Table 1.

Characteristics of Studies Identified in the Systematic Review

Study	Intervention and Participants	Study Aim	Methods	Results/Outcome
Fairweather et al. 2016 Australia	Intervention targeting speech sounds, receptive/expressive language, pragmatics and phonological awareness. N=19, average age 7.8 years (range 3–12yrs). Four SLPs	To investigate the effectiveness, feasibility and acceptability of a SLP teletherapy (TH) program for children in rural and remote areas.	Study Design: Pre/post design, reporting on degree of progress in TH tx as noted by GAS results. Equipment: Webcam enabled laptops, desktop computers or iPads, 1 of 3 low-bandwidth VC platforms (Adobe, Facetime or Skype), headsets and microphones Procedure: GAS goals developed in collaboration with supporting adults in child’s local environment. Participants received 6× 30mins SLP teletherapy sessions on a fortnightly basis using Come N See (CNS) program over a 12-week period. Semi-structured interviews conducted with parents four weeks prior to the conclusion of the sessions.	31 goals (68.9%) were achieved at either an expected or greater than expected level. Of the 19 participants, 15 (78.9%) achieved at least one goal at the expected level or beyond. 8 children (42.1%) achieved all goals. T-scores revealed 73.68% of the participants achieved at or above the expected level after up to 6 30-minute teletherapy sessions. Parents felt telehealth intervention was feasible but engagement and acceptability would be improved with regular communication between stakeholders.
Gabel et al. 2013 USA	Speech & language Tx Children. Grade – K-12 Telepractice group N=71, 63.4%M/ 36.6%F. Age 5–15 yrs. NOMS database group - N=5332, 67%M and 33%F Three SLPs	To study the effectiveness of a telepractice SLP program for school-age children by comparing data from a student sample receiving telehealth intervention with data from direct, in-person services	Study Design: Method comparison study, reporting on level of progress based on FCM scores. Equipment: Polycom videoconferencing software, desktop computers, webcam with built-in microphone, headsets, 128kbit/s internet link. Procedure: Participants in TH-led condition were compared to data from direct, in-person services available from the ASHA K-12 National Outcomes Measurement System (NOMS) database. Outcome data measured through FCMs. Participants in telepractice group received 20 minutes of therapy weekly.	70% of telepractice participants progressed one or more levels of the FCMs. Improvement varied across difficulties studied, but best outcomes identified for intelligibility and speech sound production intervention. Data compared favourably with NOMs database for same intervention. Data from telepractice participants receiving spoken language comprehension and production information differed from NOMs database with a higher percentage of participants making no progress and a lower percentage progressing multiple levels.
Grogan-Johnson et al. 2010 USA	Intervention for spoken language production, speech sound production and/or intelligibility. N=38 (13F, 25M). Age range 4–12 years. Group 1 - N= 17 Group 2 - N = 17 Four SLPs	To investigate the results of speech language therapy provided through TH compared to in-person tx.	Study Design: Single subject time-series (A–B) repeated measures design, reporting comparison across measurements taken at three points in time (beginning, middle and end of project). Equipment: Computer-based videoconferencing, headphones and a document camera. Procedure: Participants were treated in two groups – group 1 received TH tx for 4 months and then subsequently in-person therapy for 4 months. Group 2 received in-person therapy for 4 months, then TH therapy for 4 months. Participants were randomly allocated to the groups. Outcome measures were student progress on GFTA-2 and NOMS database, participant satisfaction and any interruptions to service delivery.	No significant difference in GFTA-2 scores between participants in the two treatment groups at pre-test (p=0.16); following the first treatment period (p=0.06) and second treatment period (p=0.21). Student progress reports after the first tx period identified that adequate progress or mastery was achieved for 75% of objectives in both conditions. Following second tx period mastery or adequate progress was achieved for 88% of objectives in TH and 84% of objectives for the in-person model – significant difference (p=<0.05). All participants expressed a high satisfaction with the delivery of services, progress achieved, comparison with in-person intervention and general attitude towards TH.
Grogan-Johnson et al. 2011 USA	Speech sound disorder intervention N=13 (11M, 2F). Age=6–11yrs. All children with a speech sound disorder. Telehealth group – N=7 In-person group – N=6 Two SLPs	To examine whether speech intervention using computer-based materials with school-age students via telehealth is comparable to services delivered via a in-person SLP.	Study Design: Method comparison study, reporting statistical difference between TH and in-person conditions. Equipment: Desktop computer, webcam with microphone and headset. custom TH system with real-time VC with 128kbit/s internet link and TinyEYE Speech Therapy software. Procedure: Both groups received traditional speech sound intervention for 20 minutes weekly. Multiple measures of progress assessed: 1) Pre- and post-testing using GFTA-2; 2) comparison of pre-intervention baselines with production levels post-intervention; and, 3) comparison of quarterly progress reports.	No significant difference between the TH and in-person groups on the pre- (p = 0.805) and post-tests (p = 0.805). Both groups had a significant improvement in performance (p = 0.14). Children in both SDMs improved significantly in their speech production with the telehealth students demonstrating greater IEP goal mastery.
Grogan-Johnson et al. 2013 USA	Speech sound therapy N=14. Telepractice group: N=7, Avg age=8.4yrs, range= 6.4–9.9yrs Side-by-side group: N=7, avg age=9yrs, range= 7.9–10yrs Two SLPs	To investigate telehealth-delivered intervention services by comparing speech sound intervention delivered to children in either a telepractice or in-person delivery model in an intervention program.	Study Design: Method comparison study, reporting statistical difference between TH and in-person conditions. Equipment: Laptop, web-camera with microphone and headset. Polycom VC system with 128kbit/s internet link. Procedure: Both groups received traditional speech sound intervention for 30 minutes twice per week for a 5-week period. Participants were randomly assigned to either the in-person or TH condition. Multiple measures of progress assessed: 1) pre- and post-intervention testing conducted using subtests of GFTA-2; and 2) pre-and post-recording of single word identification task.	No significant difference found between two groups on post-intervention GFTA-2 through repeated measures ANOVA (p=0.415). No statistically significant difference between the mean listener judgements for the two groups on the pre-test (p=0.160) but a statistically significant difference in mean listener judgements across time for both groups (p=0.007). Thus, both groups benefitted from intervention and that benefit was the same regardless of intervention condition.
Isaki et al. 2015 USA	Speech and/or language intervention Child participants – N=5. Mean age 7.1yrs (range 4.5–9.8 yrs) Adult participants –(not reported in review)	To evaluate the effectiveness of Apple iPads to deliver telepractice speech and/or language services.	Study Design: Pre/post design, reporting on degree of progress in TH tx as noted by achievement of goals. Equipment: Apple iPads with Facetime. Procedure: All participants received individual telepractice therapy for a total of 15 weeks per academic semester. Sessions were provided weekly for 30–45 minutes.	Participants met the majority of their therapy goals with the paediatric participants meeting at least 33% of the speech goals and 100% of the language goals. Satisfaction surveys revealed no significant change of opinions about telehealth following the intervention (p>0.05). Clinicians indicated the need to resolve technical problems with use of iPads.
Jessiman 2003 USA	Speech sound therapy and improving understanding and use of language forms (noun and verb forms, & linguistic concepts) N=2. School-aged (exact age unknown) One SLP	Field report providing preliminary information on the use of the TH technology in the provision of speech and language assessment and treatment services for 2 school-aged children.	Study Design: Pre/post design, reporting agreement between TH and in-person conditions for assessment and degree of progress in TH intervention as noted by clinical observations, informal probes and parent feedback. Equipment: custom TH system with real-time VC, document camera, room cameras and television monitors Procedure: Structured Photographic Articulation Test conducted through TH then in-person 3 days later. Language Ax (TOLD-P:3) conducted only in-person. Tx conducted twice weekly for a 2-month period through TH. Client satisfaction documented via surveys obtained post-treatment.	Inconsistency with detection of speech sound errors between TH and in-person model. Accuracy increased with use of lapel microphones creating increased agreement between conditions. Child A and Child B progressed in their speech and language goals over the 12 sessions. Child A’s progress more substantial than Child B. Reliability and validity not reported. Parents reported satisfaction with the telehealth service and the gains child made during therapy.

Note. Ax = Assessment; CAS = Childhood Apraxia of Speech; F = Female; FCM = Functional Communication Measures; GAS = Goal Attainment Scaling; GFTA-2 = Goldman-Fristoe Test of Articulation – 2^nd edition, IEP = Individual Education Plan; M = Male; Mx = Management; N = number; SDM = Service delivery model; SLP = Speech Language Pathology/ist; TH = Telehealth; tx = treatment; VC = videoconferencing.