QOL decreases initially after laryngectomy; some QOL areas recover slowly over the course of the year after surgery, and some remain significantly worse than at baseline.

Speech improves considerably between 6 months and 1 year after total laryngectomy. Nonattendance of rehabilitation is associated with a worse functional outcome in speech rehabilitation.

These results confirm that a significant minority of laryngeal cancer patients suffer from severe mental distress, and that accurate screening for clinically significant mental disorders is possible using any of the instruments evaluated here.

In view of the stability of psychological distress among half of the spouses within 3 years after TLE and their refusal of professional support, there is a need for the development and evaluation of new treatment strategies to help spouses cope with psychological distress. Our results indicated the most common additional professional need was learning relaxation methods, which may be used as a starting point for the investigation of new coping strategies in future studies.

Symptoms caused by disease are easier for patients to live with than more general nonspecific symptoms. Taking into account that some adverse effects of disease or therapy are partially irreversible, target values additional to changes of HRQL can be helpful when interpreting data.

Key words • ▶ work-related medical rehabilitation • ▶ implementation • ▶ back pain • ▶ sick leave • ▶ formative evaluation Bibliografi e DOI http://dx. Zusammenfassung▼ Hintergrund: Das Anforderungsprofi l zur Durchführung der medizinisch-berufl ich orientierten Rehabilitation (MBOR) im Auftrag der Deutschen Rentenversicherung beschreibt Standards für berufsorientierte Kernmaßnahmen in der medizinischen Rehabilitation. Wir überprüften, wie die Umsetzung der Inhalte und des empfohlenen Leistungsumfangs gelang und welche Verände-rungseff ekte mit der Umsetzung assoziiert waren. Methoden: Die Umsetzung des Anforderungsprofi ls wurde in 7 stationären orthopädischen Rehabilitationseinrichtungen mittels schriftlicher Patientenbefragungen am Rehabilitationsbeginn und Rehabilitationsende sowie 3 Monate nach Abschluss der Rehabilitation untersucht. Zusätzlich wurden aus den ärztlichen Entlassungsberichten die durchgeführten therapeutischen Leistungen extrahiert. Ergebnisse: Der empfohlene Umfang der Sozialberatung und der berufsbezogenen Gruppen wurde erreicht. Diskrepanzen gab es zum empfohlenen Umfang des Arbeitsplatztrainings. Die standardisierte Mittelwertdiff erenz (SMD) der Arbeitsunfähigkeitsdauer vor und 3 Monate nach der Rehabilitation entsprach einer nahezu moderaten Verringerung (SMD = 0,47; 95 %-KI: 0,28-0,66). 5 zusätzliche Stunden berufsorientierter Therapien gingen mit einer Verringerung der Arbeitsunfähigkeitsdauer um 1,2 Wochen einher (95 %-KI: − 2,38 bis − 0,03). Schlussfolgerungen: Das Anforderungsprofi l wurde weitgehend erfolgreich umgesetzt und setzt wichtige Standards für den Ausbau der MBOR. Die fl ächendeckende Umsetzung des MBOR-Anforderungsprofi ls bedarf einer kontinuierlichen Qualitätssicherung, die zeitnahe Rückmeldungen über den erreichten Umsetzungsgrad ermöglicht. Abstract ▼ Background:The guideline for work-related medical rehabilitation (WMR) in responsibility of the German Pension Insurance describes standards of work-related measures in medical rehabilitation. We investigated if contents and recommended amount of treatment were successfully implemented and which improvements were associated with the implementation. Methods: Implementation of the WMR guideline was evaluated at 7 inpatient orthopaedic rehabilitation centres. Patients completed questionnaires at beginning of rehabilitation, at discharge and 3 months after discharge. Details regarding the treatments provided were extracted from the standardised discharge report. Results: The recommended amount of social counselling and work-related psychosocial therapy measures were appropriate. However, there were discrepancies regarding the recommended amount of functional capacity training. The standardised mean diff erence (SMD) between baseline and 3-month follow-up sick leave duration indicated an almost medium-sized eff ect (SMD = 0.47; 95 % CI: 0.28-0.66). An additional 5 h of work-related therapy was associated with a 1.2-week decrease in sick leave duration (95 % CI: − 2.38 to − 0.03). Conclusion: The guideline was for the most p...

Mental disorders occur in laryngectomees as frequently in men as they do in women. Total laryngectomised patients who were mentally ill did not receive enough psychotherapeutic or psychiatric support. As mental health seems to be related to successful voice restoration, future research should develop and evaluate special psychosocial supportive programmes for patients with laryngeal cancer, especially regarding alcohol dependence treatment.

Motivation is not a strong predictor of speech intelligibility 1 year after laryngectomy.