Pearson's EBP Briefs: Telepractice vs. On-Site Treatment: Are Outcomes Equivalent for School-Age Children?

Editor's Note:  The content of this article was published by Pearson in the journal EBP Briefs. It is offered for CEUs through SpeechPathology.com in cooperation with Pearson. The following supplemental materials are available for download:Learning ObjectivesParticipants will be able to identify the clinical question for an example case scenario.Participants will be able to list relevant search criteria for retrieving evidence related to the clinical question.Participants will be able to identify factors to consider when evaluating the evidence.Participants will be able to describe a clinical decision based on the evidence analysis.Structured AbstractClinical Question: Do school-age children receiving treatment for speech, language, and/or communication disorders show equivalent benefit from telepractice-based intervention as from on-site intervention as shown by comparable improvement in speech, language, and communication skills across the two treatment platforms?Method: Systematic Review and Meta-AnalysisStudy Sources: PubMed, SCOPUS, CINAHL, ERIC, MEDLINE, PsycINFO, and MendeleySearch Terms: telepractice OR telehealth OR telemedicine OR telerehabilitation OR telecare OR telespeech AND speech OR language OR communication AND interven* OR treat* OR therap* AND child*Number of Included Studies: 6Primary Results: All studies reported equivalent or greater improvement in the telepractice group; however, the confidence intervals associated with the effect sizes were large. Effect size was negatively correlated with study quality with studies of poorer quality reporting larger effects (in favor of telepractice) and studies of higher quality reporting smaller or negative effects (in favor of on-site). Meta-analysis of the effect sizes from the three studies of highest quality yielded a wide confidence interval (-0.56 to 0.20) suggesting that the true effect size could range from a moderate effect in favor of on-site to a small effect in favor of telepractice.Conclusions: Although telepractice appears to be a promising platform for delivering speech and language services to school-age children, there is not yet sufficient evidence to confirm that outcomes resulting from treatment provided via telepractice are equivalent to those resulting from on-site treatment. Future studies exploring this question should focus on obtaining adequate sample sizes to meet power requirements, employing suitable controls, and implementing other quality metrics to ensure the validity and reliability of results.Clinical ScenarioDenise, a certified speech-language pathologist (SLP), has worked full-time as an SLP in her local independent school district for the past five years. Toward the end of the school year, her director notified her that the SLP at a rural school within her district made plans to move out of state leaving an empty position at the school and a caseload of kids requiring services under the Individuals with Disabilities Education Act (IDEA, 2004). The school will attempt to fill the position in the few months before the start of the next school year, but it is likely that another SLP in the district will have to fill in for a period of time. The director explained that, as one of the most proximate SLPs, Denise should expect to take on extra students. Denise calculated how many additional hours she would need to dedicate to her school position in the upcoming year and found that travel time alone would increase about 2.5 hours every week (travel to and from the rural school at least twice per week). Denise began exploring ways she could increase efficiency while still providing high-quality services to all of the students on her caseload. A brief search of the American Speech-Language-Hearing Association (ASHA) Schools Professional Issues website (http://www.asha.org/ SLP/schools/Resources-for-school-based-SLPs) revealed that telepractice might be the perfect solution because it would remove the burden of commuting to the rural school. She consulted with the SLP director to determine whether telepractice was a viable option. The director requested, as a first step, that she review the available evidence to determine how therapy provided via telepractice compares to on-site therapy. Denise agreed readily to the task.Background InformationTelepractice is defined as “the application of telecommunications technology to the delivery of speechlanguage pathology and audiology professional services at a distance by linking clinician to client/patient or clinician to clinician for assessment, intervention, and/or consultation” (ASHA, n.d.). Although telepractice is the term preferred and used by ASHA, many other terms have been applied to the provision of services through videoconference or related technology. These include telehealth, telemedicine, telerehabilitation, and telecare among others and these services have been provided in a wide variety of settings (see McLean et al., 2013 for a review).Denise searched first for review articles related to her topic of interest. She found reviews focused on the use of telepractice for children with autism spectrum disorders (ASD) (Boisvert, Lang, Andrianopoulos, & Boscardin, 2010) and children with fluency disorders (Lowe, O’Brian, & Onslow, 2013). She also found a review focusing on pediatric speech and language assessment via telepractice (Taylor, Armfield, Dodrill, & Smith, 2014) and several papers reviewing telepractice generally in the field of speech-language pathology (Hill & Theodoros, 2002; Mashima & Doarn, 2008; Reynolds, Vick, & Haak, 2009; Theodoros, 2011). These reviews indicated that telepractice is a promising approach for delivering SLP services to individuals with neurogenic disorders, voice disorders, stuttering, dysphasia, ASD, and other developmental disorders. However, Denise found no reviews that directly addressed the topic of telepractice for the provision of these services in the schools. This was surprising given that schools are the most common setting in which telepractice services are delivered (ASHA, n.d.). Denise realized that she needed to complete her own review to make an evidencebased decision about the implementation of telepractice in her school district. Systematic review and meta-analysis procedures were used to summarize the literature pertaining to the research question.Clinical QuestionTo guide her literature search, Denise formulated her clinical question using the PICO model (Oxford Centre for Evidence Based Medicine, University of Oxford, 2014) where P stands for the patient, population, or problem under consideration; I stands for the intervention or exposure; C stands for the comparison intervention; and O stands for the outcome. Her PICO terms included:P – school-age children who receive treatment for speech, language, and/or communication disordersI – telepractice-based interventionC – on-site interventionO – comparable improvement in speech, language, and/or communication skills.The question derived from these terms was: Do...