The goal of this mixed-methods study is to develop and evaluate a teletherapy training protocol and a dedicated teletherapy application for Speech-Language Pathologists (SLPs) in Pakistan. It will also assess the effectiveness, usability, and acceptability of these tools among SLPs and patients receiving speech-language therapy services. The main questions it aims to answer are:
Can a standardized teletherapy training protocol be developed and validated for Speech-Language Pathologists? Can a teletherapy application improve the delivery and effectiveness of speech-language therapy services? What are the perceptions, experiences, and satisfaction levels of SLPs and patients regarding teletherapy? Does the use of the developed protocol and application improve the quality and accessibility of speech-language therapy services?
Researchers will assess the effectiveness of the developed protocol and application by comparing outcomes before and after implementation among Speech-Language Pathologists and patients receiving teletherapy services.
Participants will:
Complete questionnaires regarding teletherapy practices, satisfaction, effectiveness, and challenges.
Participate in structured interviews to share experiences and perceptions of teletherapy.
Contribute to the development and validation of a teletherapy training protocol through expert consultation.
Use the developed teletherapy application for speech and language intervention. Participate in evaluations to assess the effectiveness, usability, and acceptability of the protocol and application.
The expected outcome of the study is the development of a validated teletherapy protocol and a comprehensive teletherapy application that can standardize telepractice and improve the accessibility and quality of speech-language pathology services in Pakistan.
• The inclusion criteria will include Speech Language Pathologists from Pakistan that are actively involved in the profession.
Speech language pathologists with minimum qualification of undergraduate degree in Speech language pathology and licensed SLP's working with patients through teletherapy mode will be included in the study.
SLP's dealing with speech, language and communication problems will be included in the study.
The patients or their guardians currently receiving speech language pathology services.
• The exclusion criteria will not involve seminars or academic activities; it will not consider the therapeutic interventions used by other counselling or session-based therapists i.e., psychologists.
Patients with psychological, visual impairment, physical limitations, and medical conditions such as cancer and other long-term diseases will be excluded from the study.
The patients with swallowing disorder are excluded in the study.
Parallel
App-supported teletherapy
BehavioralSpeech and language therapy delivered by a speech-language pathologist through scheduled live video sessions, supported by the TeleSpeech progressive web application for home practice. One 30 to 45 minute individual session per week for 12 weeks, delivered in the participant's home or in a quiet room at the site where the family prefers that. Between sessions, a home programme is assigned in the application by the treating therapist and practised on five days per week. Therapy content and targets are individualised. The treating therapist has completed the study teletherapy training protocol. Adherence is captured automatically by the application, which timestamps each login, activity and completion, and session attendance is logged.
Usual in-person speech and language therapy
BehavioralStandard face-to-face speech and language therapy as currently delivered at the participating site by a speech-language pathologist in usual practice. One 30 to 45 minute individual session per week for 12 weeks, delivered in the clinic. Between sessions, a home programme is given to the family on paper and practised on five days per week. Therapy content and targets are individualised as in usual practice. Adherence is recorded in a paper diary returned at each session, and attendance is logged from site records.
Change in Goal Attainment Scaling (GAS) T-score
Goal Attainment Scaling is a criterion-referenced method in which three to five individually agreed therapy goals are set with the participant and family before randomisation and scaled from -2 (much less than expected) to +2 (much more than expected), with 0 as the expected level of attainment. Goals are not revised after randomisation. Attainment is rated at 12 weeks by an outcome assessor masked to allocation and converted to a standardised T-score. Higher scores indicate greater attainment of individually agreed communication goals. The outcome reported is the change in T-score from baseline to 12 weeks, analysed by analysis of covariance with the baseline value, site and diagnostic group as covariates. Non-inferiority of app-supported teletherapy will be concluded if the lower bound of the two-sided 95% confidence interval for the between-arm difference lies above the pre-specified margin..
Adherence to the prescribed home practice programme
The proportion of prescribed home-practice days on which practice was completed, over the 12-week intervention period, expressed as a percentage. In the app-supported teletherapy arm this is derived from timestamps recorded automatically by the application. In the usual in-person therapy arm it is derived from a paper practice diary returned at each session. The difference in measurement method between arms is recognised and is reported as a limitation
Proportion of scheduled therapy sessions attended
The number of therapy sessions attended as a proportion of the number scheduled over the 12-week intervention period, expressed as a percentage, taken from site attendance records in both arms. A session is counted as attended if it began, whatever its duration.
Client Satisfaction Questionnaire (CSQ-8) score
Participant or caregiver satisfaction with the therapy received, measured on the eight-item Client Satisfaction Questionnaire. Total scores range from 8 to 32, with higher scores indicating greater satisfaction. Self-reported, or reported by the caregiver where the participant is a child or is unable to self-report.
System Usability Scale (SUS) score
Usability of the TeleSpeech application, measured on the ten-item System Usability Scale. Scores range from 0 to 100, with higher scores indicating better perceived usability. Collected from participants or caregivers in the app-supported teletherapy arm only, as participants in the usual in-person therapy arm do not use the application.
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