title: Effectively working on rehabilitation goals: 24-month outcome of a randomized controlled trial of the Boston psychiatric rehabilitation approach.
abstract: OBJECTIVE
  To investigate the effect of the Boston Psychiatric Rehabilitation (PR) Approach on attainment of personal rehabilitation goals, social functioning, empowerment, needs for care, and quality of life in people with severe mental illness (SMI) in the Netherlands.
  
  
  METHODS
  A 24-month, multicentre, randomized controlled trial was used to compare the results of PR to care as usual (CAU). Patients with SMI were randomly assigned by a central randomization centre to PR (n = 80) or CAU (n = 76). The primary outcome of goal attainment was assessed by independent raters blind to treatment allocation. Measures for secondary outcomes were change in work situation and independent living, the Personal Empowerment Scale, the Camberwell Assessment of Needs, and the World Health Organization Quality of Life assessment. Effects were tested at 12 and 24 months. Data were analyzed according to intention to treat. Covariates were psychiatric centre, psychopathology, number of care contacts, and educational level of the professionals involved.
  
  
  RESULTS
  The rate of goal attainment was substantially higher in PR at 24 months (adjusted risk difference: 21%, 95% CI 4% to 38%; number needed to treat [NNT] = 5). The approach was also more effective in the area of societal participation (PR: 21% adjusted increase, CAU: 0% adjusted increase; NNT = 5) but not in the other secondary outcome measures.
  
  
  CONCLUSIONS
  The results suggest that PR is effective in supporting patients with SMI to reach self-formulated rehabilitation goals and in enhancing societal participation, although no effects were found on the measures of functioning, need for care, and quality of life.
authors.affiliation: Senior Researcher, Altrecht Mental Health Care, Utrecht, the Netherlands.
authors.forename: Wilma
authors.initials: W
authors.lastname: Swildens
authors.forename: Jooske T
authors.initials: JT
authors.lastname: van Busschbach
authors.forename: Harry
authors.initials: H
authors.lastname: Michon
authors.forename: Hans
authors.initials: H
authors.lastname: Kroon
authors.forename: Maarten W J
authors.initials: MW
authors.lastname: Koeter
authors.forename: Durk
authors.initials: D
authors.lastname: Wiersma
authors.forename: Jim
authors.initials: J
authors.lastname: van Os
mesh_terms: D000328:Adult; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation*; D008875:Middle Aged; D009426:Netherlands; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D011788:Quality of Life; D012050:Rehabilitation, Vocational / Q000523:psychology*; D012720:Severity of Illness Index; D016037:Single-Blind Method; D058992:Social Participation; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult