Telehealth versus face-to-face delivery of speech language pathology services: a systematic review and meta-analysis

Background:
There is an increasing demand for the provision of speech language pathology (SLP) services via telehealth. Therefore, we systematically reviewed randomized controlled trials comparing telehealth to face-to-face provision of SLP services.

Methods:
We searched Medline, Embase, and Cochrane, clinical trial registries, and conducted a citation analysis to identify trials. We included randomized trials comparing similar care delivered live via telehealth (phone or video), to face-to-face. Primary outcomes included: % syllables stuttered (%SS) (for individuals who stutter); change in sound pressure levels monologue (for individuals with Parkinson’s disease); and key function scores (for other areas). Where data were sufficient, mean differences were calculated.

Results:
Nine randomized controlled trials were included; 8 evaluated video and 1 evaluated phone telehealth. Risk of bias was generally low or unclear, excepting blinding. There were no significant differences at any time-point up to 18 months for %SS (mean difference, MD 0.1, 95% CI –0.4 to 0.6, p=0.70). For people with Parkinson’s disease, there was no difference between groups in change in sound pressure levels (monologue) (MD 0.6, 95% CI –1.2 to 2.5, p=0.49). Four trials investigated interventions for speech sound disorder, voice disorder, and post-stroke dysphagia and aphasia; they found no differences between telehealth service delivery and face-to-face delivery.

Conclusions:
Evidence suggests that the telehealth provision of SLP services may be a viable alternative to their provision face-to-face, particularly to people who stutter and people with Parkinson’s disease. The key limitation is the small number of randomized controlled trials, as well as evidence on the quality of life, well-being and satisfaction, and economic outcomes.