Table 2.

Themes Involving Rehabilitation Process.

Main theme	Brief description	Subtheme	Description
Rehabilitant	CRE is suitable for all diagnosis groups. Attention must be given to resilience, motivation, and cognitive and emotional aspects of rehabilitants.	Resilience	The resilience of rehabilitants can vary and may differ from prediagnosis. Rehabilitants would like guidance on how to deal with this, as they often tend to go beyond their limits.
		Motivation	Participants think being motivated for rehabilitation is important. Motivation differs per rehabilitant. Working on individual rehabilitation goals, the strong involvement of professionals and the use of technologies can be motivating.
		Cognitive and emotional aspects	Rehabilitants feel frustrated when dependent on professionals and informal caregivers. Especially in the case of neurological diagnoses, rehabilitants do not always feel others empathize with what they are going through. They would like more consideration for and better explanation of their problems, for themselves and also for their caregivers. These problems include, for example, altered stimulus processing, overburden, a decline of executive functions, dealing with emotions, loss of memory, and loss of initiative.
		Diagnosis	CRE is suitable for all diagnoses. Although rehabilitants appreciate having rehabilitants with similar diagnoses on the ward, they do not consider complete differentiation based on diagnosis necessary.
Rehabilitant-centered process	The rehabilitation process should be tailored to a rehabilitants situation. This includes the goal-setting process, the level of physical and cognitive functioning, and coping with the life event for which they are rehabilitating.	Goal setting	Rehabilitation goals must fit seamlessly with the rehabilitants’ situation. Although rehabilitants think that working on their individual goals is motivating, they do not always feel involved in the goal-setting process. Some rehabilitants may not be able to set individual goals at the start of their rehabilitation and most of them value the opinion of the professionals. Participants agree that some goals are better achieved at home, not during inpatient rehabilitation.
		Tailor-made rehabilitation	Rehabilitation must be tailored to the rehabilitant's abilities. This tailoring depends on several factors, which sometimes also existed before rehabilitation, for example, the level of physical and cognitive functioning. Rehabilitants with the ability to manage the intensity and planning of the rehabilitation valued this positively.
		Coping with a life event	The coping process, which can be compared to a grieving process, can influence goal setting and continues after discharge. Rehabilitants and their caregivers must regain confidence in themselves. Contact with fellow rehabilitants and guidance from professionals, for example, a psychologist, can help with coping.
Informal caregivers	Informal caregivers should be involved in the rehabilitation process with attention to their resilience and the relation between the rehabilitant and informal caregiver.	Informal caregiver participation	Informal caregiver participation can have a beneficial effect because caregivers learn what to do at home. But it can also be inhibiting if the caregiver does not trust the rehabilitant. Attention to the resilience of the caregiver is important, and they must be continuously involved in the rehabilitation process. Informal caregivers value doing extra exercises with the rehabilitant and, if needed, are part of the conversation regarding the rehabilitation process.
		Dynamic between rehabilitant and informal caregiver	The role of the caregiver during rehabilitation can depend on the relationship with the rehabilitant. A partner may have a more natural role than another informal caregiver, such as a child. Caregivers consider it quite normal to do extra things for their spouse. However, it is important that the relationship does not become a care relationship only.
Communication	Communication is important for aligning the rehabilitation process between all involved in the process.		Adequate communication is important for building a treatment relationship, providing mutually relevant information about the disease, aligning goals, communicating exercise options, preparation for the discharge process and the coping process. Participants value reading the reports and the goals in the patient files. Special attention is needed if the rehabilitant cannot oversee his rehabilitation process, for instance, due to cognitive impairment, or if the caregiver is unable to come to the ward due to circumstances like COVID-19. Repeating the information is an important aspect.
Exercise	Exercise intensity in a CRE should be as high as possible. This can be achieved by integrating task-oriented exercises, patient-regulated exercises, and group training into the daily structure.	Therapeutic activity	Although the therapeutic activity varies, most participants indicate they would like to see a higher therapy intensity, with guidance to help avoid overburdening. Participants see a role for informal caregivers and nurses to stimulate extra therapeutic activity.
		Group training	Rehabilitants who had experienced it are very positive about group training and find it motivating and helpful to learn from each other. Those without experience in group training cannot imagine how it can be tailored to a rehabilitant's individual goals and situation. They expect it to be less intensive than individual training.
		Task-oriented exercise	Rehabilitants think doing task-oriented exercises, matching their goals and level of functioning, is important. Nurses can be supportive in task-oriented exercises. Rehabilitants want to be independent and need professionals to guide them in safe independent practice training during their daily routine.
		Patient-regulated exercise	Rehabilitants do think patient-regulated exercise is important to increase the therapy intensity, but they need guidance. Exercises need to fit rehabilitant needs, and follow-up by professionals is desired. Rehabilitants have concerns regarding overburden, practicing at insufficient intensity, and safety when training individually in therapy rooms without supervision.
Peer support	Peer support is important for learning experiences, putting things in perspective, and recognition.		Most rehabilitants think peer support is important for support, putting things in perspective, and recognition. They feel that they are not alone with these problems. Rehabilitants can learn from each other and practicing together can be motivating. Rehabilitants can have a positive or negative effect on the group dynamic.
Daily schedule	Rehabilitants want to have input in the therapy planning and would value activities outside therapy moments.	Planning	Rehabilitants prefer a therapy planning in which they have input, such as in terms of intensity, therapy moments should be spread throughout the day. This planning can help them to plan visits and avoid distractions during therapy moments.
		Activities during the day	Besides the therapy moments, participants experience a limited number of activities, which does not stimulate a sense of active rehabilitation. As rehabilitants are not always able to start an activity themselves, they would value (therapeutic) activities outside therapy moments. They also have a need to continue social activities as usual.
Nutrition	Nutrition gives energy for the rehabilitation process, and mealtimes can stimulate contact between rehabilitants.		Good and tasty nutrition is one of the first aspects participants mention as being important during rehabilitation. Nutrition gives energy to the rehabilitation process. If compatible with their goal, rehabilitants think that mealtimes can play a role in task-oriented training. A pleasant mealtime with interaction stimulates contact between rehabilitants and makes rehabilitants feel less lonely.
eHealth	eHealth can make rehabilitation more fun and challenging.		Participants’ opinions on eHealth differ regarding their use of it. They may not be using it yet but expect that it will be important for future generations. The use of eHealth must suit the person. eHealth can make the rehabilitation process more fun and can stimulate exercise. It offers communication options in case of aphasia and when used properly, technologies can increase safety, for example in the home situation.

Abbreviation: CRE, Challenging Rehabilitation Environment.