Chapter 8 194 previous findings that the ability to cope with symptoms appeared more relevant than the symptoms themselves in predicting personal recovery (25). Furthermore, these results are consistent with the findings of a meta-analysis of patients with schizophrenia-spectrum disorders in which personal and clinical recovery were relatively independent processes (26). Strengths Findings from the pilot-study on fidelity and completion directed the design of the RCT The results of the pilot study revealed shortcomings in the quality of IMR implementation in terms of fidelity and completion (Chapter 2). Based on these findings and previous research, the main study explored the impact of IMR fidelity and completion on IMR efficacy. The study design for the RCT was customized to facilitate a completion analysis; a priori, we assigned more clients to the experimental condition than to the control group. In addition, in the pilot study, variance in fidelity scores appeared to be mainly related to the trainers’ clinical skills. However, the limitations of the IMR Fidelity Scale were due to a ceiling effect. Therefore, it seemed relevant to use the IMR ITIS in the main study because the IT-IS is an IMR fidelity scale that focuses on the clinical competence of IMR trainers. Study design facilitated rigorous measurement of IMR effects By including 187 participants with various types of SMI, the sample size was relatively large and representative of the SMI target group (see Chapters 1 and 5). Additionally, we used a comprehensive set of outcome measures. This allowed for the rigorous measurement of the IMR effects. The measurement procedure was blinded. Assessing the impact of the quality of IMR implementation regarding fidelity and completion To the best of our knowledge, this is the first RCT on IMR to identify indications of the impact of fidelity on IMR efficacy (predictive validity). In this study, we investigated the impact of the IMR completion rate on IMR efficacy. To determine completion, the percentage of participants exposed to > 50% IMR sessions was assessed. However, it is also relevant to assess the average number of IMR sessions attended.
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