Effectiveness of illness management and recovery (IMR) in the Netherlands: a randomised clinical trial

The Relationship of Functioning and Life Satisfaction with Illness Management and Recovery in Patients with Bipolar Disorder: A Cross-Sectional Study

The aim of this study was to determine relationship between functioning and life satisfaction with illness management and recovery, and determinants of illness management and recovery in patients with bipolar disorder. This descriptive and correlational study was conducted with 152 participants between August 2022 and February 2023. "Personal Information Form", "Illness Management and Recovery Scale", "Functioning Assessment Short Test" and "Adult Life Satisfaction Scale" were used to collecting data. In study, a positive relationship was found between illness management and recovery and total functionality, autonomy, cognitive functionality, interpersonal relationships, and life satisfaction. Gender, marital status, educational status, employment status, total functioning, autonomy, cognitive functioning, interpersonal relationships, and life satisfaction were found to be effective in illness management and recovery. Being female, single, primary school graduate, unemployed, having low functioning (autonomy, cognitive functioning, interpersonal relationships) and having low life satisfaction were found to be determinants of illness management and recovery.

Do we all speak the same language? A critical systemic functional discourse analysis of psychiatric hospital brochures

BACKGROUND

Over the last decades, treatment of patients with mental health diseases has shifted from longer-term in-hospital diagnosis and treatment to brief crisis diagnostic and/or treatment stays in hospital wards combined with ambulatory care preventing relapse and promoting patient-centered recovery. To guarantee a shared understanding of the nature of the care provided, it is important that hospital brochures and ambulatory care information are aligned, both in the way in which they define and understand recovery and regarding how they approach the empowerment and activation of the patient.

AIM AND RESEARCH QUESTIONS

The overall aim of the study was to shed light on whether (1) hospital brochures used in crisis intervention centres in Flanders reflect the tenets of recovery-oriented and empowering care, and (2) the encoded messages are reflective of patients and their needs.

METHODS

A systemic functional critical discourse analytic framework was used to analyze a small corpus of hospital brochures.

RESULTS

Our findings suggest that the answers to both research questions are negative.

CONCLUSION

This small-scale qualitative study on the under-researched population of psychiatric patients admitted to crisis intervention wards highlights the complexities involved in imparting well-aligned psychiatric care messages to the patients, their home caregivers, the medical community and the general public.

Assessing the Psychometric Properties of the Illness Management and Recovery Scale: A Systematic Review Using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN)

The Illness Management and Recovery Scale (IMR-S) is based on the IMR program, developed to assess the recovery process for people with severe mental disorders by considering the perceptions of clients and clinicians involved in it. The aim of this study was to analyze the psychometric properties of the IMR-S so as to determine the reliability and suitability of its scores for evaluating recovery. Two coders searched five databases for studies, published between January 2004 and May 2023, that describe the psychometric assessment of the IMR-S. Studies were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist. Finally, 46 papers were included. Methodological quality was very good for most of the studies that provide information on internal validity, and limited for those that report on responsiveness. Measurement properties were positive for convergent validity and measurement error. The quality of evidence was high for structural validity studies. Although this study only includes research published in English and may have overlooked certain psychometric properties evaluated in studies published in other languages, our findings suggest that the IMR-S is a valid and reliable instrument, demonstrating its potential to offer guidance for clinical practice.

Fidelity and Clinical Competence in Providing Illness Management and Recovery: An Explorative Study

Illness Management and Recovery (IMR) is a psychosocial intervention supporting people with serious mental illnesses. In this study, 15 IMR groups were assessed for fidelity and clinician competency to establish the implementation level of all IMR elements and explore complementarity of the IMR Treatment Integrity Scale (IT-IS) to the standard IMR Fidelity Scale. Use of the IT-IS was adapted, similar to the IMR Fidelity Scale. Descriptive statistics were applied. Implementation success of IMR elements varied widely on the IMR Fidelity Scale and IT-IS (M = 3.94, SD = 1.13, and M = 3.29, SD = 1.05, respectively). Twelve IMR elements (60%) were well-implemented, whereas eight (40%) were implemented insufficiently, including some critical cognitive-behavioral techniques (e.g., role-playing). The scales appeared largely complementary, though strongly correlated (r (13) = 0.74, p = 0.002). Providing all IMR elements adequately requires a variety of clinical skills. Specific additional training and supervision may be necessary.

Effects of Illness Management and Recovery: A Multicenter Randomized Controlled Trial

There have been inconsistent findings in the literature with respect to the efficacy of Illness Management and Recovery (IMR) in the psychosocial treatment of people with schizophrenia or other severe mental illnesses. This study aimed to comprehensively investigate the effectiveness of IMR, including the impact of completion and fidelity. In this randomized controlled trial (RCT), 187 outpatients received either IMR plus care as usual (CAU) or only CAU. Multilevel modeling was implemented to investigate group differences over an 18-month period, comprising 12 months of treatment and six months of follow-up. The primary outcome was overall illness management, which was assessed using the client version of the IMR scale. Secondary outcomes included measures regarding illness management, clinical, personal, and functional recovery, and hospitalizations. The interviewers were blinded to group allocation. This clinical trial was registered with the Netherlands Trial Register (NL4931, NTR5033). Patients who received IMR showed statistically significant improvement in self-reported overall illness management (the primary outcome). Moreover, they showed an improvement in self-esteem, which is a component of personal recovery. There were no effects within the other questionnaires. There were also no statistically significant between-group differences in terms of hospitalizations. Patients in both groups showed statistically significant improvement in clinician-rated overall illness management, social support, clinical and functional recovery, and self-stigma over time. IMR completion was associated with stronger effects. High IMR fidelity was associated with self-esteem. This study confirms the efficacy of IMR in overall illness self-management. To our knowledge, this is the first RCT on IMR to explore the impact of fidelity on treatment efficacy. Future studies should further establish efficacy in personal recovery. To improve efficacy, it appears important to promote IMR completion and fidelity.

Psychometric Properties of a Fidelity Scale for Illness Management and Recovery

This study examined the psychometric properties and feasibility of the Illness Management and Recovery (IMR) Fidelity scale. Despite widespread use of the scale, the psychometric properties have received limited attention. Trained fidelity assessors conducted assessments four times over 18 months at 11 sites implementing IMR. The IMR Fidelity scale showed excellent interrater reliability (.99), interrater item agreement (94%), internal consistency (.91–.95 at three time points), and sensitivity to change. Frequency distributions generally showed that item ratings included the entire range. The IMR Fidelity scale has excellent psychometric properties and should be used to evaluate and guide the implementation of IMR.

Trial registration: ClinicalTrials.gov Identifier: NCT03271242.

Determinants of clinical, functional and personal recovery for people with schizophrenia and other severe mental illnesses: A cross-sectional analysis

OBJECTIVE

To analyze the relationships between insight, medication adherence, addiction, coping and social support-components of Illness Management and Recovery (IMR)-as determinants of clinical, functional and personal recovery in patients with schizophrenia and other severe mental illnesses. Our rationale lay in the interrelations between these concepts suggested in a conceptual framework of IMR.

METHODS

The cross-sectional design used baseline data of outpatient participants in a randomized clinical trial on IMR (N = 187). We used structural equation modeling (SEM) to describe pathways between degrees of insight, medication adherence, addiction, coping and social support, and degree of clinical, functional and personal recovery. We also explored whether clinical recovery mediated functional and personal recovery.

RESULTS

Our final model showed that coping was associated with clinical, functional and personal recovery. Direct associations between coping and functional and personal recovery were stronger than indirect associations via clinical recovery. Although SEM also showed a significant but weak direct pathway between social support and functional recovery, there were no significant pathways either between social support and clinical or personal recovery, or between insight, medication adherence, addiction and any type of recovery.

CONCLUSIONS

Coping may be a determinant of all three types of recovery, and social support a determinant of functional recovery. Clinical recovery appears not to be a prerequisite for functional or personal recovery. While our results also suggest the relevance of improving coping skills and of enhancing social support, they only partially support the conceptual framework of IMR.

Illness management and recovery: one-year follow-up of a randomized controlled trial in Danish community mental health centers: long-term effects on clinical and personal recovery

BACKGROUND

Illness Management and Recovery (IMR) is a curriculum-based rehabilitation program for people with severe mental illness with the short-term aim of improving illness self-management and the long-term aim of helping people achieve clinical and personal recovery.

METHOD

Participants with schizophrenia or bipolar disorders were recruited from three community mental health centers in the Capital Region of Denmark and randomized to receive group-based IMR and treatment as usual or only the usual intervention. All outcomes were assessed at baseline, postintervention, and the one-year follow-up. Long-term outcomes were categorized according to clinical recovery (i.e., symptoms, global functioning, and hospitalization) and personal recovery (i.e., hope and personal agency). Generalized linear mixed model regression analyses were used in the intent-to-treat analysis.

RESULTS

A total of 198 participants were included. No significant differences were found between the IMR and control groups in the Global Assessment of Functioning one year after the intervention, nor were there significant differences in symptoms, number of hospital admissions, emergency room visits, or outpatient treatment.

CONCLUSION

The present IMR trial showed no significant effect on clinical and personal recovery at the one-year follow-up. Together with the results of other IMR studies, the present study indicates that the effect of IMR on symptom severity is unclear, which raises questions regarding the impact of IMR on functioning. Additionally, IMR did not affect personal recovery. Although more research is needed, the results indicate that the development of other interventions should be considered to help people with severe mental illness achieve a better level of functioning and personal recovery.

TRIAL REGISTRATION

Trial registered at http://www.clinicaltrials.gov ( NCT01361698 ).

Illness management and recovery program for mental health problems: reducing symptoms and increasing social functioning

AIMS AND OBJECTIVES

To evaluate the effectiveness of the Illness Management and Recovery Program in comparison with the current standard of care in terms of reduction of symptoms, rehospitalisation rates and social functioning in Asia.

BACKGROUND

Focus of treatment for Mental Health had been shifted from mere management of symptoms to that of achievement of recovery. In the recovery process, strategies to achieve higher level of functioning were used (Psychiatric Services 2014, 65, 171). However, two main factors hindered clients from attaining recovery: first, the lack of Mental Health resources in the community and second the negative attitudes of healthcare professionals towards mental illness (American Journal of Psychiatric Rehabilitation 2012, 15, 131). Hence, it is essential to implement an effective programme that will train mental health professionals to use more effective techniques and materials in helping the clients to better integrate into society by achieving skills in their attempt to work towards recovery.

DESIGN

This study adopts a time series experimental quantitative design.

METHODS

Fifty participants who consented to the study were randomly assigned to two groups. Participants in the experimental group received the experimental management and recovery programme, while the control group received standard care management by the community psychiatric nurses for a period of 12 months.

RESULTS

Participants in the experimental group reported significantly lower number of admissions, shorter length of stay, lower Brief Psychiatric Rating Scale scores, and also reported significantly higher scores on both the Illness Management and Recovery Scale and the Global Assessment Scale.

CONCLUSION

This study demonstrated the effectiveness of IMR in helping Asian people with mental illness to not only reduce symptoms and hospitalisations but also improve social functioning. They have benefitted from the program although they are living in a different cultural setting from where IMR was developed.

RELEVANCE TO CLINICAL PRACTICE

The success of this study has raised the standard of care in the community intervention and led more people to their recovery.

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.