Rehabilitation workforce perspectives on strategies to improve adherence to physical rehabilitation in patients with delirium post-neurosurgery: a qualitative study

Abstract Delirium following neurosurgery is a frequent and complex condition associated with cognitive fluctuations, reduced engagement, and poor rehabilitation outcomes. Although early physical rehabilitation is recommended, sustaining adherence in individuals experiencing delirium remains challenging. Current evidence provides limited guidance on how rehabilitation professionals adapt their strategies to maintain participation. This study aims to explore the perspectives of the rehabilitation workforce on strategies used to improve adherence to physical rehabilitation among patients experiencing delirium after neurosurgery. A qualitative exploratory and descriptive study was conducted using individual semi-structured interviews carried out between May and July 2025. Audio-recorded interviews were transcribed verbatim and analysed using Braun and Clarke’s thematic analysis. Twenty-four rehabilitation professionals took part in the study, including rehabilitation nurses, physiotherapists, and physicians, all with experience in caring for post-neurosurgery patients with delirium. Eight interrelated themes were developed through the analytical process: Environmental Control, Creating a Therapeutic Relationship, Personalised Care, Motivation, Pain Management, Rehabilitation Techniques, Family Involvement, and Monitoring and Adjustment. Participants described adaptive, tailored approaches to support adherence, focusing on optimising the environment, regulating sensory input, validating emotions, simplifying communication, aligning goals with personal meaning, and providing positive reinforcement. Short, frequent sessions and continuous monitoring were emphasised as crucial for sustaining engagement amid cognitive fluctuations. The findings provide a practical framework for integrating tailored strategies into neurorehabilitation, highlighting teamwork, emotional validation, and flexible responses as central to sustaining engagement among patients experiencing post-neurosurgery delirium.