Chapter 2 36 such as medication dosage, employment, or number of hospitalizations (10). The fourth, (i.e. later), RCT by Salyers et al. (9) compared IMR with an active control group. This measured psychiatric symptoms, quality of life, illness selfmanagement, patient activation, medical adherence, perceived recovery, hope, and service utilization. No significant differences were found between the outcomes of IMR and those of a problem-solving group. Seventy-two percent of the participants did not complete the IMR program. Due to these mixed results, more research is needed on the outcomes of IMR. In our main study we aim to study the effects of IMR in a Dutch context in a randomized multi-centre, single-blinded, clinical trial intended to compare IMR with treatment as usual for outpatient clients with severe and persistent mental illness. We will investigate whether IMR leads to better illness management, fewer symptoms and fewer relapses, and also to better subjective and objective recovery. Our study design was inspired by Mueser’s Conceptual Framework for IMR, which is claimed to affect many aspects of illness management and recovery (1, 10). We expect the planned RCT to produce positive results on both of the IMR scales, similar to those found in the earlier studies that used CAU as a control (6-8) (see above). We also hope to gain additional information with regard to symptoms, coping and recovery, on which the earlier results differed. The two main differences between our planned RCT and previous studies are 1.) that we will use various outcome measures on illness management, illness outcomes and recovery to provide a thorough measurement of the effects of IMR; and 2.) by testing our hypotheses, we will test various associations supposed by Mueser et al. (1) in their conceptual framework. By testing various components of the model, it might thus be said that we will test the model as a whole. Rationale for assessing feasibility through piloting Before deciding whether an RCT could be conducted, we evaluated the implementation of IMR in a pilot study intended to explore the feasibility of an RCT and to provide practical guidelines for the optimal implementation of IMR in a Dutch setting. Feasibility can be defined as “the extent to which a practice can be used or carried out within a setting” (5, 14). Feasibility studies are pieces of research done before a main study. They are used to estimate important parameters that are needed to design the main study (15). Sometimes feasibility studies and pilot studies are not distinguished from each other (16).
RkJQdWJsaXNoZXIy MjY0ODMw