Klaske van Sluis

164 9.1. English summary and subjective outcomes. EMST appeared to be feasible and safe in use after total laryngectomy. MEP improved over time during the training period but no improvement in the clinically relevant outcome measures are seen in our sample of relatively fit participants. We recommend further investigation of the training in a larger group of (less fit) participants who report specifically pulmonary complaints to investigate if this increase in MEP can result in a clinical benefits such as less frequent coughing. In Chapter 8 we present the results of a qualitative study in which we inter- viewed female patients on their perspective of life after total laryngectomy. The study aimed to gain insight into the impact of total laryngectomy on women’s daily life while identifying their specific rehabilitation needs. In-depth, semi- structured interviews with eight women who had undergone total laryngectomy were conducted. Using an interview guide, participants were encouraged to dis- cuss their everyday experiences, while also focusing on issues typical to women. The transcribed interview data is analysed by the method of Thematic Analysis, taking interpretative phenomenological analysis as a lead. The interviews reveal three main themes: disease and treatment as a turning point, re-establishing meaningful everyday activities, and persistent vulnerability. Study participants report that they experience challenges in their rehabilitation process due to physical disabilities, dependency on others, and experienced stigma. Women who undergo total laryngectomy are likely to experience issues in returning to work, the performance of informal care work, the spousal relationship, in- timacy, and social interaction due to stigmatization. Medical pre-treatment counselling and multidisciplinary rehabilitation programs should help patients form realistic expectations and prepare them for the changes they will face. A gender- and age-matched total laryngectomized patient visitor can contribute to this process. Rehabilitation programs should incorporate the partner and offer psycho-social support for women following total laryngectomy to return to their former roles in family life, social life and work-related activities. In Chapter 9 the studies which are incorporated in this thesis are discussed and recommendations for clinical practice and future research are provided. To work towards uniformity in evaluating speech outcomes after total laryngec- tomy, consensus is needed regarding the assessment tools used. Having one final score for each multidimensional outcome including perceptual outcome, (automated) acoustic scores, and patient-reported outcomes helps to inves- tigate change over time within patients and improves comparability between studies. Our studies show that automated assessment are promising. The AVQI is a potential instrument to classify voice outcomes and also correlates highly with perceptual voice quality and intelligibility outcomes. In future research, a specific cut-off value for AVQI and VHI-10 outcomes in total laryngectomy patients can be determined with help of a validation study. Future work can build further on this systematic evaluation of voice outcomes, to create a larger data-set and work towards personalized predictions. For clinical practice we recommend to provide tailored rehabilitation programs. Pre-treatment coun- selling should incorporate information on expected outcomes to facilitate shared