34 Chapter 2 Discussion Until now, no scientific vision is available regarding a CRE. This review provides, for the first time, a description of a CRE and the topics that can be identified for modelling a CRE. After examining the relevant literature, seven main topics were identified: 1) therapy time, 2) group training, 3) patient-regulated exercise, 4) family participation, 5) task-oriented training, 6) enriched environment, and 7) team dynamics. All studies included in this review, regarding therapy time during inpatient rehabilitation, agreed on a low level of activity of patients. Differences in the precise level of activity could be explained by the way in which the activities were perceived or were concluded to be therapeutic, ie, eating/drinking, transport/traveling, ADL, and communication. Other possible explanations were differences in the amount of group therapy, patient-regulated exercise, and family participation. Furthermore, the studies agreed on the importance of activity and increased therapy time for better rehabilitation outcomes for all diagnostic groups.13-32 The challenge is to increase therapy time; however, in most countries, no increase in revenue or numbers of staff can be expected. Some studies presented ideas to meet this challenge, eg group therapy, independent practice, family participation and task-specific training during ADL.13,14,25-30 Since these factors are important in a rehabilitation program, they are also important topics for modeling CRE. Group therapy can be used for multiple goals in multiple diagnostic groups and is an effective way to increase therapy time without increasing staff levels. Although not all studies compared group therapy and individual therapy, all reported a positive effect of group therapy on rehabilitation goals. Studies comparing these two forms of therapy reported at least an equal effect of group therapy compared to individual therapy.34-39 Therefore, group therapy is an effective way to increase therapy activity and can be used during rehabilitation to work on patient goals. It may enhance rehabilitation outcomes and have a beneficial effect on the length of stay in a rehabilitation facility. Staff needs to be encouraged to let group therapy be part of their treatment options.
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