24 Chapter 2 Rehabilitation of geriatric patients has a positive effect on outcomes for functioning, relative risk for nursing home admission, and relative risk for mortality.9 After rehabilitation in a Skilled Nursing Facility (SNF), on average 73% of the geriatric patients are discharged to their home situation. However, this percentage varies between diagnostic groups, where 63% of patients after stroke are able to go home compared to 81% of patients with a traumatic injury.10 Recently, one study investigated implementation of a structured program to increase activity for stroke survivors receiving inpatient rehabilitation.11 This program is similar to the rehabilitation programs on geriatric rehabilitation wards in SNFs in the Netherlands. In these SNFs the rehabilitation process is formalized in what is called a ‘Challenging Rehabilitation Environment’ (CRE). However, since there is no official definition of a CRE, there are considerable differences between the wards. CRE involves the comprehensive organization of care and support by the rehabilitation team, as well as the environment in which the rehabilitation takes place.12 However, because the above-mentioned program did not include the environment or team dynamics of the multidisciplinary team, it seems to be less specific than a CRE.11 This narrative review explores the evidence from relevant literature regarding topics related to a CRE with the aim to address the question: What is a challenging rehabilitation environment and which topics can be identified to help model such an environment? Method To answer the research question, a narrative review was performed. Therefore, a literature search was made in PubMed using combinations of the following terms: 1) rehabilitation, 2) multidisciplinary, 3) enriched environment, and 4) patient participation. After accepting a publication for inclusion in the present review, the list of keywords was searched for relevant keywords to supplement the literature search for this article; this led to the list of search terms presented in Table 1.
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