Department Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
Oktober , Bladel, The Netherlands.
Clin Interv Aging. 2019 Aug 12;14:1451-1460. doi: 10.2147/CIA.S207863. eCollection 2019.
After hospitalization, 11% of the older patients are referred to rehabilitation facilities. Nowadays, there is a trend to formalize the rehabilitation process for these patients in a Challenging Rehabilitation Environment (CRE). This concept involves the comprehensive organization of care, support and the environment on a rehabilitation ward. However, since literature on the principles of CRE is scarce, this review aimed to explore and describe the principles of CRE.
A search was made in PubMed for relevant literature concerning CRE. Then, articles were hand searched for relevant keywords (ie, task-oriented training, therapy intensity, patient-led therapy, group training), references were identified, and topics categorized.
After evaluating 51 articles, 7 main topics of CRE were identified: 1) Therapy time; ie, the level of (physical) activity; the intensity of therapy and activity is related to rehabilitation outcomes, 2) group training; used to increase practice time and can be used to achieve multiple goals (eg, activities of daily living, mobility), 3) patient-regulated exercise; increases the level of self-management and practice time, 4) family participation; may lead to increased practice time and have a positive effect on rehabilitation outcomes, 5) task-oriented training; in addition to therapy, nurses can stimulate rehabilitants to perform meaningful tasks that improve functional outcomes, 6) enriched environment; this challenges rehabilitants to be active in social and physical activities, and 7) team dynamics; shared goals during rehabilitation and good communication in a transdisciplinary team improve the quality of rehabilitation.
This is the first description of CRE based on literature; however, the included studies discussed rehabilitation mainly after stroke and for few other diagnostic groups.
Seven main topics related to CRE were identified that may help patients to improve their rehabilitation outcomes. Further research on the concept and effectivity of CRE is necessary.
住院后，11%的老年患者会被转介到康复机构。如今，有一种趋势是在具有挑战性的康复环境（CRE）中为这些患者正式制定康复流程。这一概念涉及在康复病房中全面组织护理、支持和环境。然而，由于关于 CRE 原则的文献很少，因此本综述旨在探讨和描述 CRE 的原则。
在 PubMed 上搜索有关 CRE 的相关文献。然后，手工搜索相关关键词（即任务导向训练、治疗强度、患者主导的治疗、小组训练）的文章，识别参考文献，并对主题进行分类。
在评估了 51 篇文章后，确定了 CRE 的 7 个主要主题：1）治疗时间；即（身体）活动水平；治疗和活动的强度与康复结果相关，2）小组训练；用于增加练习时间，并可用于实现多个目标（例如，日常生活活动、移动能力），3）患者调节的运动；增加自我管理水平和练习时间，4）家庭参与；可能会增加练习时间，并对康复结果产生积极影响，5）任务导向训练；除了治疗，护士还可以刺激康复者进行有意义的任务，从而提高功能结果，6）丰富的环境；这促使康复者积极参与社交和身体活动，7）团队动态；康复期间的共同目标以及跨学科团队中的良好沟通，提高了康复质量。
这是基于文献对 CRE 的首次描述；然而，纳入的研究主要讨论了中风后和其他少数诊断组的康复。
确定了与 CRE 相关的 7 个主要主题，这些主题可能有助于患者改善康复结果。需要进一步研究 CRE 的概念和有效性。
