CRediT contribution statement
Louise Allan (https://orcid.org/0000-0002-8912-4901): Conceptualisation (lead), Funding acquisition, Methodology, Supervision, Writing – original draft.
Jinpil Um (https://orcid.org/0000-0002-6314-0508): Conceptualisation, Project administration, Resources, Writing – original draft.
Abby O’Connell (https://orcid.org/0000-0001-7598-927X): Conceptualisation, Data curation, Investigation, Methodology, Project administration, Resources, Writing – reviewing and editing.
Shruti Raghuraman (https://orcid.org/0000-0002-7366-1147): Conceptualisation, Data curation, Formal analysis, Investigation, Methodology, Validation, Visualisation, Writing – original draft.
Alison Bingham (https://orcid.org/0009-0004-3305-8724): Formal analysis, Investigation, Resources, Supervision, Writing – reviewing and editing.
Abigail Laverick (https://orcid.org/0009-0002-8937-5556): Formal analysis, Investigation, Resources, Supervision, Writing – reviewing and editing.
Kirstie Chandler (https://orcid.org/0009-0003-3043-5160): Formal analysis, Investigation, Resources, Supervision, Writing – reviewing and editing.
James Connors (https://orcid.org/0009-0002-4312-9499): Data curation, Formal analysis, Methodology, Validation, Writing – original draft.
Sarah Morgan-Trimmer (https://orcid.org/0000-0001-5226-9595): Conceptualisation, Formal analysis, Funding acquisition, Methodology, Supervision, Writing – reviewing and editing.
Rowan H Harwood (https://orcid.org/0000-0002-4920-6718): Conceptualisation, Funding acquisition, Methodology, Writing – reviewing and editing.
Victoria A Goodwin (https://orcid.org/0000-0003-3860-9607): Conceptualisation, Funding acquisition, Methodology, Supervision, Writing – reviewing and editing.
Obioha C Ukoumunne (https://orcid.org/0000-0002-0551-9157): Conceptualisation, Formal analysis, Funding acquisition, Methodology, Supervision, Writing – reviewing and editing.
Annie Hawton (https://orcid.org/0000-0002-1336-5899): Conceptualisation, Formal analysis, Funding acquisition, Methodology, Supervision, Writing – reviewing and editing.
Elizabeth Goodwin (https://orcid.org/0000-0003-1351-9170): Data curation, Formal analysis, Methodology, Validation, Writing – original draft.
Rob Anderson (https://orcid.org/0000-0002-3523-8559): Conceptualisation, Funding acquisition, Methodology, Writing – reviewing and editing.
Thomas Jackson (https://orcid.org/0000-0001-6320-9600): Conceptualisation, Funding acquisition, Methodology, Writing – reviewing and editing.
Alasdair MJ MacLullich (https://orcid.org/0000-0003-3159-9370): Conceptualisation, Funding acquisition, Methodology, Writing – reviewing and editing.
Sarah Richardson (https://orcid.org/0000-0002-5771-1845): Conceptualisation, Funding acquisition, Methodology, Writing – reviewing and editing.
Daniel Davis (https://orcid.org/0000-0002-1560-1955): Conceptualisation, Funding acquisition, Methodology, Writing – reviewing and editing.
Lesley Collier (https://orcid.org/0000-0002-3788-3420): Conceptualisation, Funding acquisition, Methodology, Supervision, Writing – reviewing and editing.
W David Strain (https://orcid.org/0000-0002-6826-418X): Conceptualisation, Funding acquisition, Methodology, Writing – reviewing and editing.
Rachael Litherland (https://orcid.org/0009-0003-9747-6207): Conceptualisation, Funding acquisition, Methodology, Writing – reviewing and editing.
Jon Glasby (https://orcid.org/0000-0003-3960-7988): Conceptualisation, Funding acquisition, Methodology, Writing – reviewing and editing.
Aseel Mahmood (https://orcid.org/0000-0001-6332-8239): Data curation, Formal analysis, Investigation, Methodology, Validation, Writing – reviewing and editing.
Bethany Whale (https://orcid.org/0009-0002-3502-5200): Data curation, Investigation, Project administration, Writing – reviewing and editing.
Phoebe Dawe (https://orcid.org/0009-0001-0307-1571): Data curation, Investigation, Project administration, Writing – reviewing and editing.
Naomi Burnett-Fry (https://orcid.org/0009-0006-1618-8222): Data curation, Investigation, Project administration, Writing – reviewing and editing.
Linda Clare (https://orcid.org/0000-0003-3989-5318): Conceptualisation, Funding acquisition, Methodology, Supervision, Writing – original draft.
Acknowledgements
We would like to express our sincere gratitude to all the patients and carers who took part in the intervention. We also wish to thank the stakeholders and members of the Public and Patient Involvement and Engagement (PPIE) group for their valuable input throughout the research process. Their insights helped shape the study and ensured its relevance and impact. We are also grateful to the NIHR Applied Research Collaboration South West Peninsula (PenARC), the NIHR Exeter Biomedical Research Centre and the Exeter Clinical Trials Unit for their support.
Patient data statement
This work uses data provided by patients and collected by the NHS as part of their care and support. Using patient data is vital to improve health and care for everyone. There is huge potential to make better use of information from people’s patient records, to understand more about disease, develop new treatments, monitor safety and plan NHS services. Patient data should be kept safe and secure, to protect everyone’s privacy, and it is important that there are safeguards to make sure that they are stored and used responsibly. Everyone should be able to find out about how patient data are used #datasaveslives. You can find out more about the background to this citation here: https://understandingpatientdata.org.uk/data-citation.
Data-sharing statement
All data requests should be submitted to the corresponding author for consideration. Access to anonymised data may be granted following review.
Ethics statement
This feasibility study has been approved by the London–South East Research Ethics Committee (IRAS ID: 302675) on 24 October 2022 and Scotland A Research Ethics Committee (IRAS ID 319555) on 28 October 2022. Participants provided written informed consent prior to participating in this research.
Information governance statement
The University of Exeter is committed to handling all personal information in line with the UK Data Protection Act (2018) and the General Data Protection Regulation (EU GDPR) 2016/679. Under the Data Protection legislation, University of Exeter is the Data Controller, and you can find out more about how we handle personal data, including how to exercise your individual rights and the contact details for the University of Exeter Data Protection Officer, by contacting: dataprotection@exeter.ac.uk.
Disclosure of interests
Full disclosure of interests: Completed ICMJE forms for all authors, including all related interests, are available in the toolkit on the NIHR Journals Library report publication page at https://doi.org/10.3310/GJLA2006.
Primary conflicts of interest: Louise Allan has received funding from the following grants and contracts:
Taylor et al.: Lewy Body Dementia Doctoral Training Network (LBD-DTN), Alzheimer’s Society (£3,172,928.66, 2025–34).
Fox et al.: Sustainable Prevention Innovation and Involvement Dementia Network + (SPIN-D), ESRC-NIHR-Alzheimer’s Society (£1,173,592.31, 2024–8).
Corbett et al.: Clinical Validation and Commercialisation of the ReaCTIVE App for Early Cognitive Impairment, NIHR Invention for Innovation Programme (£1,948,424.00, 2023–8).
Costafreda et al.: TailorEd Intervention for Brain Health and Cognitive Enrichment (ENHANCE), NIHR Programme Grant (£2,458,685, 2023–9).
Fox et al.: Social Prescribing for People to Live Enjoyably with Dementia/Memory Problems in Daily Life (SPLENDID), NIHR Programme Grant (£2,687,230, 2022–7).
Allan et al.: Maintaining Independence in People with Dementia Who Have Had a Fall (Maintain Study), Alzheimer’s Society Project Grant (£353,693.00, 2022–4).
Frayling et al.: Genetic Evaluation of Multimorbidity Towards Individualisation of Interventions (GEMINI), MRC (£3,072,338, 2021–5).
Fox et al.: The Clinical, Social, and Cost Effectiveness of a Decision Support Tool for Optimising Tailored Management of Sleep (TIMES), NIHR Programme Grant (£1,998,663.00, 2021–6)
She has received consulting fees from the National Institute for Health and Clinical Excellence (NICE) and has received payment for lectures and presentations from the British Association of Psychopharmacology. She also serves on the Advisory Board for Pendlebury et al.’s NIHR i4i Study Orchard.
Rowan H Harwood reported receiving research funding and fellowships from several organisations: one grant and three PhD fellowships from the Alzheimer’s Society; a research grant from the German Federal Joint Committee Innovations Fund; four research grants from the NIHR; and one PhD fellowship from the British Geriatrics Society/Dunhill Medical Trust. He has provided expert testimony for Kent Police (Operation Magenta) and has authored various medico-legal reports unrelated to this publication. He holds or has held leadership and fiduciary roles including Chair of the WHO Technical Advisory Group (TAG) for measuring healthy ageing (unpaid), ex-member of the NIHR HTA PCCPI Panel (unpaid), and Editor-in-Chief, now Chair, of Age and Ageing, for which he is remunerated by the British Geriatrics Society.
Sarah Richardson holds a National Institute for Health and Care Research (NIHR) Clinical Lectureship, funded by Health Education England (HEE)/NIHR, and is supported by the NIHR Newcastle Biomedical Research Centre (reference: NIHR203309).
Victoria A Goodwin has received funding from the NIHR, Alzheimer’s Society, Chartered Society of Physiotherapy and the Vivensa Foundation. She holds a NIHR Senior Investigator award. She has received travel expenses for speaking at conferences from the professional organisations hosting the events. She was a member of the Data Monitoring and Ethics Committee (DMEC) for the Home Health Trial. She also holds or has held leadership roles in the following NIHR panels and committees: NIHR HTA General Committee (2023–present), NIHR Academy Doctoral Support and Enhancement (DSE) Panel (2020–3) and NIHR Senior Investigator Panel (2024–present).
Elizabeth Goodwin has received funding from the National Institute for Health and Care Research (NIHR) for an unrelated study through the NIHR Health Technology Assessment programme (Funder reference: NIHR160348). Payment was made to University of Exeter.
W David Strain reported receiving a UKRI Fellowship as the Parliamentary Thematic Research Lead for Health. Additionally, WDS has received research funding from Gilead Pharmaceuticals for work on the use of Remdesivir in the management of Long COVID. He has received payments for lectures and educational events from several pharmaceutical companies: a lecture for Biocon Pharmaceuticals, two lectures for AstraZeneca and served as Course Director for a COVID-19 programme funded by Pfizer. He has also served on the Data Safety Monitoring Board for an NIHR-funded Long COVID study.
Jon Glasby holds current grants from the Economic and Social Research Council (ESRC)/Health Foundation and the National Institute for Health and Care Research (NIHR). He also undertakes applied service evaluations for health and social care services across the public and voluntary sectors. He is the Director of IMPACT, the UK centre for implementing evidence in adult social care. He sits on various advisory boards related to social care policy and academic research studies; however, none present a direct conflict with this study or report. He is a Non-Executive Director (NED) of an NHS Trust and of a local authority Children’s Trust. He is also a former NED of one of the Trusts involved in the present study. Additionally, he is a Fellow of the Academy of Social Sciences and a Senior Fellow of the NIHR School for Social Care Research. He chairs the NIHR Doctoral Local Authority Fellowship (DLAF) panel.
Linda Clare is a National Institute for Health and Care Research (NIHR) Senior Investigator (personal award, from 1 April 2025) and is supported through institutional awards from the NIHR Policy Research Unit in Dementia and Neurodegeneration at the University of Exeter (from 1 January 2024) and the NIHR Applied Research Collaboration South-West Peninsula (since 2019). She is also a member of the NIHR Research Programme in Social Care Committee and the NIHR Dementia Strategy Group.
The other authors have no other potential conflicts of interest to disclose.
Copyright and credit statement
Every effort has been made to obtain the necessary permissions for reproduction, to credit original sources appropriately and to respect copyright requirements. However, despite our diligence, we acknowledge the possibility of unintentional omissions or errors and we welcome notifications of any concerns regarding copyright or permissions.
Publications
Peer-reviewed journal articles
Allan L, O’Connell A, Raghuraman S, Bingham A, Laverick A, Chandler K, et al. A rehabilitation intervention to improve recovery after an episode of delirium in adults over 65 years (RecoverED): study protocol for a multi-centre, single-arm feasibility study. Pilot Feasibility Stud 2023;9:162. https://doi.org/10.1186/s40814-023-01387-y
Mahmoud A, Raghuraman S, Richards E, Morgan-Trimmer S, Goodwin VA, Anderson R, et al. Experience of carers for older people with delirium: a qualitative study. Aging Mental Health 2025;29:881–8. https://doi.org/10.1080/13607863.2024.2430526
Allan LM, O’Connell A, Harwood RH, Bingham A, Laverick A, Chandler K, et al. The challenges of rehabilitation and delirium trials in the current NHS landscape: learning from the RecoverED feasibility trial. Age Ageing 2025;54:afaf196. https://doi.org/10.1093/ageing/afaf196
Raghuraman S, Richards E, Mahmood A, Morgan-Trimmer S, Clare L, Anderson R, et al. Understanding rehabilitation and support needs after an episode of delirium: a qualitative thematic analysis of interviews with older people with delirium, family carers and healthcare professionals. BMC Geriatr 2025;25:547. https://doi.org/10.1186/s12877-025-06196-x
Bingham A, Laverick A, Chandler K, Raghuraman S, Goodwin V, Morgan-Trimmer S, et al. The design and development of a home-based rehabilitation programme for those recovering after an episode of delirium. BMC Health Serv Res 2025;25:1464. https://doi.org/10.1186/s12913-025-13614-8
Papers in press
Raghuraman S, Mahmoud A, Bingham A, Laverick A, Chandler K, O’Connell A, et al. A rehabilitation intervention to improve recovery after delirium in older people: mixed methods process evaluation of the RecoverED multi-site feasibility study. BMC Geriatrics 2026; in press.
Allan L, Um J, O’Connell A, Raghuraman S, Bingham A, Laverick A, et al.; on behalf of the RecoverED Team. A rehabilitation intervention to improve Recovery after an Episode of Delirium in adults over 65 years (RecoverED): a multi-centre, single arm feasibility study. BMJ Open 2026; in press.
Developing a programme theory of a complex, home-based rehabilitation intervention for recovery after an episode of delirium. PLOS ONE 2026; in press.
Oral presentations
British Geriatrics Society Spring Meeting 2024. Reflections on implementing RecoverED: facilitation strategies and support.
European Delirium Association Conference 2024. Understanding the rehabilitation and support needs after an episode of delirium: a realist analysis of interviews with older people with delirium, carers and healthcare professionals.
British Geriatrics Society Spring Meeting 2025. A rehabilitation intervention to improve recovery after an episode of delirium in adults over 65 years (RecoverED).
British Geriatrics Society Spring Meeting 2025. Rehabilitation after an episode of delirium: mixed methods process evaluation of the RecoverED multi-site feasibility study.
Posters
British Geriatrics Society Autumn Meeting 2022. Using realist programme theory to design a new intervention for improving recovery after delirium.
European Delirium Association Conference 2022. Using realist programme theory to design a new intervention for improving recovery after delirium.
British Geriatrics Society Spring Meeting 2024. Experience of family caregivers for older patients with delirium: a qualitative study.
British Geriatrics Society Spring Meeting 2024. The need for delirium education and psychosocial care after discharge: a realist analysis of interviews with key stakeholders.
International Clinical Trials Methodology Conference (ICTMC) 2024. Challenges with identifying NHS occupational therapy and physiotherapy staff for the RecoverED and Maintain complex intervention studies.
Alzheimer’s Association International Conference 2025. A rehabilitation intervention to improve Recovery after an Episode of Delirium in adults over 65 years (RecoverED): a multi-centre, single arm feasibility study.
Alzheimer’s Association International Conference 2025. A rehabilitation intervention to improve recovery after delirium in older people: mixed methods process evaluation of the RecoverED multi-site feasibility study.
Disclaimers
This article presents independent research funded by the National Institute for Health and Care Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, CCF, PGfAR or the Department of Health and Social Care. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, the PGfAR programme or the Department of Health and Social Care.