Speech therapists' perspectives about using tele-speech therapy: a qualitative study

Rapid transition to telepractice across the lifespan in speech-language pathology: Insight from a survey of clinicians in Canada

PURPOSE

This study aims to describe the experiences and needs of Canadian speech-language pathologists (SLPs) who conducted communication assessments via telepractice across the lifespan during the first year (2020) of the COVID-19 pandemic.

METHOD

The present study consisted of an online survey that aimed to capture both quantitative aspects of telepractice-based communication assessment and the qualitative experience of shifting to telepractice. One hundred sixty-eight practicing SLPs across Canada participated in the survey, between September 2020 and January 2021. Quantitative results were analysed using descriptive statistics while open-ended responses were analysed using thematic analysis.

RESULT

SLPs identified challenges and opportunities relating to client and family engagement, access to and knowledge of technology, and the reliability of assessment tools. SLPs also identified a future need for online assessment materials and training, such as materials adapted for different communication needs (e.g. augmentative and alternative communication).

CONCLUSION

The present study contributes to a growing understanding worldwide of potential benefits and challenges related to telepractice, fuelled by the necessary shift in practices in our field during the COVID-19 pandemic. The results provide direction for continuing to build a valid and inclusive approach to telepractice in the future.

Barriers to Video Call-Based Telehealth in Allied Health Professions and Nursing: Scoping Review and Mapping Process

BACKGROUND

Telehealth interventions have become increasingly important in health care provision, particularly during the COVID-19 pandemic. Video calls have emerged as a popular and effective method for delivering telehealth services; however, barriers limit the adoption among allied health professionals and nurses.

OBJECTIVE

This review aimed to identify and map the perceived barriers to the use of video call-based telehealth interventions among allied health professionals and nurses.

METHODS

A comprehensive literature search was conducted in the PubMed and CINAHL databases on June 22, 2022, and updated on January 3, 2023, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Only original studies published in English or German since June 2017 that reported barriers to the use of video call-based telehealth interventions were eligible for inclusion. The studies had to involve interviews, focus groups, or questionnaires with physical therapists, occupational therapists, speech and language therapists, audiologists, orthoptists, dieticians, midwives, or nurses. Each publication was coded for basic characteristics, including country, health profession, and target group. Inductive coding was used to identify the patterns, themes, and categories in the data. Individual codings were analyzed and summarized narratively, with similarities and differences in barriers identified across health professions and target groups.

RESULTS

A total of 56 publications were included in the review, with barriers identified and categorized into 8 main categories and 23 subcategories. The studies were conducted in various countries, predominantly the United States, Australia, the United Kingdom, Canada, Israel, and India. Questionnaires were the most commonly used evaluation method, with 10,245 health professionals involved. Interviews or focus groups were conducted with 288 health professionals. Most of the included publications focused on specific health care professions, with the highest number addressing barriers for physical therapists, speech and language therapists, and audiologists. The barriers were related to technology issues, practice issues, patient issues, environmental issues, attributions, interpersonal issues, policies and regulations, and administration issues. The most reported barriers included the lack of hands-on experience, unreliable network connection, the lack of technology access, diminished fidelity of observations and poor conditions for visual instructions, the lack of technology skills, and diminished client-practitioner interaction and communication.

CONCLUSIONS

This review identified key barriers to video call-based telehealth use by allied health professionals and nurses, which can foster the development of stable infrastructure, education, training, guidelines, policies, and support systems to improve telehealth services. Further research is necessary to identify potential solutions to the identified barriers.

Applications of Telemedicine in Speech-Language Pathology: Evaluation of Patient Satisfaction

OBJECTIVES

The study aimed to evaluate patient satisfaction with speech-language therapy televisits and to identify factors influencing the level of satisfaction.

METHODS

Participants were recruited from an academic tertiary voice and swallowing center who had completed ≥1 telehealth session of speech-language therapy with a speech-language pathologist between March, 2020 and April, 2021. Patient satisfaction was assessed using the Short Assessment of Patient Satisfaction (SAPS), a validated 7-item survey. Demographic characteristics of participants were collected from a review of patient charts.

RESULTS

65/239 patients completed the SAPS survey, representing a response rate of 27%. The average age of study participants was 54.92 ± 16.45 years, with 49.2% identifying as female, 33.9% as male, and 16.9% as trans-female. The mean SAPS score was 22.60 ± 3.89, with 84.62% of patients satisfied or very satisfied with their visit. Patients were most satisfied with provider respect (3.91 ± 0.34) and care received (3.74 ± 0.64), and least satisfied with visit length (2.32 ± 1.38) and explanation of treatment results (2.62 ± 1.72). Patient satisfaction was positively correlated with younger age and an increased number of televisits. Satisfaction did not differ significantly by gender identity, type of therapy received, insurance type, travel distance, or prior in-person therapy.

CONCLUSION

Clinicians are able to achieve high patient satisfaction with speech-language therapy when delivered by telehealth. Patient satisfaction remained high across diverse patient populations and range of clinical needs. Clinicians should remain cognizant of the unique limitations of older patients when conducting telehealth visits.

LAY SUMMARY

Clinicians are able to achieve high patient satisfaction with speech-language therapy when delivered via telehealth. Satisfaction remained high regardless of gender identity, type of therapy received, type of insurance, travel distance, or completion of prior in-person therapy.

LEVEL OF EVIDENCE

4 Laryngoscope, 133:895-900, 2023.

Tele-rehabilitation in voice disorders during the pandemic: a consensus paper from the French Society of Phoniatrics and Laryngology

OBJECTIVES

To establish a consensus protocol for telerehabilitation in speech therapy for voice disorders.

METHODS

The study was conducted according to a modified Delphi method. Twenty speech therapist or laryngologist experts of the French Society of Phoniatrics and Laryngology assessed 24 statements of voice telerehabilitation with a 10-point visual analog scale ranging from 1 (totally disagree) to 10 (totally agree). The statements were accepted if more than 80% of the experts rated the item with a score of ≥ 8/10. The statements with ≥ 8/10 score by 60-80% of experts were improved and resubmitted to voting until they were validated or rejected.

RESULTS

The French Society of Phoniatrics and Laryngology experts validated 10, 6, and 2 statements after the first, second and third voting round, respectively. Seven statements did not reach agreement threshold and were rejected. The validated statements included recommendations for setting (N = 4), medical/speech history (N = 2), subjective voice evaluations (N = 3), objective voice quality measurements (N = 3), and voice rehabilitation (N = 5). The experts agreed for a follow-up consisting of combined telerehabilitation and in-office rehabilitation. The final protocol may be applied in context of pandemic but could be assessed out of pandemic period for patients located in rural regions.

CONCLUSIONS

This Delphi study established the first telerehabilitation protocol of the French Society of Phoniatrics and Laryngology for patients with voice disorders. Future controlled studies are needed to assess its feasibility, reliability, and the patient perception about telerehabilitation versus in-office rehabilitation.