Knowledge, Attitudes, and Practices of Speech Language Pathologists in India about Telerehabilitation Services during the COVID-19 pandemic
Purpose: The global impact of the COVID-19 pandemic has opened opportunities for service providers and patients to continue with clinical services in certain extraordinary settings and circumstances. Telerehabilitation in the field of speech language pathology in India is still at its infancy, with a majority of the Speech Language Pathologists (SLP) accustomed with the conventional face-to-face system of service delivery. The present study aims to gather the knowledge, attitudes, and practices (KAP) of SLPs in India regarding telerehabilitation services during the pandemic. Methods: The study was conducted in three phases: phase I involved the development and validation of a questionnaire to explore the KAP of SLPs regarding telerehabilitation services. The items were framed based on a Likert rating scale (strongly agree, agree, neutral, disagree, and strongly disagree), yes-no-maybe format, open-ended, and multiple-choice format. Phase II involved data collection, while phase III involved data analysis. Descriptive statistics was done to derive the frequency and percentage for discrete variables and mean and SD for continuous variables. Results: Many SLPs feel underprepared in their technical knowledge and skills needed for telerehabilitation. Furthermore, a majority of the SLPs also did report patients to be relatively lesser motivated and satisfied with tele practices due to issues that are discussed in the paper. Conclusion: This study is an initial attempt to touch upon the fabric of telerehabilitation services delivered by SLPs of India. Future studies are directed to study the technical, professional, and personal issues encountered during telerehabilitation services specifically pertaining to specific communication disabilities.
1. Field MJ. Telemedicine: a guide to assessing telecommunications for health care. Washington (DC): National Academies Press; 1996.
2. Chellaiyan VG, Nirupama A, Taneja N. Telemedicine in India: where do we stand? J Family Med Prim Care. 2019;8(6):1872-6. http://dx.doi. org/10.4103/jfmpc.jfmpc_264_19. PMid:31334148.
3. Rao PKS, Yashaswini R. Telepractice in speech-language pathology and audiology: prospects and challenges. J Indian Speech Lang Hear Assoc. 2018;32(2):67-72. http://dx.doi.org/10.4103/jisha.JISHA_39_17.
4. Mohan HS, Anjum A, Rao PKS. A survey of telepractice in speech-language pathology and audiology in India. Int J Telerehabil. 2017;9(2):69-80. http:// dx.doi.org/10.5195/ijt.2017.6233. PMid:29238451.
5. Molini-Avejonas DR, Rondon-Melo S, Amato CA, Samelli AG. A systematic review of the use of telehealth in speech, language and hearing sciences. J Telemed Telecare. 2015;21(7):367-76. http://dx.doi. org/10.1177/1357633X15583215. PMid:26026181.
6. Theodoros DG. Telerehabilitation for service delivery in speech-language pathology. J Telemed Telecare. 2008;14(5):221-4. http://dx.doi.org/10.1258/ jtt.2007.007044. PMid:18632993.
7. Kim NY, Ha J-W, Park K-S, Lee G, Park SN, Bae Y-S. Perception of Korean speech-language pathologists on telepractice service. Commun Sci Disord. 2020;25(4):987-97. http://dx.doi.org/10.12963/csd.20776.
8. Kraljević JK, Matić A, Dokoza KP. Telepractice as a reaction to the COVID-19 crisis: insights from croatian slp settings. Int J Telerehabil. 2020;12(2):93-104. http://dx.doi.org/10.5195/ijt.2020.6325. PMid:33520098.
9. Tenforde AS, Borgstrom H, Polich G, Steere H, Davis IS, Cotton K, et al. Outpatient physical, occupational, and speech therapy synchronous Telemedicine: a survey study of patient satisfaction with virtual visits during the COVID-19 pandemic. Am J Phys Med Rehabil. 2020;99(11):977-81. http://dx.doi.org/10.1097/PHM.0000000000001571. PMid:32804713.
10. Cason J, Cohn ER. Telepractice: an overview and best practices. Perspect Augment Altern Commun. 2014;23(1):4-17. http://dx.doi.org/10.1044/ aac23.1.4.
11. Beiting M, Nicolet G. Screenless Teletherapy and Silent Telesupervision: leveraging technology for innovative service delivery and clinician training in Speech-language Pathology during the COVID-19 Era. CommonHealth. 2020;1(3):106-20. http://dx.doi.org/10.15367/ch.v1i3.413.
12. Olson KE, O’brien MA, Rogers WA, Charness N. Diffusion of technology: frequency of use for younger and older adults NIH Public Access. Ageing Int. 2011;36(1):123-45. http://dx.doi.org/10.1007/s12126-010-9077-9. PMid:22685360.
13. Gunjawate DR, Ravi R, Yerraguntla K, Rajashekhar B, Verma A. Impact of coronavirus disease 2019 on professional practices of audiologists and speech-language pathologists in India: a knowledge, attitude and practices survey. Clin Epidemiol Glob Health. 2021:9:110-5. http://dx.doi. org/10.1016/j.cegh.2020.07.009. PMID: 32838065.
14. Leochico CF, Valera MJ. Follow-up consultations through telerehabilitation for wheelchair recipients with paraplegia in a developing country: a case report. Spinal Cord Ser Cases. 2020;6(1):58. http://dx.doi.org/10.1038/ s41394-020-0310-9. PMid:32632104.
15. Patdu ID, Tenorio AS. Establishing the legal framework of telehealth in the philippines. Acta Med Philipp. 2016;50(4):237-46. http://dx.doi. org/10.47895/amp.v50i4.763.
16. Househ M, Grainger R, Petersen C, Bamidis P, Merolli M. Balancing Between Privacy and Patient Needs for Health Information in the Age of Participatory Health and Social Media: A Scoping Review. Yearb Med Inform. 2018;27(1):29-36. http://dx.doi.org/10.1055/s-0038-1641197. PMid:29681040.
17. Wales D, Skinner L, Hayman M. The efficacy of telehealth-delivered speech and language intervention for primary school-age children: a systematic review. Int J Telerehabil. 2017;9(1):55-70. http://dx.doi.org/10.5195/ ijt.2017.6219. PMid:28814995.
18. Fridler N, Rosen K, Herzberg O, Lev A, Kaplan D, Hildesheimer M, et al. Tele-Rehabilitation Therapy vs. Face-to-Face Therapy for Aphasic Patients. In: eTELEMED 2012: The Fourth International Conference on eHealth, Telemedicine, and Social Medicine [Internet]. 2012 [cited 2020 Oct 12]. p. 18-23. Available from: https://www.researchgate.net/publication/274713926_TeleRehabilitation_Therapy_vs_Face-to-Face_Therapy_for_Aphasic_Patients
19. Cherney LR, Van Vuuren S. Telerehabilitation, virtual therapists, and acquired neurologic speech and language disorders. Semin Speech Lang. 2012;33(3):243-57. http://dx.doi.org/10.1055/s-0032-1320044. PMid:22851346. 20. Theodoros D, Russell T. Telerehabilitation: current perspectives. Stud Health Technol Inform. 2008;131:191-209. PMID: 18431862.
21. Macrohon BC, Cristobal FL. Rural healthcare delivery using a phone patch service in the teleconsultation program of the Ateneo de Zamboanga University School of Medicine in Western Mindanao, Philippines. Rural Remote Health. 2011;11(2):1740. http://dx.doi.org/10.22605/RRH1740. PMid:21548709.
22. Keck CS, Doarn CR. Telehealth technology applications in speech-language pathology. Telemed J E Health. 2014;20(7):653-9. http://dx.doi.org/10.1089/ tmj.2013.0295. PMid:24820794.
23. Leochico CF, Espiritu AI, Ignacio SD, Mojica JAP. Challenges to the emergence of telerehabilitation in a developing country: a systematic review. Front Neurol. 2020;11:1007. http://dx.doi.org/10.3389/fneur.2020.01007. PMid:33013666.
24. Villafania J. Feasibility of telerehabilitation in the service delivery of speech-language pathology in the Philippines. In: Proceedings of the 11th Pan-Pacific Conference of Rehabilitation [Internet]. 2018; Hong Kong. Hong Kong: Polytechnic University; 2018 [cited 2021 Mar 23]. Available from: http://pasp.org.ph/Abstracts
25. Camden C, Pratte G, Fallon F, Couture M, Berbari J, Tousignant M. Diversity of practices in telerehabilitation for children with disabilities and effective intervention characteristics: results from a systematic review. Disabil Rehabil. 2020;42(24):3424-36. PMid:30978110.
26. Prelock PA, Hutchins T, Glascoe FP. Speech-language impairment: how to identify the most common and least diagnosed disability of childhood. Medscape J Med. 2008;10(6):136.
27. Carlsson LH, Norrelgen F, Kjellmer L, Westerlund J, Gillberg C, Fernell E. Coexisting disorders and problems in preschool children with autism spectrum disorders. Scientific World Journal. 2013;2013:213979. http:// dx.doi.org/10.1155/2013/213979. PMid:23737708.
28. Leochico CF, Mojica JA. Telerehabilitation as a teaching-learning tool for medical interns. PARM Proc. [Internet]. 2017 [cited 2021 Mar 23];9:39-43. Available from: https://www.researchgate.net/publication/319204674_ Telerehabilitation_as_a_teaching-learning_tool_for_medical_interns_ PARM_Proceedings_Official_Journal_of_the_Philippine_Academy_of_ Rehabilitation_Medicine
29. Alis C, Del Rosario C, Buenaobra B, Blanca CM. Lifelink: 3G-based mobile telemedicine system. Telemed e-Health. 2009;15(3):241-7. http:// dx.doi.org/10.1089/tmj.2008.0098. PMID: 19382861.
30. Ramos RM, Cheng PGF, Jonas SM. Validation of an mHealth app for depression screening and monitoring (psychologist in a pocket): correlational study and concurrence analysis. JMIR Mhealth Uhealth. 2019;7(9):e12051. http://dx.doi.org/10.2196/12051. PMid:31538946.