Dear Dr. Raghuraman,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
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We look forward to receiving your revised manuscript.

Kind regards,

Tim Luckett

Academic Editor

PLOS ONE

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2. Please describe in your methods section how capacity to provide consent was determined for the participants in this study. Please also state whether your ethics committee or IRB approved this consent procedure. If you did not assess capacity to consent please briefly outline why this was not necessary in this case.

3. In the ethics statement in the Methods, you have specified that verbal consent was obtained. Please provide additional details regarding how this consent was documented and witnessed, and state whether this was approved by the IRB.

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5. We noted in your submission details that a portion of your manuscript may have been presented or published elsewhere. Figure 2. Preliminary programme theory

Adapted from O’Rourke et al., 2020 (PMID: 32734773), representing Stage 1 of programme theory development. This initial framework was subsequently refined and expanded through the multi-stage process reported in the present study.

Please clarify whether this [conference proceeding or publication] was peer-reviewed and formally published. If this work was previously peer-reviewed and published, in the cover letter please provide the reason that this work does not constitute dual publication and should be included in the current manuscript.

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b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories. You also have the option of uploading the data as Supporting Information files, but we would recommend depositing data directly to a data repository if possible.

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8. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match.

When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section.

9. Thank you for stating the following financial disclosure:

This study is funded by a start-up grant from the University of Exeter and by the National Institute of Health and Care Research Programme Grants for Applied Research Programme (NIHR202338).

Professor Goodwin is a National Institute for Health and Care Research (NIHR) Senior Investigator. The views expressed in this article are those of the author(s) and not necessarily those of the NIHR, or the Department of Health and Social Care.

Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

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11. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: N/A

Reviewer #2: N/A

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3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #1: Yes

Reviewer #2: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Thank you for submitting your manuscript entitled ‘Developing a programme theory of a complex, home-based rehabilitation intervention for recovery after an episode of delirium’.

Your work is extremely important, and I read your manuscript with great interest. I really enjoyed the research and program journey that this manuscript details and explores. Your manuscripts provide valuable information to assist with knowledge translation and replication.

It is fantastic to see delirium recovery models of care being developed. I look forward to seeing further publications about RecoverED.

Overall comments:

Abstract is clear and succinct.

Introduction is also clear and succinct.

Your methods are well described. Figure 1 is great.

Phase 4: the research team consisted of a wide MDT; however, the voice of nursing was missing. Can you please clarify this?

Page 9: Who were the HCP participants? Suggest making this clearer. I think it is important to show that you captured all the voices of the MDT, including nursing. If you did not capture the voices of nursing staff, then I think this needs to be discussed as a limitation.

Results were clear and easy to follow. I think Figure 4 is brilliant. Figures 5 & 6 were both easy to follow and compliment the text.

I wonder if there were any negative attitudes towards delirium that need to be challenged/ addressed in order to make the program success? Did the education challenge attitudes?

I really enjoyed reading your discussion. I wonder how we can support people who do not have a carer?

Excellent conclusion.

Minor suggestions:

On page 7, please correct the error of the bracket in this sentence: ‘The aim was to generate a deeper understanding of contextual factors (context mapping; (10), identify unmet rehabilitation and support needs, and align conceptual gaps in community-based delirium care pathways to the context and desired outcomes.’ I think there is a bracket missing after ‘context mapping’?

Page 10: referencing error (Wong 2015).

Page 10: Can you please provide a reference for the process evaluation published elsewhere?

Figure 6: I am glad you changed to face-to-face interactive learning.

Reviewer #2: This paper has interesting and comprehensive methods and is well written and clearly reported. There is a clear description of who was involved in each stage. Interesting logic model of how the intervention is presumed to work produced.

I note that data will be made available upon request, rather than included in the manuscript.

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what does this mean? ). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our Privacy Policy .-->

Reviewer #1: No

Reviewer #2: No

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Developing a programme theory of a complex, home-based rehabilitation intervention for recovery after an episode of delirium

PONE-D-25-52519R1

Dear Dr. Raghuraman,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager®  and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact  and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support ..

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Tim Luckett

Academic Editor

PLOS One

Additional Editor Comments:

At the authors' discretion, I wonder whether it's more grammatically correct for the title to read "programme theory FOR" rather than "programme theory OF"? I note that, in the text, the authors refer to "programme theory underpinning" which would be another option to consider for the title.

Comments to the authors:

Reviewer #1: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

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3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: N/A

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4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #1: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

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Reviewer #1: Thank you for taking the time to review your manuscript and for addressing my comments.

I have no further comments or concerns.

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what does this mean? ). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our Privacy Policy .-->

Reviewer #1: Yes: Amy MontgomeryAmy Montgomery

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