Telepractice in the Communication Treatment of Individuals with Post-stroke Aphasia: Systematic Review
Telepractice, a branch of telehealth, which is the delivery of services to distant sites employing telecommunication, has been developing rapidly nowadays. Owing to the nature of the condition and treatment foci in aphasia, telepractice has been identified as a potential mode for intervention to persons with aphasia (PWA) in the field of speech-language pathology. Based on the American Speech-Language Hearing Association (2005), telepractice is considered a means to extend services to a wider context overcoming the barriers of transportation, costs, and limited availability of services. Thus, exploration of treatment accessibility to underserved populations in middle/low-income countries or rural areas via telepractice is warranted. The primary objectives of this study are to systematically review literature on telepractice of speech-language pathology services for PWA, with a focus to synthesize and analyze data that will be useful to low-income countries to consider telepractice as an alternate option and also to contribute to broaden the evidence base of aphasia practices via telepractice and include the newest available evidence. A systematic review was conducted in this study following the guidelines of Cochrane Handbook (Higgins et al., 2020). The study utilized a systematic search based on PRISMA guidelines and included 11 articles following a thorough screen for eligibility. A pre-designed coding manual was utilized in order to extract relevant data. All the included studies evaluated the feasibility of telepractice in intervention and to investigate the effectiveness of treatment programs conducted via teletherapy. A majority of the participants (72%) included in the review are PWA secondary to strokes. The treatment areas studies targeted are word retrieval, language skills, communication skills and language and communication skills, with communication skills being the area covered in highest number of studies. The review found that telepractice in the targeted treatment programs is feasible and effective. However, the included articles lack strong methodological designs limiting the certainty of the evidence. Participant-perceived data indicated some advantages of telepractice, such as overcoming transport/cost barriers, receival of higher intensity of treatment, and facilitations for non-verbal strategies to improve language and communication skills. In addition, the results revealed that all but one of the included studies was completed in a high-income country. Most of the findings also lack adequate details on therapy receival and delivery setting dynamics from a standpoint of replicating the studies or in order to generalize the findings. In conclusion, the current review shows limited evidence guidelines for the use of telepractice in rural and middle/low-income countries. There is a need to explore simple affordable technology options in telepractice and evaluate their effectiveness in low/middle-income contexts. Empirical data on efficacy of telepractice for PWA drawn from strong methodological designs should also be considered to encourage evidence-based clinical practice using telepractice in those contexts.
Aphasia, Communication intervention, Speech language therapy, Stroke rehabilitation, Systematic review, Telepractice, Speech Pathology and Audiology
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