172 Chapter 7 In chapter 6 the CREATE-tool was tested in 5 rehabilitation wards, that included 50 team members. It showed that the CREATE-tool could identify areas for improvement for rehabilitation wards, and to be a feasible methodology for the assessment of areas for improvement. Theoretical considerations Although the framework for the development of the conceptualization and the CREATE-tool included a literature search and several rounds of systematic stakeholder involvement sessions, there are some theoretical themes that have not been extensively included in the tool, and these should here be discussed. Neuropsychiatric symptoms During the rehabilitation, rehabilitants and informal caregivers must cope with the life event that was the indication for the rehabilitation. This indication can lead to neuropsychiatric symptoms, especially in neurological disorders such as stroke, or when the rehabilitant has a delirium. Examples of neuropsychiatric symptoms are altered stimulus processing, overburden, decline of executive functions, loss of memory, loss of initiative, and problems with dealing with emotions. Literature has shown that neuropsychiatric symptoms like depression, disinhibition and anxiety are highly prevalent in rehabilitants, and these symptoms are negatively associated with quality of life and home discharge after rehabilitation.5-9 In the qualitative study presented in chapter 3, rehabilitants and informal caregivers indicated that they experience a lack of attention for neuropsychiatric symptoms and the emotional aspects of the rehabilitation. These aspects were referred to a number of times in the conceptualization and the CREATE-tool, but this is only a small part of the tool and not always integrated into the whole process of rehabilitation. Therefore, there is a chance that these aspects will be overlooked, and professionals mainly focus on stimulating physical functioning during rehabilitation. Information about neuropsychiatric symptoms and their treatment may result in better rehabilitation outcomes.5-9 Therefore, it is important in a CRE to pay attention to all aspects of rehabilitation, including neuropsychiatric symptoms.
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