Salyers Michelle P, McGuire Alan B, Kukla Marina, Fukui Sadaaki, Lysaker Paul H, Mueser Kim T
Psychiatr Serv. 2014 Aug 1;65(8):1005-11. doi: 10.1176/appi.ps.201300354.
The purpose of the study was to rigorously test Illness Management and Recovery (IMR) against an active control group in a sample that included veterans.
A total of 118 participants with schizophrenia spectrum disorders, 56 of whom were veterans, were recruited from a Department of Veterans Affairs medical center and a community mental health center in the same city and were randomly assigned to an IMR group (N=60) or a weekly problem-solving group intervention (N=58). Groups met weekly for nine months. Blinded assessments were conducted at baseline, nine months, and 18 months on measures of symptoms, functioning, illness self-management, medication adherence, subjective recovery experiences, and service utilization.
No significant differences were found between IMR and problem-solving groups. Participants in both groups improved significantly over time in symptom severity, illness management, and quality of life and had fewer emergency department visits. Participation rates in both interventions were low. Only 28% of consumers assigned to IMR and 17% of those assigned to the problem-solving group participated in more than half the scheduled groups, and 23% and 34%, respectively, attended no sessions.
This is the first randomized controlled trial of IMR to report negative findings. Given the inclusion of an active control group and the low participation rates, further research is needed to understand factors affecting IMR effectiveness. Increased attention may need to be paid to facilitate more active participation in IMR, such as individual follow-up with consumers and the integration of IMR with ongoing treatment.
本研究旨在对包括退伍军人在内的样本，将疾病管理与康复（IMR）与一个积极对照组进行严格对比测试。
从同一城市的一家退伍军人事务部医疗中心和一家社区心理健康中心招募了总共118名患有精神分裂症谱系障碍的参与者，其中56名是退伍军人，并将他们随机分配到IMR组（N = 60）或每周一次的解决问题小组干预组（N = 58）。小组每周会面，为期九个月。在基线、九个月和18个月时，对症状、功能、疾病自我管理、药物依从性、主观康复体验和服务利用等指标进行盲法评估。
IMR组和解决问题小组之间未发现显著差异。随着时间的推移，两组参与者在症状严重程度、疾病管理和生活质量方面均有显著改善，且急诊就诊次数减少。两种干预措施的参与率都很低。分配到IMR组的消费者中只有28%，分配到解决问题小组的消费者中只有17%参加了超过一半的预定小组，分别有23%和34%的人未参加任何课程。
这是第一项报告IMR阴性结果的随机对照试验。鉴于纳入了一个积极对照组且参与率较低，需要进一步研究以了解影响IMR有效性的因素。可能需要更多关注以促进更积极地参与IMR，例如对消费者进行个体随访以及将IMR与正在进行的治疗相结合。
