Randomized controlled trial of a multisite speech pathology telepractice service providing swallowing and communication intervention to patients with head and neck cancer: Evaluation of service outcomes

BACKGROUND

The purpose of this study was to present our evaluation of a new speech pathology telepractice service supporting the swallowing and communication management of patients with head and neck cancer.

METHODS

A multicenter randomized controlled trial was conducted within a large public cancer service. Referrals from speech pathologists at 3 regional sites (spoke sites) were managed by a specialist clinician from a cancer center (hub site) either via standard care (phone/email support/appointments at the hub site) or a newly established telepractice service (online consultation between the hub site and spoke site).

RESULTS

Eighty-two referrals (39 for standard care and 43 for telepractice care) were managed. Service efficiency favoring the telepractice model was reported with a significant reduction in the number (p = .004) and duration (p = .024) of contact events required to manage the referrals. Higher consumer and clinician satisfaction was also reported for the telepractice service.

CONCLUSION

A speech pathology telepractice service benefits both the patient and health provider through higher service efficiency and treatment satisfaction. © 2017 Wiley Periodicals, Inc. Head Neck 39: 932-939, 2017.

Assessment of communication and swallowing function post laryngectomy: A telerehabilitation trial

We validated an Internet-based telerehabiliatation system designed to assess the oromotor, swallowing and communication outcomes of patients following laryngectomy. Simultaneous online and face-to-face (FTF) assessments were made of 20 patients. The online assessment was conducted using a videoconferencing system developed specifically for telerehabilitation. There was greater than 80% agreement between the online and FTF clinician for all variables relating to oromotor function, swallowing status and communication ability. However, visualization of the stoma was poor. Clinician satisfaction with the functionality of the system was low, although their ratings were high for ease of use and the potential for telerehabilitation as a service delivery method. Patients were 100% satisfied with the usability of the system and the quality of service received. The study suggests that online assessment is a potentially viable service delivery method for evaluating the speech and swallowing status of patients post laryngectomy.

Pre-operative counselling for laryngectomy patients: a systematic review

Objectives:

This study aimed to undertake a systematic review of the literature about pre-operative counselling for laryngectomy patients, identify its practice and patient and (where possible) carer perceptions.

Methods:

A search strategy was formulated using a concept map and a Population, Intervention, Comparative Interaction and Outcomes (‘PICO’) schema. All publications from 1975 to 2015 reporting pre-operative counselling of laryngectomy patients were included. Papers were retrieved and critiqued, and those included were assigned a level of evidence (according to the Joanna Briggs Institute schema).

Results:

Of the 56 papers retrieved, 21 were included in the review. The literature is limited: studies demonstrate bias and are of poor methodological quality. There are clear, persistent reports by patients and carers of shortfalls in clinical practice.

Conclusion:

Studies on pre-operative counselling for laryngectomees are flawed in design and represent weak levels of evidence. Pre-operative counselling has not been operationalised, resulting in differing paradigms being examined. Aggregation of data and/or results is not possible and the veracity of many studies is questioned.

Assessment of communication and swallowing post-laryngectomy: a telerehabilitation trial

Ten laryngectomy patients were assessed using a purpose-designed, multimedia videoconferencing system incorporating a freestanding, self-focusing camera. Swallowing, stoma and communication status were assessed simultaneously by a remote clinician and face-to-face, by a second clinician at the patient's site. The remote trial took place over a distance of approximately 1700 km using a commercial 3G phone network. A satisfaction questionnaire was also completed. There was excellent agreement between the two assessing clinicians. Image quality obtained via the freestanding camera was rated as lower than direct observation, but it was sufficient to assess the stoma and status of the voice prosthesis. During the trial, occasional difficulties with audio delays and image distortion were experienced, although these were manageable. Both patient and clinician satisfaction with remote assessment was high. The results provide further evidence to support the use of telerehabilitation for evaluating the speech and swallowing status of laryngectomy patients following discharge from acute care.