Table 2.

Themes involving rehabilitation processes.

Main Theme	Brief Description	Sub-Theme	Description
Rehabilitant	CRE is suitable for all diagnosis groups. Attention to rehabilitants’ cognitive functioning and resilience and stimulating the self-reliance of rehabilitants are necessary.	Characteristics	Rehabilitants undergo rehabilitation for different diagnoses, e.g., in the fields of neurology, orthopedics, and trauma. They often have multiple diagnoses and are already experiencing a functional decline in the home situation. They are often not familiar with using technologies to perform exercises. Traditionally, rehabilitants and informal caregivers expect to be taken care of during their stay at the rehabilitation ward, and they do not expect to have to perform daily tasks themselves.
		Cognitive aspects	Often, rehabilitants suffer from cognitive problems or delirium. Besides already existing cognitive problems, cognition may decline as a result of the life event or diagnosis for which they are receiving rehabilitation. Neuropsychiatric symptoms such as depression or disrupted stimulus processing occur as a result of a neurological condition. It is important to be aware of these symptoms, as they can affect the rehabilitation process, but also acknowledge that this is an often underexposed and, as a result, under addressed aspect during rehabilitation. Adapting rehabilitation to the needs and learning style of the rehabilitant is important, and professionals must be aware that information and exercises must be offered in different ways.
		Resilience	Rehabilitants’ resilience is often low, especially at the beginning of the rehabilitation process. Rehabilitants and informal caregivers need to understand and learn to deal with this. For balance, it is important to create rest moments for rehabilitants, and therapies must be spread out over the whole week, not just provided during working hours. Participants acknowledge this but have difficulty determining how much rest a rehabilitant needs and how to best provide it.
		Self-reliance	Although all participants consider it important that rehabilitants have self-management abilities and take control of their rehabilitation, not all rehabilitants are able to do this from the start. To be able to take control, rehabilitants must know what the possibilities are and have the opportunity to practice on their own as well as carry out their own planning. Rehabilitants’ motivation can be improved if they know what is expected of them and what they are working for.
Goals	Individual goals are needed for the rehabilitation process in a CRE. Some rehabilitants need guidance in setting their goals. There is a desire for an appropriate set of measurement instruments for GR.	Goal setting	Shared goals for rehabilitation (rehabilitants, informal caregivers and professionals) are important. Not all rehabilitants are able to express their goals at the start, but with support from informal caregivers, relevant goals can usually be defined. Sometimes, their goals are unrealistic for their level of functioning. Goal setting in smaller steps, with good guidance and communication by the professionals and tailored to the rehabilitants’ needs, will improve the chances that rehabilitants will achieve their goals. One of the main goals of rehabilitants is to work on self-reliance and independence to practice what they need to be able to go home. In addition, professionals should be aware of possible cultural differences in the importance of goals.
		Learning new skills	There is a discussion on teaching rehabilitants new skills. Society increasingly demands digital skills. Although the participants think inpatient rehabilitation is a good moment to learn these new skills, they also admit that not all rehabilitants are willing to learn these skills and rarely succeed in reaching a higher level of independence than before.
		Observation and measuring	A wide range of measurement instruments indicate the level of function of a rehabilitant, although not many instruments are validated in the population in GR. Therefore, functional observation (live or by recording) is still often used. Participants long for a set of measurement instruments appropriate for the population, which can be used to motivate and inform the rehabilitant about their progress.
Exercise	Exercise intensity in a CRE is as high as possible. This can be achieved by integrating task-oriented exercises, patient-regulated exercises and group training into the daily structure.	Exercise intensity	Exercise intensity should be as high as possible on all days of the week, based on the rehabilitant’s ability. Currently, this intensity is often not high enough. Exercise intensity comprises all activities as part of the rehabilitation. Rehabilitants, informal caregivers and staff should be aware that it is not only the moments with a therapist that are important for the rehabilitation; they need to integrate training into their daily routine.
		Task-oriented exercises	Although you must sometimes start at the level of body functions, therapy in a rehabilitation setting aims at the participation level. Task-oriented exercise is in line with this. For example, tasks can be practiced in activities of daily living, at mealtimes and in hobbies. All staff must have the attitude and the time to stimulate rehabilitants to practice meaningful tasks, which are tailored to their home situation, throughout the day.
		Patient-regulated exercises	Patient-regulated exercises can increase exercise intensity and stimulate the rehabilitants’ independence and self-management during rehabilitation. Homework exercises can increase the amount of patient-regulated exercise and can affect how rehabilitants continue to perform exercises after discharge. To stimulate patient-regulated exercise, 24/7 access to training facilities is desirable and informal caregivers and staff should stimulate rehabilitants to practice, although independent exercise is often at a lower intensity than supervised training.
		Group training	Group training can be an effective way to increase exercise intensity, but it should be compatible with the goals of the rehabilitant. Training in groups stimulates contact with and learning from others, prevents loneliness, and stimulates rehabilitation. Therefore, it is important that staff members stimulate a positive group process on a rehabilitation ward.
Daily schedule	Within a CRE, the entire day the team needs to be focused on rehabilitation and activities. Exercise is adapted to the pace of the rehabilitant.	Daytime activities	A daily schedule that challenges rehabilitants to take initiative and increase their exercise intensity is desired. When rehabilitants are too passive between therapy moments, this can sometimes lead to cognitive decline. Recreational activities not focused on the rehabilitation goals can keep the rehabilitants motivated, for example, activities with a game element. It is recommended to allow visitors/guests, other than the informal caregivers (who can assist during rehabilitation), only during predefined visiting times.
		Planning	Some rehabilitation wards work with a day planning for the rehabilitants in which all therapies are planned. Some rehabilitants and informal caregivers appreciate this planning, but it often causes problems. Because of external factors, such as hospital visits, the planning needs to be quite flexible. Working without a therapy plan enables responding to the rhythm of the rehabilitant and promotes interdisciplinary cooperation. In addition, it is desirable to have walk-in moments for the therapy so that rehabilitants can take control of when they practice, if they are able to.
Involving client system	Good communication is necessary to involve informal caregivers in the rehabilitation process. They can help in the rehabilitation process, but they should be prevented for overburdening.	Informal caregiver participation	The informal caregivers and their abilities and perceived burden partly determine whether a rehabilitant can go home. They can provide information about the rehabilitant’s previous level of functioning and the goals for the rehabilitation. Although informal caregivers can be seen as fellow practitioners, who motivate and help during the rehabilitation process, staff must prevent overburdening them. Attention must also be paid to bereavement and the informal caregiver’s need for information. Participants would like to see informal caregivers perform tasks in supporting the rehabilitant during rehabilitation similar to what they will be doing at home.
		Communication	Communication is a key aspect in involving informal caregivers. Rehabilitants and informal caregivers need to be informed about the principles of a CRE so that they know how important it is to practice during daily activities and which extra exercises they can perform during the rehabilitation process. This information must be presented in a way suitable for the rehabilitant and informal caregiver. It is also important to give information about the disease for which they are undergoing rehabilitation and about the new skills they must learn.
Nutrition	Nutritional status partly determines the rehabilitation capability, therefore a balanced diet is necessary.		A rehabilitant’s nutritional status partly determines their rehabilitation capability. Rehabilitants are not always aware of this relationship and do not consume enough protein-rich foods. It is important to realize a balanced diet with products that are as common as possible, so rehabilitants will be able to continue the diet at home. Pleasant mealtimes stimulate good intake, and joint meals are therefore seen as standard. It is important to pay attention to the energy levels of a rehabilitant. Intake or swallowing can be negatively affected if a rehabilitant is too tired.
Technology	Technology develops very fast and contributes to safe and challenging rehabilitation.	Domotics	Domotics, e.g., systems to automatically measure body functions or fall signaling, can help to offer security, privacy, and night rest to rehabilitants and can also be time-saving for professionals. An important condition is that privacy is guaranteed and that the security of the system can also be guaranteed at home.
		eHealth	Although the use of eHealth is currently limited, it can be useful in the future as a supplement to exercising, monitoring, safety, and feedback options. Nowadays, many applications are not yet suitable for the target group or are not always applicable during functional activities. In addition, eHealth is developing very fast, making it difficult for healthcare professionals to keep abreast of all possibilities.