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Lookup NU author(s): Dr Sarah Richardson
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2026 Raghuraman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background: Delirium in older adults is associated with persistent cognitive and functional decline, increased institutionalisation, and higher mortality. Evidence-based strategies to support recovery after hospitalisation remain limited. This paper outlines the development and refinement of the programme theory underpinning RecoverED, a novel, home-based, multicomponent rehabilitation intervention designed to support post-delirium recovery. Methods: We applied a realist-informed, multi-stage process to develop the RecoverED programme theory. This included a rapid realist review, qualitative interviews with older adults, carers, and healthcare professionals, an expert panel workshop, iterative programme theory meetings, and a process evaluation embedded within a single-arm feasibility trial. Data were synthesised into a logic model linking intervention components to hypothesised mechanisms and outcomes. Results: The programme theory outlines how cognitive and physical rehabilitation, psychosocial support, health monitoring, lifestyle guidance, and delirium education are expected to promote recovery. Cognitive activities aim to rebuild executive function and daily independence; physical rehabilitation maintains mobility; psychosocial support reduces anxiety and promotes confidence; health monitoring and lifestyle guidance address comorbidities; and delirium education supports sense-making. Key mechanisms include personalised goal-setting, continuity of professional support, and integration with community services. The process evaluation within the feasibility trial confirmed the relevance and acceptability of these pathways, while suggesting refinements to training, psychosocial strategies, and education delivery. Conclusion: This paper provides an empirically grounded framework detailing the development and refinement of a programme theory for post-delirium rehabilitation, illustrating the value of flexible, theory-driven approaches to guiding recovery.
Author(s): Raghuraman S, Morgan-Trimmer S, Anderson R, Goodwin VA, Clare L, Richards E, Bingham A, Goodwin E, Harwood R, Hawton A, Mahmoud A, Richardson SJ, Um J, Ukoumunne OC, Allan L
Publication type: Article
Publication status: Published
Journal: PLoS One
Year: 2026
Volume: 21
Issue: 3
Online publication date: 31/03/2026
Acceptance date: 19/01/2026
Date deposited: 13/04/2026
ISSN (electronic): 1932-6203
Publisher: Public Library of Science
URL: https://doi.org/10.1371/journal.pone.0342149
DOI: 10.1371/journal.pone.0342149
Data Access Statement: No new primary data were generated as part of this publication. The datasets underpinning the individual studies are available through their respective publications. The minimal dataset underlying the findings reported in this manuscript comprises anonymised qualitative interview excerpts (Phase 2) used to inform the analyses and conclusions presented. These coded interview extracts have been made publicly available via the institutional repository ORE (https://doi.org/10.24378/exe.31161238) with all potentially identifying information removed in accordance with ethical approvals and participant consent. Additional methodological detail required to interpret the data is provided within the paper.
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