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


METHODS
This 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).


RESULTS
Eighty-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).


CONCLUSIONS
Results 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.
Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus University Medical Centre, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. b.roosenschoon@parnassiagroep.nl.|Parnassia Psychiatric Institute, Parnassia Academy, Kiwistraat 32, 2552, DH, Den Haag, The Netherlands. b.roosenschoon@parnassiagroep.nl.
Bert-Jan
http://orcid.org/0000-0002-4290-6789
BJ
Roosenschoon
Tilburg School of Social and Behavioral Sciences, Department of TRANZO, Tilburg University, Warandelaan 2, 5037, AB, Tilburg, The Netherlands.|Parnassia Psychiatric Institute, Dijk en Duin, Oude Parklaan 125, 1901, ZZ, Castricum, The Netherlands.
Jaap
J
van Weeghel
Parnassia Psychiatric Institute, Bavo-Europoort, Prins Constantijnweg 48-54, 3066, TA, Rotterdam, The Netherlands.
Moniek
M
Bogaards
Parnassia Psychiatric Institute, Parnassia Academy, Kiwistraat 32, 2552, DH, Den Haag, The Netherlands.|Faculty of Social and Behavioral Sciences, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333, AK, Leiden, The Netherlands.
Mathijs L
ML
Deen
Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus University Medical Centre, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.|Parnassia Psychiatric Institute, Bavo-Europoort, Prins Constantijnweg 48-54, 3066, TA, Rotterdam, The Netherlands.
Cornelis L
CL
Mulder
D000293:Adolescent; D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D010865:Pilot Projects; D015397:Program Evaluation; D016032:Randomized Controlled Trials as Topic; D055815:Young Adult
Feasibility; IMR; Illness Management and Recovery; Pilot study; Recovery; Schizophrenia; Self management; Severe mental Illness