General introduction 19 More recently, another adaptation of the IMR workbooks was made, named "Eigen Regie en Herstel” (ERH) (Self-Direction and Recovery) (63). Finally, at ANTES (formerly Bavo-Europoort), a new version of the ERH curriculum was developed based on more than a decade of IMR experience and is now being used. The modernized ERH program includes 13 modules (100). Moreover, a version of IMR for people with mild intellectual disabilities ('IMR-light') was developed and was translated into Dutch (101, 102). The extent to which variants differ from the original version can be determined using a model fidelity assessment, if desired. The greater the difference, the more new research is required. Research on IMR In September 2018, we conducted a literature search that yielded 65 studies on IMR, including six randomized controlled trials (RCTs) (103-110). These six RCTs yielded inconsistent results. In short (we will return to this in the Discussion, Chapter 8), regarding illness selfmanagement as measured using the client version of the IMR scale (a scale that was also used as the primary outcome in the RCT executed as part of this thesis; see Chapter 5), three RCTs reported positive results for IMR compared with the control group (104, 105, 110), while the remaining three RCTs reported null results (103, 106, 107, 109). Regarding illness management, measured using the clinician version of the IMR scale, four RCTs reported positive results for IMR (103-105), whereas one RCT reported null results (107, 109). Three RCTs reported that IMR had positive effects on reducing psychiatric symptoms (104, 105, 110), whereas three RCTs identified in the literature search reported null results (104, 106, 108, 109). Regarding hospitalization, only one RCT reported positive results (110); the remaining RCTs reported no effect (103-106, 108). Three RCTs reported no effect on personal recovery (105-107, 109) and one RCT reported no effect on employment (104). Two RCTs did not observe any effects of IMR (106, 107, 108, 109). Because of these mixed results, more research was needed on the outcomes of IMR, particularly in the Dutch context. The differences in results between these studies may be related to variations in patient populations, sample sizes, control group characteristics, IMR duration, degree of IMR exposure, and model fidelity (65, 111).
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