Study protocol 67 timing of measurements, the type of control group and the fidelity of the implementation of IMR. The results of the four RCTs are presented in Table 1. The first three RCTs compared IMR with care as usual (CAU) (16–18). On the overall score of the client version of the Illness Management and Recovery Scale (IMRS (19), two of these studies showed significantly positive results for clients assigned to IMR, with respective effect sizes of .36 (18) and .29 (16). The other study found significant improvement in IMRS scores only if the analyses were limited to sites with high IMR fidelity (17). On the overall score of the clinician version of the IMRS, all three of these studies showed significantly positive results for clients assigned to IMR, with respective effect sizes of .28 (17), .39 (18) and .34 (14, 16). On the overall score of both the client version and the clinician version of the IMRS, the more recent RCT of Salyers—in which IMR was tested against an active control group (15)—showed no significant differences between the experimental and control group. In all four studies, additional significantly positive results for IMR were found on client-reported knowledge in one study (17), on client-reported coping in another study (16), on clinician-reported quality of life in a third study (18), and on observerrated psychiatric symptoms in two of these studies (16, 18). These results were either not found in the other RCTs, or the domains in question were not measured. No significant outcomes were found on objective outcomes such as medication dosage, employment, or hospitalisations and emergency visits. While Salyers found no significant differences between IMR and the active control group on any of the domains measured (Table 1), the respective participation rates in the two interventions were only 28 and 17 % (15). These mixed results indicated the need for more research. We aim to use an RCT design to study the effects of IMR in a Dutch context. On both IMR scales, we expect positive results of the sort found in the earlier studies that used CAU as a control (16–18). We also hope to gain additional information regarding symptoms, coping and recovery, on which the earlier results differed. By using different outcome measures of illness management, illness outcomes, and recovery, our study will provide a thorough measurement of the effects of IMR.
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