Illness Management & Recovery (IMR) in the Netherlands; a naturalistic pilot study to explore the feasibility of a randomized controlled trial

Abstract

BackgroundIllness Management & Recovery (IMR) is a curriculum-based program for people with severe and persistent mental illness. To date, four randomized controlled trials (RCTs) have been published on it. As these produced mixed results, we conducted a pilot study to test the feasibility of conducting a new RCT in a Dutch psychiatric institute. Because our primary objective was to evaluate support for implementing IMR on a broader scale, we examined participant recruitment, client outcomes, and clients’ and clinicians’ satisfaction. Secondary objectives were to evaluate fidelity, trainers’ training and supervision, and to explore program duration, dropout, and client characteristics related to dropout. For reporting, we used the checklist for pilot studies adopted from the CONSORT Statement.MethodsThis program evaluation included a process-evaluation and an outcome evaluation with a One Group Pre-Posttest Design (N = 81). Interviews and internal reports were used to monitor participant numbers, program duration, dropout, and completers’ characteristics. Clients’ and clinicians’ satisfaction and provision of trainers’ training and supervision were assessed through interviews. Fidelity was assessed on the IMR Fidelity Scale; client outcomes were assessed on the IMR scale (client and clinician versions) and the Recovery Markers Questionnaire (RMQ).ResultsEighty-one participants were recruited of 167 people who were assessed for eligibility. Completers and clinicians were satisfied, and scores for completers improved significantly on the IMR scale (clinician version) (d = 0.84) and RMQ (d = 0.52), and not significantly on the IMR scale client version (d = 0.41). Mean fidelity was good, but three groups had only moderate fidelity. Our feasibility criterion for trainers’ education and supervision was partly attained. Dropout from treatment was 51 %; female participants and people who scored higher on both IMR-scales at baseline had a significantly lower chance of dropping out. The duration of IMR varied (M = 12.7 months, SD = 2.87).ConclusionsResults suggested that feasibility of conducting an RCT on IMR was good. Special attention is required to fidelity, IMR duration, trainers’ education and supervision, and dropout, especially of men. One study limitation was our inability to conduct follow-up measurements of non-completers.

Illness management and recovery: one-year follow-up of a randomized controlled trial in Danish community mental health centers: long-term effects on clinical and personal recovery

“…Currently, a Cochrane review of IMR is being conducted; a meta-analysis will be conducted as part of this review if the symptom data are adequate, which will provide a better understanding of the effect of IMR on symptoms [33]. Furthermore, after a Dutch feasibility study of the IMR program, the authors proceeded to a RCT; the results from this RCT will contribute to clarifying the effect of IMR on symptoms [34].…”

Clinical and brain structural effects of the Illness Management and Recovery program in middle‐aged and older patients with schizophrenia

“…Thus, 19 patients completed the IMR program. As in a previous study, we defined IMR program completion as attending ≥ 70% of the sessions in the program. These 19 patients were defined as the IMR group.…”

Psychometric properties of the Turkish version of Illness Management and Recovery Scale‐Patient form

“…Mental illnesses are characterized by impairments in various areas of functionality such as personal care, social relationships, family and environmental communication, professional life, and leisure activities 1,2 . Recovery occurs among individuals with mental disorders when they discover their strengths and abilities and determine their personal goals 3,4 …”

“…One program that has an evaluation scale is the Illness Management and Recovery (IMR) program, which focuses on managing the illness and recovery of individuals with mental disorders, preventing relapses, and achieving long‐term remission. The program, which requires the cooperation of healthcare professionals, the patient, and the patient's relatives, is an evidence‐based rehabilitation program that is carried out individually or in groups using structured, curriculum‐based psychosocial interventions 3,7,10‐12 …”

“…1,2 Recovery occurs among individuals with mental disorders when they discover their strengths and abilities and determine their personal goals. 3,4 Recovery refers not only to the disappearance of the symptoms but also to a process that involves developing personal and social skills and identifying the meaning of recovery for the individual, which typically includes hopefulness, having a say, self-acceptance, and collaboration with healthcare professionals. 5,6 It is important for patients to manage their illness in the recovery process because equipping patients with skills enables them to be more proactive, to control their illness, and to recover by advancing towards a more functional life.…”