHealth, 8) environmental aspects, 9) staff aspects, 10) organizational aspects, and 11) return home. For rehabilitants and informal caregivers, communication and peer support were two separate themes, while for professionals these topics fell under involving informal caregivers and exercise respectively.
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