81 Professionals’ perspectives of a Challenging Rehabilitation Environment Introduction Rehabilitation involves the identification of a person’s problems, challenges, and needs. This leads to defining rehabilitation goals and subsequent interventions offered by a multidisciplinary team.1 Persons undergoing rehabilitation are trying to adapt and self-manage their current condition, and, in line with the ideas of Huber et al. on positive health, the term “rehabilitants” is therefore more appropriate than the term “patients”.2 A specific form of rehabilitation is geriatric rehabilitation (GR), which has recently been defined as ‘a multidimensional approach of diagnostic and therapeutic interventions, the purpose of which is to optimize functional capacity, promote activity and preserve functional reserve and social participation in older people with disabling impairments’.3 Rehabilitation for older people is even more challenging than for younger persons. With the ageing of the population, the demand for GR in Europe has increased.4 In 2019, 53,320 rehabilitants in the Netherlands were referred to GR.5 After hospitalization on an acute geriatric ward in Italy, 11% of patients aged ≥ 75 years were referred to a rehabilitation unit.6 Common reasons for hospitalization in older persons are cardiac events, infections, fall-related injuries, stroke, cancer, or medical/surgical interventions.7 In the Netherlands, there is a trend towards having the rehabilitation process take place within the context of a challenging rehabilitation environment (CRE). A CRE is a widely accepted practice-based innovation in the Netherlands.8-10 It is a unique concept which is positioned on the rehabilitation ward, covering all rehabilitation aspects that possibly influence rehabilitation outcomes. The concept involves the comprehensive organization of care and support by the rehabilitation team as well as the environment in which the rehabilitation takes place.8,11 In comparison to regular rehabilitation (with mostly mono-disciplinary goals and interventions), in a CRE, the rehabilitation interventions are integrated into all aspects of the day and daily life, and the rehabilitation process is offered in an interprofessional way, with team and rehabilitant goals and interventions.12 A review conducted by the authors initially identified seven main components for modelling CRE: (1) therapy time; (2) group training; (3) patient-regulated exercise; 4
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