Report
A survey on advantages and disadvantages of telerehabilitation by speech-language-hearing therapists in Japan
2025 Volume 3 Issue 2 Pages 84-96
Details
2025 Volume 3 Issue 2 Pages 84-96
The COVID-19 epidemic has had a major impact on speech-language-hearing therapists (SLHTs) in Japan. Although there have been reports of telerehabilitation in Japan, the actual situation has not been reported. Therefore, we examined the merits and demerits of telerehabilitation in speech-language-hearing therapy after the COVID-19 outbreak and explored its potential for speech-language-hearing therapy in the future. SLHTs nationwide were asked to respond to a survey form developed by the authors using Google Forms. The survey period was between October 26 and December 31, 2023. Participants were divided into two groups according to their experience of telerehabilitation (with experience/WE group and without experience/WO group), and they were asked about the advantages and disadvantages of telerehabilitation. We received responses from 214 SLHTs (95 males, 119 females), with 28 (13.1%) in the WE group. In the WO group , 3 categories (occupational, infectious, and differences between inpatient and outpatient rehabilitation) were identified as advantages of telerehabilitation, and 2 (equipment and clinical) as disadvantages. The WO group identified 4 categories (environmental, clinical, provider, and infectious) as advantages and 3 (system, equipment, and clinical) as disadvantages. The reason why most of the responses in the advantage category were from the perspective of infection prevention may be because this survey was conducted after the COVID-19 outbreak; the difference seen between the two groups may suggest that the clinicians in the WO group, who had never experienced telerehabilitation, had wariness toward telerehabilitation. It is important to accumulate more evidence in the future.
Short Communication: The advantages and disadvantages of telerehabilitation in speech-language-hearing therapy after the COVID-19 pandemic were examined to explore the potential of telerehabilitation in speech-language-hearing therapy in the future in Japan. SLHTs nationwide were invited to respond to the survey. The large number of responses in terms of infection prevention in the advantages may be due to the fact that this survey was conducted after the COVID-19 outbreak. In the group that had no experience with telerehabilitation, it is speculated that the clinicians were cautious about telerehabilitation.
The outbreak of the novel coronavirus disease (COVID-19) has had a major impact on medical and nursing care settings, where face-to-face contact with clients is a basic practice. Rehabilitation, which often involves physical contact with patients, is no exception. Speech-language-hearing therapists (SLHTs) observe the oral cavity and conduct vocal training routinely. Additionally, patients may experience choking or coughing during dysphagia rehabilitation. Therefore, regarding the risk classification of aerosol infections in SLHT interventions, swallowing compensation approaches or exercise therapy is considered a moderate risk with a risk of infection by airborne droplets1). Consequently, evaluation and rehabilitation may be restricted2,3). In this context, guidelines for providing rehabilitation to patients who need it, even during the COVID-19 pandemic4), and efforts to utilize online communication systems have been reported in various fields5,6). In Japan, there have been some reports on the implementation of rehabilitation using online communication systems (telerehabilitation) during the corresponding period7). Guidelines for infection control measures have been presented4), and the implementation of speech-language-hearing therapy using telerehabilitation has also been reported8). However, the actual situation has not yet been reported.
Therefore, this study investigated the status of telerehabilitation for speech-language therapy following the COVID-19 pandemic in Japan. The purpose of this survey was to clarify the advantages and disadvantages of telerehabilitation, and to explore the potential of telerehabilitation in speech-language therapy in the future.
The survey was administered to SLHTs nationwide using a questionnaire developed by the authors (Table 1) . The survey was explained to the respondents, and only those subjects or groups of professionals who gave their informed consent were asked to complete the survey. The questionnaire was distributed to SLHTs through convenience sampling, Internet-based professional groups, and 45 professional prefectural associations. The survey was conducted between October 26 and December 31, 2023. The survey items included basic attributes (sex, years of rehabilitation experience, and facility affiliation). Participants were divided into two groups according to their experience with telerehabilitation (with experience [WE] and without experience [WO] groups), and each group was asked about the advantages and disadvantages of telerehabilitation. After completion of the survey form response period, the descriptive portions of the survey form were aggregated. The survey was conducted using an anonymous Google Form, and consent was availed based on the participants’ response to the survey form. The purpose of the survey was explained in writing, and an outline was provided at the beginning of the response screen.
| question | choices |
|---|---|
| sex | male |
| female | |
| others | |
| age | |
| SLHT years of experience | |
| Have you had experience with remote rehabilitation? | Yes |
| No | |
| This question is for people who have performed remote rehabilitation before. Please tell us what benefits you think there are in implementing remote rehabilitation. |
|
| This question is for people who have performed remote rehabilitation before. Please tell us about the challenges and disadvantages of implementing remote rehabilitation. |
|
| This question is for people who have never performed remote rehabilitation. What do you think are the expected benefits of implementing remote rehabilitation? |
|
| This question is for people who have never performed remote rehabilitation. What do you think are the expected challenges and disadvantages of implementing remote rehabilitation? |
|
A thematic analysis was used for the descriptive statements in the survey instrument. The procedure for qualitative analysis was to convert the descriptive statements into text, code them, and categorize them. We proceeded with the following steps in our analysis. 1) For the analysis, the first and second authors repeatedly read the data to better understand its contents. 2) For coding, we extracted important parts of the data and assigned codes to them. 3) To identify themes, we categorized the codes by finding commonalities among them, extracted repeated patterns and meanings in the data, and raised the level of abstraction. We proceeded by comparing the similarities and differences between the categories. In this process, the meanings described were clarified, and the abbreviations and acronyms were revised. The qualitative data were then analyzed by inductive manual coding using a qualitative content analysis approach. 4) The characteristics of the categories were classified, and themes were added by looking at the semantic content. As a modification and close examination of the themes, the extracted themes were reevaluated and checked for consistency with the overall data, and then the final themes were organized, and the results were summarized. During this step, content analysis emphasized the objectivity and reproducibility of the results. The first and second authors divided the text into fragmentary data and labeled them. The labels created were organized through group discussions among all the authors. The grouping process involved reading and comparing individual labels, grouping similar labels into categories, and inductively forming themes. For example, “Reimbursement issues. Possibility of inadequate confirmation of effectiveness” included two elements: reimbursement and possibility of inadequate confirmation of effectiveness. Therefore, it was assumed that “Reimbursement” and “Quality/Effectiveness” were applicable.
This study was approved by the Ethics Review Committee of the International University of Health and Welfare (approval date: September 26, 2023; approval number: 23-Im-039).
A total of 214 participants (95 males and 119 females) from 34 prefectures responded to the survey. Because the authors asked local professional groups/organizations for their cooperation in this survey, the exact number of copies distributed to their members and the response rate were unknown.
Table 2 shows the basic demographics of the respondents and their experiences with telerehabilitation. Only 28 participants (13.1%) answered “yes” to the question of whether they had experience with telerehabilitation, while the rest did not. Among 28 respondents in the WE group regarding the advantages of telerehabilitation, three categories and seven themes were identified (Table 3). The three categories were “job type,” “infectious,” and “differences between inpatient and outpatient rehabilitation,” whereas the seven themes were “dealing with people with geographical problems,” “location constraints,” “time constraints,” “infection control for medical personnel,” “providing rehabilitation to infected patients,” “complementing outpatient rehabilitation,” and “device use.” In terms of the benefits to the environment, opinions such as “can be done in any location” were mentioned. Regarding the advantages in terms of infection prevention, responses included “Rehabilitation can be conducted without worrying about the risk of infection.” In terms of differences between inpatient and outpatient rehabilitation, comments such as “It provided an opportunity for outpatients to practice computer operation skills.”
| All n (%) | Experience with telerehabilitation | |||
|---|---|---|---|---|
| WE group n (%) | WO group n (%) | |||
| 214 (100) | 28 (13.1) | 186 (86.9) | ||
| Sex | Male | 95 (44.4) | 14 (14.7) | 81 (85.3) |
| Female | 119 (55.6) | 14 (11.8) | 105 (88.2) | |
| Years of SLHT experience | 1–5 y | 20 (9.3) | 1 (5.0) | 19 (95.0) |
| 6–10 y | 38 (17.8) | 4 (10.5) | 34 (89.5) | |
| 11–15 y | 48 (22.4) | 8 (16.7) | 40 (83.3) | |
| 16–20 y | 64 (29.9) | 3 (4.7) | 61 (95.3) | |
| 21–25 y | 27 (12.6) | 7 (25.9) | 20 (74.1) | |
| 26 y or more | 17 (7.9) | 5 (29.4) | 12 (70.6) | |
| Work settings | Medical facility | 157 (73.4) | 10 (6.4) | 147 (93.6) |
| Long-term care facilities | 22 (10.3) | 3 (13.6) | 19 (86.4) | |
| Educational institutions | 19 (8.9) | 4 (21.1) | 15 (78.9) | |
| Visiting services | 7 (3.2) | 2 (28.6) | 5 (71.4) | |
| Welfare and health facilities | 13 (6.1) | 4 (30.8) | 9 (69.2) | |
| Private practice, freelance | 7 (3.2) | 5 (71.4) | 2 (28.6) | |
Medical facility: hospital, medical clinic, dental clinic
Long-term care facilities: day care facilities, nursing home
Educational institutions: research facilities, schools for SLHTs
Visiting services: home-visit nursing service, home-visit rehabilitation service rehabilitation, home-visit dental service
WE: with experience of telerehabilitation, WO: without experience of telerehabilitation, SLHT: speech-language-hearing therapist
| Categories | Themes (n) | Examples of comments |
|---|---|---|
| Environment | Addressing geographical issues (7) | Rehabilitation can be continued for those who have geographical difficulties in getting to the hospital |
| Possible to provide rehabilitation to those who live far away | ||
| Possible to conduct rehabilitation in areas where there are no SLHTs nearby | ||
| Location restrictions (6) | Rehabilitation can be conducted anywhere as long as there is an internet environment | |
| No burden of move | ||
| Can be done regardless of location | ||
| Both the patients and SLHTs can do rehabilitation at home | ||
| Not affected by weather | ||
| Time constraints (6) | Not influenced by distance | |
| Freedom of working hours without constraints | ||
| Easy to adjust schedule | ||
| Easier to make appointments | ||
| Ability to save time for both parties | ||
| Infectious | Infection control protection for medical staff (6) |
No risk of infection |
| Infection control/protection | ||
| Rehabilitation Can be conducted without concern for infection risk | ||
| No need to wear masks | ||
| Rehabilitation of patients with infetions (6) | Speech therapy could be continued even during pandemic of COVID-19 | |
| Able to provide rehabilitation to infected and hospitalized patients | ||
| Able to respond quickly to patients’ needs | ||
| Able to provide rehabilitation even if family or class member have positive or intense contacts with COVID-19 | ||
| Can provide stimulus input through remote communication even while in isolation | ||
| Cognitive training is easier to implement than motor rehabilitation because it does not require physical contact | ||
| Differences between inpatient and outpatient rehabilitation | Complementary to outpatient rehabilitation (6) |
Outpatient rehabilitation may only allow a small amount of time for rehabilitation, and training can be provided in a complementary manne |
| Although it was remote, patients felt the effects of the rehabilitation, even if only gradually, through repetition of small accumulations | ||
| Parents commented that they were able to receive the training comfortably | ||
| It was an opportunity for patients to practice computer operation | ||
| It matched the needs of those who wanted to practice intensively before or after school | ||
| Use of devices (2) | The use of PC and tablet devices motivates children | |
| Easier to facilitate group training |
SLHT: speech-language-hearing therapist, PC: personal computer
Four categories and 15 themes regarding the benefits of telerehabilitation, as cited by the WO group (Table 4), were extracted. The four categories were “environmental,” “clinical,” “provider,” and “infectious.” The fifteen themes were “transfer,” “region,” “difficulty in getting to the hospital,” “time of provision,” “location,” “frequency,” “appointments,” “follow-up,” “continuity,” “activities of daily living (ADLs)/quality of life (QOL)”, “assessment and training,” “family,” “consultation,” “advantages of the speech-language-hearing therapy,” and “infection prevention.” Similar to the WE group, those related to the environment, such as transportation and the community, and those related to infections were mentioned. Furthermore, as a response not found in the WE group, there was an opinion that “it provides an opportunity to evaluate or understand the living patient’s situation or environment” in the ADL/QOL theme. Regarding evaluation and training, there were clinically relevant advantages, such as “There is a lot of information that can be obtained by observation, including imitation training, oral reading tasks, family guidance, etc., which can be useful, including feedback.” As an advantage for SLHTs, “Reduction in time spent on SLHT travel” was mentioned.
| Categories | Themes (n) | Examples of comments |
|---|---|---|
| Environment | Movement (51) | Reduce waiting time |
| More time freedom | ||
| Reduced travel time | ||
| Cutting costs associated with travel | ||
| Transition of in-home rehab to tele-rehab | ||
| Prevention of drop-outs | ||
| Reduction of physical burden of patients due to travel | ||
| Region (35) | Patients can receive the service even if they are far away, difficult to visit, in depopulated areas, on remote islands, or in bad weather | |
| Rehabilitation staff can reach patients in areas with few medical resources | ||
| Reduction of disparities in medical care in remote areas | ||
| Ability to receive rehabilitation at home | ||
| Difficulty in going to hospital (26) | Providing rehabilitation for those who have difficulty going to outpatient clinics after discharge from hospital | |
| Possible even for physically disabled people | ||
| Users no longer have to worry about transportation | ||
| Time of provision (6) | Flexible time of provision | |
| Location (11) | Location does not matter | |
| Not limited by distance | ||
| Frequency (8) | Frequency of training can be increased | |
| Possible to increase the number of users | ||
| Can ensure necessary frequency of rehabilitation | ||
| Appointment (6) | It is easy to clarify the start and end time of rehabilitation | |
| Easy to make appointments | ||
| Provide rehab for those who have conflicting times for training, such as work or school | ||
| Clinical | Follow-up (18) | Enables follow-up for those who have difficulty commuting to the hospital |
| Seamless access to home and hospital | ||
| Continuity (10) | Able to provide services on a sustained basis | |
| Can be implemented to the extent possible even if the patient is unwell | ||
| Easy to sustain the effect of treatment | ||
| ADL/QOL (11) | Opportunity to learn about living conditions and environment | |
| Opportunity to connect to social participation and exchange opportunities | ||
| Able to provide rehabilitation services that are appropriate for daily life | ||
| Advice can be given on problems after discharge from the hospital | ||
| Able to understand how things are going at home | ||
| Able to adjust the environment to suit the living situation | ||
| Evaluation/training (10) | Able to provide part of evaluation treatment | |
| Information obtained from family guidance, etc. is considered to be useful, including feedback | ||
| Clinical | Family (11) | Easy to provide guidance to the mother |
| Family members can observe | ||
| Can receive rehabilitation at home | ||
| Can be shared with many people | ||
| Easy to obtain cooperation from family members | ||
| Consultation (5) | Easy to consult | |
| Peace of mind through professional support | ||
| Provider | SLHT side (20) | Decreases time and cost associated with travel |
| Ease of use on the part of the therapist | ||
| Easy to use | ||
| Can receive SLHT close to home | ||
| Recording allows for documentation of training | ||
| Can provide rehabilitation to more people | ||
| Easier to take the time | ||
| Infectious | Infection (32) | No risk of infection |
| Can provide services to those who cannot intervene due to infection, etc. | ||
| Can provide rehabilitation safely |
Two categories (“device” and “clinical”) of disadvantages of telerehabilitation were extracted in the WE group (Table 5). Four themes were extracted for each device. In other words, they include “internet communication environment,” which was strongly influenced by the communication environment, “device operation,” which was mentioned as something that only those who are proficient with electronic devices such as personal computers (PCs) and smartphones can do, “sound quality” which was mentioned as something that makes it difficult to hear the distortion of synthesized sounds, and “telemedicine system” which was mentioned as a delay in its introduction in rural areas. The “clinical” category included clinical aspects such as lack of physical contact or palpation and difficulties in understanding symptoms.
| Categories | Themes (n) | Examples of comments |
|---|---|---|
| Device | Internet communication environment (4) | Strongly affected by communication environment |
| Sound is interrupted | ||
| Communication is interrupted | ||
| Operation (10) | Online setting is time-consuming | |
| Voice volume and quality are difficult to reflect | ||
| Can only be done by people who are proficient with electronic devices such as computers and smartphones | ||
| May need assistance with computer settings | ||
| Cannot start smoothly | ||
| Connection and setup of voice and camera takes time | ||
| Difficult to get people to understand how to use online tools | ||
| Difficult to see if the angle of view on the other end is poor | ||
| Significantly difficult to communicate through non-verbal means | ||
| Only patients who can enter verbal instructions can do so | ||
| Sound quality (4) | Difficult to hear synthesized sound distortion | |
| Telemedicine systems (2) | Delayed introduction in rural areas | |
| Clinical | Physical contact/palpation (3) | Inability to touch directly when needed |
| Limited stimulus input | ||
| Difficult to grasp body condition | ||
| Symptom recognition (7) | Difficult to see tongue movement | |
| Unable to confirm the user’s symptoms (including evaluation) in detail | ||
| Difficult to understand the condition of family members. Particularly unable to perform writing tasks appropriately | ||
| Difficulty in detailed evaluation | ||
| Unable to observe things off-screen | ||
| Difficult to grasp details of symptoms | ||
| Disability/Disease (6) | Sometimes encountered difficulties in cognitive function and hearing loss | |
| Developmental delays may make it difficult to respond to on-screen rehabilitation | ||
| Preschoolers have difficulty sitting in front of a screen | ||
| When dealing with aphasia and higher brain function, instructions are not communicated well | ||
| Communication is difficult for those with aphasia | ||
| Difficult to perform rehabilitation for higher brain dysfunction, especially attention tasks | ||
| Assessment/training (9) | Some tasks require assistants on the patient’s side | |
| For SLHTs, desk-based tasks are difficult to implement | ||
| Difficulty in not being able to see the family’s reaction on the screen and in providing guidance to the family | ||
| It is difficult to reassign the task when the child leaves the screen, although it is done in consideration of the amount of time the child can concentrate | ||
| Unable to evaluate using the device | ||
| In group training, everyone is a listener except the speaker | ||
| Practical (3) | It is difficult to see the chart | |
| It is easier to communicate in person | ||
| Difficult to communicate remotely | ||
| Calculation (2) | Unable to get reimbursement | |
| I couldn’t get insurance points |
Three disadvantage categories (“system,” “equipment,” and “clinical”) and 25 themes were identified in the WO group. As in the WE group, in addition to content related to reimbursement, internet communication, and operation, there were clinical disadvantages, such as difficulty in confirming the effectiveness of the clinical aspects of the system. Other disadvantages that were not mentioned in the WE group, such as limitations of the intervention content and disadvantages in terms of risk, were also mentioned (Table 6).
| Categories | Themes (n) | Examples of comments |
|---|---|---|
| System | Reimbursement (27) | Reimbursement cannot be calculated |
| Priority of work is low due to inability to calculate reimbursement | ||
| Lack of knowledge about reimbursement | ||
| Self-funded treatment (3) | Need to sign a contract for self-funded treatment | |
| Difficult to recommend when self-financing | ||
| Environment/facilities (29) | Online system is not in place | |
| Hospital system is not in place | ||
| Difficult to obtain understanding in the workplace | ||
| Requires hospital approval process | ||
| Cost associated with equipment | ||
| Operational coordination (4) | Need to coordinate with in-hospital operations | |
| Personnel shortage | ||
| Personal information (4) | Personal information may be reflected in the patient’s background | |
| Requires protection of personal information | ||
| Requires special software | ||
| Date change/time adjustment (7) |
How to contact for date and time change is tangled | |
| Not sure if it will go smoothly and on time | ||
| Support (8) | Need a support patients to provide support | |
| Equipment | Issues on the provider side (23) | Cost issues for introduction |
| Handling of equipment | ||
| Preparation of equipment environment | ||
| Quiet environment required | ||
| Impact of resolution on audio and image quality | ||
| Issues with introduction, such as explanation of procedures | ||
| Challenges on the patient side (24) | Burden on patient/family regarding equipment | |
| Differences in operation | ||
| Communication problems | ||
| Burden of communication costs | ||
| Operation (29) | Difficulties in operating equipment for the elderly and patients with higher brain dysfunction | |
| Digital equipment and operation on the patient side | ||
| Difficulty in learning to operate devices due to aging | ||
| Clinical | Quality/Effectiveness (26) | Difficult to confirm effectiveness |
| May be less effective when compared to face-to-face | ||
| No sense of accomplishment in rehabilitation | ||
| Inability to understand detailed situation | ||
| Requires high level of knowledge, skills, communication skills, etc. | ||
| Insufficient and inaccurate evaluation | ||
| When a caregiver is needed for swallowing rehabilitation, there are difficult situations such as posture and eating condition during direct training | ||
| Evidence (4) | No evidence has been accumulated | |
| Validity of examination and evaluation is not known | ||
| Targets (20) | Limited target diseases | |
| Treatment is limited to subjects for whom treatment can be completed interactively | ||
| Difficult in some areas such as aphasia, higher brain, and swallowing | ||
| Speech therapy is easier | ||
| Difficult to use for people with aphasia and others who need to devise ways to communicate | ||
| Easily affected by vision loss | ||
| Limited to those who can pay attention to the screen and respond to instructions | ||
| Elderly (18) | Elderly patients are resistant to screen-based communication | |
| Face-to-face may be more effective, e.g., for elderly patients | ||
| Children (3) | Need to devise ways to keep children focused | |
| Difficult with hyperactive child patients | ||
| Communication and rapport (19) | Difficult to feel a sense of atmosphere | |
| Difficult to instruct | ||
| Difficult to form relationships | ||
| Difficult to convey subtle nuances | ||
| Difficult to feel a sense of closeness | ||
| Difficult to know if training methods are being communicated well | ||
| Speech/Hearing (6) | Older people will have difficulty hearing | |
| People with hearing loss have more difficulty hearing with sound through a machine | ||
| Susceptibility to hearing loss | ||
| Limitations to rehabilitation (17) | Become instructional-centered | |
| Difficulty in gathering necessary information | ||
| Difficulty viewing images | ||
| Fewer clues to understand the patient’s intentions | ||
| Difficulty in teaching | ||
| Evaluation/response (26) | Observation items are limited | |
| Difficult in some areas to evaluate based on screen only | ||
| Errors in judgment | ||
| Unable to check patient performance | ||
| Palpation (28) | Cannot palpate | |
| Cannot be applied manually | ||
| Postural adjustments are difficult | ||
| Muscle strengthening exercises: “Can’t check muscle output during muscle strengthening exercises” | ||
| Speech sound evaluation (11) | Limited in assessing articulation and swallowing | |
| Unable to understand the patient’s true voice | ||
| It is difficult to accurately hear the patient’s voice | ||
| Inspection (6) | Unable to examine the oral cavity in detail | |
| Unable to see the whole body | ||
| Limitations on interventions (10) | When examination items are used, examinations cannot be performed | |
| Difficulty in utilizing picture cards, etc. | ||
| Limitations in the scope of rehabilitation content and evaluation | ||
| Difficult to implement direct training | ||
| Risk (11) | There is a risk of conducting training without proper evaluation | |
| Trouble when training effects are not as expected, etc. | ||
| Possibility of missing more symptoms, etc. | ||
| Inability to pick up all reactions | ||
| Unsure how cost-effective the user side will feel | ||
| Difficult to know if there are collaborators, degree of care burden, etc. | ||
| Activity/sociality (2) | Decreased opportunities to communicate with others | |
| For those whose outpatient visits are activities for going out, the amount of activity will decrease |
The discontinuation rate of outpatient rehabilitation owing to COVID-19 has been reported to be higher than that of inpatient rehabilitation9). Thus, the COVID-19 pandemic has had a significant impact on speech and language therapy. Consequently, telerehabilitation has been reported as a method of continuing outpatient rehabilitation in Japan8). However, we found that the number of people with experience in telerehabilitation is very small. We believe that the fact that, so few people have experience with telerehabilitation, despite the existence of COVID-19, is an indication that telerehabilitation is not widespread in Japan.
Both the WE and WO groups recognized infection control as a major advantage of telerehabilitation, which may be attributed that this survey was conducted after the pandemic had ended. In addition, the WE group identified environmental benefits, including the ability to accommodate geographically disadvantaged patients and to overcome location and time constraints, consistent with reports preceding the pandemic10,11). The COVID-19 epidemic may have made in-person rehabilitation difficult, and participants may have recognized the various advantages of telerehabilitation. In contrast, unlike the WE group, the advantages of telerehabilitation cited by the WO group were characterized by many opinions from the SLHT’s perspective, such as it being easier to find time and reducing travel time to the patient’s home. It was inferred that this was because the therapists’ perspectives were mentioned since they had not yet had the opportunity to hear the patients’ opinions, as they had not yet conducted telerehabilitation. Based on the results of this study, maintaining the frequency of intervention irrespective of the situation or location is possible, and thus contributes to the maintenance and improvement of physical and mental functions, as it can be implemented even during times of infection spread or when there are geographical problems, such as patients living in remote areas. In addition, the study suggests the benefit of reduced travel time, which can be expected to increase the number of patients who can receive interventions per day or extend the intervention time per person. Therefore, it is expected that telerehabilitation will be utilized by SLHTs who have not yet implemented it.
Regarding the disadvantages of telerehabilitation, the WE group cited disadvantages related to devices and clinical practice. For those related to devices, disadvantages such as the internet communication environment and operations, such as proficiency in operating personal computers and other devices, were cited. With advances in medical technology and infrastructure, research interest in telemedicine is growing rapidly12), and it is expected that problems will be reduced as personal computers and smartphones become even more widespread with technological advances in the future. However, it is also reported that operation of electronic devices becomes difficult in patients with impaired cognitive functions, such as those after brain injury, who are often targeted by SLHTs13,14). In order for telerehabilitation to spread in the future, it is necessary to establish a physical and human environment and support system, such as requesting family members and caregivers to assist in operation. In terms of clinical disadvantages, the respondents mentioned the inability to make physical contact during stimulus input and evaluation, limitations in understanding and assessing symptoms and diseases, and limitations in conducting training. The assessment of voice quality and volume has been shown to have low agreement between remote and face-to-face assessments15). Therefore, it was inferred that this was due to the difference in rehabilitation conducted relative to the patient.
The WO group listed similar disadvantages to those of the WE group. However, their opinions were much more diverse than the WE group’s. One reason for this is the large number of participants in the WO group. Furthermore, the opinions of “ensuring clinical quality” and “difficulty in evaluation/training” cited by the inexperienced WO group may also include a sense of caution due to never having conducted telerehabilitation. It is believed that eliminating the disadvantages and wariness felt by these WO groups will lead to the implementation of telerehabilitation.
Furthermore, a common disadvantage shared by both groups is that telerehabilitation is not covered under insurance in Japan and cannot be billed. One respondent commented, “Since it is not covered by insurance, it is not a priority”. Therefore, it is assumed that telerehabilitation will not be performed after discharge from the hospital and may be terminated. Various studies have been conducted on telerehabilitation globally, which have shown its effectiveness in treating higher brain dysfunction16). In Japan, there have been several reports on telerehabilitation in the area of speech-language-hearing therapy8,17–20). However, evidence for remote rehabilitation has not been sufficiently accumulated21,22). Therefore, it is essential to verify the effectiveness of telerehabilitation in Japan and to accumulate evidence to promote its expansion.
Telerehabilitation has been suggested as a tool for providing post-discharge support and rehabilitation to older adults living in the community and those living in remote areas. However, for the purpose of telerehabilitation to spread and be utilized in Japan in the future, it is also important to indicate its advantages (location, time, frequency, and infection control), along with further recognition that telerehabilitation can complement face-to-face rehabilitation. Moreover, informing not only the SLHTs but also the patients and their assistants about the methodology of telerehabilitation is important.
This study had two limitations. First, this study is based on a survey questionnaire, and the opinions of SLHTs who did not respond to the survey questionnaire were unavailable. Second, the survey respondents included a group of SLHTs professionally related to authors and those who were found on the Internet. Therefore, it is possible that their responses were influenced by their relationships with the authors. Third, the sample size of WE group was too small compared to WO group, which may have introduced bias.
A questionnaire was used to investigate the advantages and disadvantages of telerehabilitation for SLHTs. This study shows that telerehabilitation has various advantages and the potential to be used for prevention and post-discharge support. However, evidence should be accumulated further to resolve the disadvantages of telerehabilitation for its widespread use in the future.
The authors express their deepest gratitude to all participants of this study.
Conceptualization, Ashiga H., Kojima K., and Omori F; methodology, Ashiga H., Kojima K., and Omori F; validation, Ashiga H., Kojima K., and Omori F; formal analysis, Ashiga H. and Kojima K.; investigation, Ashiga H., Kojima K., and Omori F; data curation, Ashiga H. and Kojima K.; writing—original draft preparation, Ashiga H.; writing—review and editing, Kojima K., Omori F., and Fujiu-Kurachi M.; visualization, Ashiga H. and Kojima K.; supervision, Fujiu-Kurachi M.; project administration, Ashiga H. and Fujiu-Kurachi M. All authors have read and agreed to the published version of the manuscript.
The authors declare no potential conflicts of interest with respect to the research, authorship, or publication of this article.
None.
