Accepted Manuscript

Title: Evaluating satisfaction of patients with stutter regarding

the tele-speech therapy method and infrastructure

Authors: Maryam Eslami Jahromi, Leila Ahmadian

PII: S1386-5056(18)30196-5
DOI: https://doi.org/10.1016/j.ijmedinf.2018.03.004
Reference: IJB 3670

To appear in: International Journal of Medical Informatics

Received date: 10-12-2017

Revised date: 1-2-2018
Accepted date: 15-3-2018

Please cite this article as: Maryam Eslami Jahromi, Leila Ahmadian,
Evaluating satisfaction of patients with stutter regarding the tele-speech
therapy method and infrastructure, International Journal of Medical
Informatics https://doi.org/10.1016/j.ijmedinf.2018.03.004

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Evaluating satisfaction of patients with stutter regarding the tele-speech
therapy method and infrastructure

Maryam Eslami Jahromia, Leila Ahmadianb,*

a
Health Service Management Research Center, Institute for Futures Studies in Health, Kerman
University of Medical Sciences, Kerman, Iran.

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b
Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University
of Medical Sciences, Kerman, Iran.

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*Corresponding author at:
Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University
of Medical Sciences, Kerman, Iran.

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Haft-bagh Highway, Kerman, Iran, PO Box: 7616913555
Email: ahmadianle@yahoo.com; l.ahmadian@kmu.ac.ir (L. Ahmadian)

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Highlights


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Participants in general were satisfied with the tele-speech therapy method.
 Tele-therapy is a practical method when speech therapists are not available.
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 Poor Internet connection is one of the main challenges in tele-speech therapy.

 Availability of tele-speech therapy encourage patients to recommend this to others.
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Abstract
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Objective: Investigating the required infrastructure for the implementation of telemedicine and
the satisfaction of target groups improves the acceptance of this technology and facilitates the
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delivery of healthcare services. The aim of this study was to assess the satisfaction of patients with
stutter concerning the therapeutic method and the infrastructure used to receive tele-speech therapy
services.
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Methods: This descriptive-analytical study was conducted on all patients with stutter aged
between 14 and 39 years at Jahrom Social Welfare Bureau (n=30). The patients underwent speech
therapy sessions through video conferencing with Skype. Data were collected by a researcher-
made questionnaire. Its content validity was confirmed by three medical informatics specialists.
Data were analyzed using SPSS version 19.
Results: The mean and standard deviation of patient satisfaction scores concerning the
infrastructure and the tele-speech therapy method were 3.15±0.52 and 3.49±0.52, respectively. No
significant relationship was found between the patients satisfaction and their gender, education
level and age (p>0.05). The results of this study showed that the number of speech therapy sessions
did not affect the overall satisfaction of the patients (p>0.05), but the number of therapeutic
sessions had a direct relationship with their satisfaction with the infrastructure used for tele-speech

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therapy (p<0.05).
Conclusions: The present study showed that patients were satisfied with tele-speech therapy.

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According to most patients the low speed of the Internet connection in the country was a major
challenge for receiving tele-speech therapy. The results suggest that healthcare planner and policy

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makers invest on increasing bandwidth to improve the success rate of telemedicine programs.

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Keywords

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Adoption, Patient Satisfaction, Speech Therapy, Telerehabilitation, Videoconferencing.
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1. Introduction

Stuttering is a communication disorder that in long-term it can upset the quality of life of the
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affected people [1]. The treatment of these people is prevents many negative effects of this problem
on their occupational, social, emotional and educational performances [2, 3]. Due to problems such
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as the lack of adequate therapists in some areas, transportation costs and long waiting times for
receiving services, access to speech therapy services is difficult [4]. Recent advances in the field
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of information and communication technology is overcoming these barriers and supports the
provision of tele-health services, especially in the field of rehabilitation [5]. The American Speech-
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Language-Hearing Association (ASHA) stated that tele-practice is an appropriate model for

providing services and removing access barriers [6]. Tele-rehabilitation suggested as a solution for
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the treatment of stutterers [7].

Currently, there are many video conferencing software on the market, one of which is Skype
[8]. The ease of use and low cost of Skype has made it popular [9]. Since this program requires a
minimum of technical skills [10], it can be used for providing the remote therapy services to public.
So far, several studies have been done on remote therapy. The results of these studies has supported
the use of tele-speech therapy as an effective alternative method when speech therapists are not
available, and has shown the feasibility of delivery of tele-speech therapy services [11-15]. In
addition, studies have shown the satisfaction of individuals receiving the treatment through video
conferencing [16, 17], and attractiveness of this method of providing services. Other studies also
reported that receiving treatment through video conferencing save patients time [18, 19] and
related costs [20].

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While several studies have been conducted on tele-speech therapy services in various

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countries such as the United States [13, 21], Australia [11, 22], Canada [23], Italy [15] and South
Korea [16], so far no studies have been done in this regard in Iran. As the national information

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infrastructure plays a key role in the success of telemedicine programs, evaluating this
infrastructure in the early phases of implementation helps policymakers to plan for successful

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programs. The aim of this study was to determine the satisfaction level of stutterers concerning the
tele-speech therapy treatment and the infrastructure used to provide this service. The results of this
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study can indicate the acceptance of this technology among patients. It can also help policymakers
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to determine the adequate infrastructure required to set up tele-speech therapy.
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2. Methods

2.1. Study design

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This descriptive-analytic study was conducted to determine the satisfaction level of patients with
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stutter regarding tele-speech therapy in 2017.

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2.2. Participants

The study population was composed of patients admitted to rehabilitation centers covered by the
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Jahrom Social Welfare Bureau during a 3-month period. Both two rehabilitation centers covered
by this bureau were included and all 30 patients admitted to these two centers were enrolled in the
study. The inclusion criteria were; patients aged 14 or higher, suffering from stuttering disorder,
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and having experience with conventional face to face treatment. To prevent the heterogeneity of
participants we decided to recruit patient with advanced stutter. According to Guitar's
categorization [24] for stuttering patients, advanced stutter is from the age of 14-years and above.
Guitar determined four levels of stuttering. Borderline stuttering occurs during the ages of 1.5 - 6,
beginning stuttering spans the ages of 2 - 8, intermediate stuttering spans the ages of 6 - 13, and
an individual is classified as an advanced stutterer from the age of 14-years and above. Patterns of
stuttering with tension, escape, and avoidance behaviors at this age are firmly established.

2.3. Tele-speech therapy

In order to hold tele-speech therapy, depending on the patient's condition and the severity of
stuttering, the number of treatment sessions was first determined by the speech therapist. Then

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patient treatment sessions were held via video conferencing through Skype. We used Skype
because it has become very popular among Iranian users and it can be used by any person with a

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low speed Internet connection (the minimum speed of Skype for video calls is 128 kbps) [25].
Moreover, it has been shown that using Skype through computer-to-computer is completely secure

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as Skype has a proprietary encryption protocol [26-28]. Therefore, in this study, the therapy
sessions were held through computers. To preserve the confidentiality of patient information the

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patient credentials were not used in their Skype accounts and their demographic and clinical

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information were not exchanged. Also, audio and video communication between patient and
speech therapist was not recorded. The patients’ names were not recorded on the assignment
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exchanged through the Skype. Patients were also assured about the confidentiality of their
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information.

2.4. Data collection and tool

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The data collection tool was a researcher-made questionnaire designed by the review of the
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literature [12, 13, 16-19, 29] and consultation with medical informatics specialists. The
questionnaire contained four sections. The first section was related to demographic information of
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participants (4 questions), the second section consisted questions related to satisfaction regarding
the infrastructure used to deliver tele-speech therapy (12 questions), the third section comprised
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questions on patient's satisfaction regarding the treatment method (25 questions), and the fourth
section contained three open-ended questions about the advantages and disadvantages of a remote
treatment method compared to the conventional face-to-face method, and their preferred treatment
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method. The answers to the questions about measuring satisfaction (second and third sections of
the questionnaire) were collected using a five-point Likert scale from very low to very high
satisfaction.
The validity of the questionnaire was verified by three medical informatics specialists. The
test-retest method was used to determine the reliability of this questionnaire. To do this, ten
participants completed the questionnaire after the speech therapy sessions. Two weeks later, they
completed the same questionnaire and the correlation coefficient was calculated which was equal
to 0.93. In order to collect data, the researchers distributed 30 questionnaires among the study
population during their last treatment session.

2.5. Data analysis

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Data analysis was done using descriptive and analytical statistics using SPSS software version 19.
We assigned the scores between 1; very low and 5; very high to the participants satisfaction with

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each item. The statistical mean of 3 was considered as a cut-off-point for the analysis so that the
satisfaction scores higher than three were considered as desired satisfaction. The non-parametric

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point-biserial correlation coefficient test was used to examine the relationship between participants
gender and the research variables, i.e. overall satisfaction and satisfaction with the infrastructure

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and the treatment method. Spearman's correlation coefficient was used to evaluate the relationship
of participants’ age, education, and the number of their therapeutic sessions, with their overall
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satisfaction, and the satisfaction regarding the infrastructure and treatment method.
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2.6. Ethics
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The study was approved by the Research Ethics Committee of Kerman University of Medical
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Sciences (Code of Ethics: IR.kmu.REC.1396.1085). The participants also participated with

informed consent in the study and were assured about the confidentiality of their information. All
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participants signed a printed consent form before participation in the study. For patients younger
than 18 year old, parents or legal guardians gave their consents. The study objective was explained
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to this group of patients in presence of their parents and when both patients and parents were
agreed on the participation in the study, the form was signed by the parents.
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3. Results

In total, all patients with stuttering who admitted to the centers and received tele-speech therapy
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answered the questionnaires (100%). Participants consisted of 56.7% male and 43.3% female with
a mean age of 23.23±6.39. More than half of them had a non-academic degree (56.6%). More than
one third of the patients with an academic degree had undergraduate degrees (36.7%). The number
of speech therapy sessions for each patient varied from 4 to 20 sessions (table1).
 Table 2 shows the patients' satisfaction with the infrastructure used for tele-speech therapy.
More than half of the patients (n=16, 53.3%) reported that the quality of the sound was “high” or
“very high”. Most of the participants (n=24, 80%) reported a “low” or “very low” quality for the
image of the therapist shared during speech therapy. Half of the participants (n=15, 50%) stated
that the quality of the Internet connection was "low" or "very low". About 70% of the participants
mentioned that the computer hardware and the headset used during the tele-speech therapy were

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appropriate.

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Table 3 shows the patients' satisfaction with tele-speech therapy method. The majority of the
patients (n=24, 80%) couldn’t have a good eye contact with speech therapists through this method

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of the treatment. Most patients considered tele-speech therapy method as good as conventional
face-to-face method.

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Figure 1 shows the mean and standard deviation of the overall satisfaction scores of the

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participants and its components (satisfaction of the patient with the infrastructure and therapy
method). In total, the scores of overall satisfaction and its components were higher than the
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statistical average.
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Table 4 presents the relationship between satisfaction score and patients’ gender, education,
age and the number of treatment sessions. The results showed that there was no significant
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relationship between gender and the scores of overall satisfaction and satisfaction with its
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components (the infrastructure and the therapeutic method) (p>0.05). The results of the Spearman's
correlation coefficient showed that participants education and age had no significant relationship
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with the scores of overall satisfaction and satisfaction with its two components (p>0.05).
There was also no significant relationship between the number of treatment sessions with overall
satisfaction score and the satisfaction score related to therapeutic method (p>0.05), but the
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relationship between the number of treatment sessions and the satisfaction score related to
infrastructure was significant (p<0.05). The higher the number of treatment sessions, the greater
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the satisfaction score related to the infrastructure.

In response to the question about the advantages and disadvantages of the tele-speech
therapy method compared to a conventional face-to-face method with a speech therapist, all
participants (n=30) believed that tele-speech therapy saves their time, as the time spent on traveling
and in the waiting room will be eliminated. On the other hand, from the patients’ point of view,
the provision of tele-speech services saves travel costs. Concerning the disadvantages of this
method of treatment, participants stated that they should spend some time preparing the
environment for communication, and sometimes due to the low speed of the Internet connection,
the communication was not as good as it should be. The Internet speed variation, which
occasionally interrupted the image or sound of the therapist, led to difficulty in understanding the
instructions and tasks given by the therapist during the treatment session. Moreover, eye contact

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and the nature of communication were not well established, and it was difficult to express feelings
and understand facial expressions. The sense of seriousness and attendance at a completely formal

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meeting was diminished and resulted in taking the tasks or training assignments less serious.

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Most of the participants (n=24) mentioned that the preferred method of treatment is the
conventional face-to-face treatment method. Participants believed that the conventional

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therapeutic method has many advantages over tele-speech treatment and preferred to refer to the
nearest therapist if there is any nearby, unless it is not possible to find a good therapist or it is
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required to visit a more experienced therapist in another place.
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4. Discussion
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The results of this study showed that the participants, in general were satisfied with the tele-speech
therapy method and they believed that the applied infrastructure used for this treatment is
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appropriate. Patients reported that the services provided by telecommunications improved their
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condition and they were interested in receiving this type of treatment. Their satisfaction and
availability of this method encourage patients to also recommend this therapeutic method to others.
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Although the quality and speed of the Internet connection, as well as the clarity of the image
transmission, were not sometimes favorable for communication during speech therapy, and
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patients could not have eye-to-eye contact with the speech therapist, they believed that this
treatment is appropriate and would save their time and money. Moreover, they believed that this
type of treatment could meet their expectations as they can understand the assignments determined
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by the therapist during the treatment. However, as they did not have direct eye contact and faced
with a delay in displaying videos due to low Internet connection sometimes it was difficult for
them to concentrate on the treatment during the whole time of treatment session. This issue was
stated by the patients when they answered the open-ended questions at the end of the questionnaire.
 The findings of the present study showed that patients with any age, sex, and education level
had the same satisfaction with tele-speech therapy. Moreover, repeated use of the applied required
infrastructure for providing tele-speech therapy led to more satisfaction with this infrastructure as
patients who had passed more therapeutic sessions, took more satisfaction score regarding this
infrastructure. The reason for this is the learning effect due to more interacting with the system
and the greater acceptance due to repetition.

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Several studies have examined the satisfaction of individuals in the field of tele-speech
therapy. In Fridler study [12], the satisfaction of aphasia patients with tele-speech therapy

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compared to the conventional face-to-face method was investigated. All patients had been satisfied
with the tele-speech therapy method and accepted this method the same as the conventional

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method. They only raised concern about the interaction with the therapist, which was more
favorable to them in face to face treatment. In the present study, more than half of the patients had

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less convenience in interacting with speech therapists in remote therapy. In accordance to the

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present study that 86.7% of the participants believed that tele-speech therapy was effective in
improving their condition, in the study done by Carey [18] the mean patients' satisfaction score of
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stutters improved from a score of 6.8 out of 9 (1= very satisfied; 9= extremely dissatisfied) before
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tele-rehabilitation to 2.7, 12 months after the maintenance stage of a therapeutic program. The
results of this study showed that 66.7% of the participants would also like to participate in tele-
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speech therapy programs in the future. A higher percentage of the participants (83%) in the
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Grogan-Johnson study [13] were enthusiast to receive tele-speech therapy services through video
conferencing. The results of the Ciccia study [29] on children's speech, language, and hearing
screening using Skype showed that families had a high level of satisfaction with the applied
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technology and video conferencing used to assess the children, and assigned an average score 4.4
out of 5 to this method of screening. Satisfaction surveys in the Johnson study [21] showed that
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students and parents strongly supported the provision of tele-speech services, and as our study
concluded, video conferencing was a good way to provide speech-language health services.
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Another study [17] investigate the satisfaction of parents, teachers and school administrators in a
remote North Carolina village regarding the achievement of speech-language goals for learners
and facilitating access to care providers and showed a satisfaction score more than 4 out of 5. Most
patients receiving the services in the present study stated that the provision of tele-speech therapy
would save the cost of the treatment. Towey's study [20] also looked at the cost savings of
telemedicine and by providing tele-speech therapy to 7 patients with vocal cord dysfunction, it was
concluded that this method could reduce the costs in the first month up to 72%, and treatment
results through tele-speech therapy were considered successful. In the Choi's study [16], patients
with chronic aphasia had a high degree of satisfaction with an average score of 4.88±0.35 out of 5
regarding tele-speech therapy, and this treatment was effective and practical for them. In
Constantinescu’s study [7], all participants were also satisfied with the online evaluation of speech

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disorders in patients with Parkinson's disease. In Carey's study [19], adolescent considered tele-
speech therapy useful and convenient, and the only challenge that they reported on web-based

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services compared to the clinic visit was the technical problems such as computer hardware
problem. In this study, unlike the present study participants would more prefer to use

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telecommunication as a preferred method if they need treatment in the future. In the study done by
Ciccia [29], participants also preferred to see the specialist through video conferencing. While in

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our study, the preferred method for receiving treatment for most of the participants was a

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conventional face-to-face method. The reason for this difference may relate to poorer infrastructure
and lower Internet connection in Iran. In the Alizadeh et al study. [30], 86.7% of medical students
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participating in the study reported that high-speed Internet connection is the most important factor
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in the development of telemedicine projects. In a study done by Hayavi Haghighi and colleagues
[31], regarding the feasibility of the implementation of telemedicine at one of the universities in
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Iran, it was concluded that the current Internet bandwidth of the university is only suitable for
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implementation of lowest level of telemedicine projects and solving this infrastructure problem for
providing optimal use of telemedicine is necessary. In Carey’s study [11], treatment for adults
with stuttering through Camprdown program with tele-phone showed that most of the participants
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were comfortable with receiving tele-health treatment, and if the speech therapists are not
available, they would be willing to do a remote rehabilitation again. The Bridgman et al. [14] also
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supported the webcam Lidcombe program for preschool children, as well as treatment at the clinic,
and all children achieved satisfactory treatment outcomes and their stuttering was reduced.
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Agostini's study [15] also confirmed the feasibility of tele-therapy in patients with anomia after a
stroke. The Lincoln study [22] showed delivery of tele-speech therapy services to children was
very acceptable to the school children in New South Wales, Australia. In general, the participants
were satisfied with the technology and reported that occasional technology problems were
expected. In agreement with our study, participants in the study of Sicotte [23] had a high degree
of satisfaction with remote therapy and reported that interactive video conferencing could provide
a model for providing feasibility and effectiveness care in the absence of a physical service
provider.
In our study, we measured the patient satisfaction with tele-speech therapy in two separated
dimensions including therapy method and applied infrastructure. This makes it possible for
policymakers to distinguish, in case of patients’ dissatisfaction, where the problem is and to help

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them to stay focused on the exact problem. If the tele-therapy method is acceptable, but the poor
infrastructure is the issue raised by the patients, they can improve the acceptance of this treatment

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by providing and upgrading the required infrastructure.
Since this study is the first experience of tele-speech therapy, it is not realistic to expect a

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high degree of satisfaction, in fact, continuing this therapy beyond this study period and regular
repetition and frequent use of this treatment infrastructure will improve the results. On the other

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hand, because of weakness in infrastructure and facilities in Iran, the results of this study is only

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generalizable to countries with the same situation. According to the Akamai’s report on state of
the Internet, in the first quarter of 2017, Iran, at an average speed of 4.7 Mbps of Internet speed,
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has ranked 107th out of 149 countries [32]. Other countries with a similar Internet connection to
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Iran, can make use of our results and apply this kind of intervention. Due to the centralized health
system in Iran, the organizational structure of all Iranian rehabilitation centers is similar and the
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results of this research are useful for domestic rehabilitation centers. All participants responded to
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our questionnaire and this increased the accuracy of the study. This could be due to the fact that at
the beginning of the study, patients were told that after using the tele-speech therapy services, a
questionnaire will be provided and completion of the questionnaire will help policymakers to set
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up these types of services. The opinions and outcomes of stuttering patients, depending on the
severity and type of speech impairment, may be different and affect their responses to questions.
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Subsequent studies can be used to investigate the satisfaction of different groups of patients with
different problems. Considering that qualitative study can collect participant's opinions deeply.
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Therefore, in the next phase of the study, we are going to evaluate patient's perspective
qualitatively.
Nowadays, health centers in Iran start to implement tele-practice projects and assess this
kind of projects [33, 34]. Our evaluation in this study showed that not only the patients feel
satisfied with the treatment, but also they felt this treatment method was effective and improve
their condition. Therefore, the results of this research can provide useful insight to health
policymakers and managers for the implementation of tele-speech therapies. In this regard, it is
recommended that the managers of the rehabilitation centers evaluate the readiness of the centers
in terms of the necessary technical infrastructure and, in order to set up a successful tele-speech
therapy program. This can help them to develop a successful program and deal with existing
barriers before to start. Healthcare policy makers need to invest in increasing the Internet

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bandwidth for rehabilitation centers and upgrading telecommunications equipment to increase the
speed of communication lines in order to benefit from the introduction of tele-speech therapies.

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5. Conclusions

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Considering the results of this research it is feasible and acceptable to implement and make benefit
of tele-speech therapy method. The application of new technology-based methods in improving

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the health and treatment of patients will increase access to health care and thus increase patient

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satisfaction. Remote therapy as a flexible method provides patients with access to the therapist at
any time and place, and this kind of treatment enables patients to actively participate in their own
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care. Due to the low Internet connection in the country, policymakers must invest more to increase
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the Internet bandwidth. This can help health authorities to benefit more from tele-practice method
in providing health care especially when the therapist is not available.
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Authors’ contributions
All the authors participated in writing the article and revising the manuscript.
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Miss. Maryam Eslami Jahromi collected and analyzed the data and wrote the first draft of the
manuscript.
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Dr. Leila Ahmadian participated in the design and concept of the study and revised the manuscript
critically.
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Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or
publication of this article: This study resulted from research project No. 96.10.60.532 funded by
Kerman University of Medical Sciences.
Conflict of Interest
The authors declared no potential conflicts of interest with respect to the research, authorship
and/or publication of this article

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Summary points

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What was already known about the topic?
 Access to speech therapy services due to lack of adequate therapists in some areas,

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transportation costs and long waiting times for receiving services is difficult.
 Remote health services improved availability and accessibility of health care services.
 Providing care through videoconferencing can save patients’ time and costs.

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What this study added to our knowledge?
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Tele-speech therapy is feasible and acceptable therapeutic approach among patients.
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 Policymakers must invest more on infrastructure and improve the Internet bandwidth to
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have an effective telepractice.

 The application of new technological-based methods in improving the health and treatment
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of patients will increase access to health care and thus increase patient satisfaction.
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Acknowledgments
The authors thank the authorities and speech therapists in the rehabilitation centers who sincerely
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cooperated in this research. They also grateful to Dr. Kambiz Bahaadinbeigy for his consultation
for running the project. The authors also would like to thank the participants for their cooperation
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in completing the questionnaires.

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Books.
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Journal of Research in Behavioural Sciences, 2015. 12(4): p. 593-601.
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CC
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 4.5

3.49
3 3.32
3.15
Mean+SD

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1.5

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0

SC
Overall Infrastructure Treatment method
Patient Satisfaction

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Figure 1. Mean and standard deviation of overall satisfaction and its components scores.
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A
M
D
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EP
CC
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Table1. Demographic characteristics of participants in the study

Demographic Information N %

Gender
Male 17 56.7
Female 13 43.3

Age

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<20 12 40
20-29 14 46.6
30-39 4 13.3
>40 0 0

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Educational degree
High school and lower 7 23.3

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Diploma 10 33.3
Associate's 1 3.3
Bachelor's 11 36.7
Masters's 1 3.3

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N Mean
Number of treatment sessions N
4-20 15.1
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Table 2. Patients satisfaction regarding applied infrastructure for tele-speech therapy.

Questions regarding infrastructure Very low Low Partial High Very high
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N (%) N (%) N (%) N (%) N (%)

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To what extent was the voice of

0 (0) 0 (0) 13 (43.3) 14 (46.7) 3 (10)
therapist clear to you?
To what extent was the sound speed
1 (3.3) 10 (33.3) 7 (23.3) 12 (40) 0 (0)
EP

suitable for speech therapy?

How good was the quality of sound
when communicating during speech 0 (0) 2 (6.7) 12 (40) 15 (50) 1 (3.3)
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therapy?
To what extent was the speech
0 (0) 14 (46.7) 13 (43.3) 3 (10) 0 (0)
therapist's image clear to you?
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How good was the speed of playing

8 (26.7) 16 (53.3) 5 (16.7) 1 (3.3) 0 (0)
video during speech therapy?
How good was the image quality
when communicating during speech 1 (3.3) 8 (26.7) 17 (56.7) 4 (13.3) 0 (0)
therapy?
 How appropriate was the size and the
distance of the speech therapist in 0 (0) 2 (6.7) 7 (23.3) 13 (43.3) 8 (26.7)
your monitor frame for you?
How good was the Internet connection
1 (3.3) 9 (30) 13 (43.3) 7 (23.3) 0 (0)
status during speech therapy?
To what extent was the quality and
speed of the Internet connection
4 (13.3) 11 (36.7) 12 (40) 3 (10) 0 (0)
suitable for communication during

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speech therapy?
To what extent was the computer
hardware appropriate for performing 0 (0) 3 (10) 6 (20) 12 (40) 9 (30)

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speech therapy?
How appropriate was the instrument
0 (0) 2 (6.7) 9 (30) 10 (33.3) 9 (30)

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used (headset) for speech therapies?
How appropriate was the software
(Skype) used to perform speech 1 (3.3) 7 (23.3) 9 (30) 10 (33.3) 3 (10)

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therapy?

N
Table 3. Patient satisfaction regarding tele-speech therapy approach.
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Questions regarding satisfaction of Very low Low Partial High Very high
tele-speech approach N (%) N (%) N (%) N (%) N (%)
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How understandable was the sound of

a speech therapist through a computer 0 (0) 0 (0) 6 (20) 19 (63.3) 5 (16.7)
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for you?
How well were you able to
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communicate with the image of the

7 (23.3) 8 (26.7) 10 (33.3) 3 (10) 2 (6.7)
speech therapist through the
computer?
EP

To what extent did this treatment meet

0 (0) 2 (6.7) 10 (33.3) 13 (43.3) 5 (16.7)
your expectations?
Are you still willing to take part in this
CC

2 (6.7) 2 (6.7) 6 (20) 9 (30) 11 (36.7)

treatment?
To what extent do you recommend
1 (3.3) 1 (3.3) 3 (10) 8 (26.7) 17 (56.7)
this treatment to others?
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How easy was to use this treatment

0 (0) 4 (13.3) 10 (33.3) 11 (36.7) 5 (16.7)
approach?
How good was the tele-speech therapy
compared to conventional face to face 0 (0) 2 (6.7) 5 (16.7) 10 (33.3) 13 (43.3)
therapy?
To what extend did this tele-speech
therapy provide you long-term 2 (6.7) 5 (16.7) 13 (43.3) 9 (30) 1 (3.3)
therapeutic goals?
How easy was to ask questions and
8 (26.7) 12 (40) 3 (10) 6 (20) 1 (3.3)
express your concerns remotely?
How much time did your therapist
0 (0) 1 (3.3) 5 (16.7) 14 (46.7) 10 (33.3)
spend to answer your questions?
Have you had less time during tele-

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speech approach compared to 0 (0) 5 (16.7) 5 (16.7) 11 (36.7) 9 (30)
conventional face to face method?
How much were you comfortable with

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1 (3.3) 5 (16.7) 14 (46.7) 8 (26.7) 2 (6.7)
this treatment approach?
How much was the interaction with
6 (20) 14 (46.7) 6 (20) 3 (10) 1 (3.3)

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speech therapist convenient?
How much can you use this treatment
without the need for someone else's 0 (0) 5 (16.7) 5 (16.7) 6 (20) 14 (46.7)

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help?
How satisfied are you with the service
0 (0) 2 (6.7) 9 (30) 11 (36.7) 8 (26.7)
provided?
To what extent was the therapy
N
A
delivered to you by Speech Therapist 0 (0) 1 (3.3) 3 (10) 11 (36.7) 15 (50)
effective to improve your condition?
M

How would you like to receive tele-

1 (3.3) 3 (10) 8 (26.7) 14 (46.7) 4 (13.3)
speech therapy?
How much do you like to continue this
D

2 (6.7) 5 (16.7) 9 (30) 11 (36.7) 3 (10)

treatment approach?
To what extent can you make eye
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contact with the speech therapist in 14 (46.7) 10 (33.3) 4 (13.3) 2 (6.7) 0 (0)
this approach?
How much do you recognize the
EP

instructions given by the speech 0 (0) 2 (6.7) 12 (40) 15 (50) 1 (3.3)

therapist through the computer?
How do you feel the therapist
CC

0 (0) 5 (16.7) 5 (16.7) 9 (30) 11 (36.7)

understands you?
To what extent does this approach is
1 (3.3) 4 (13.3) 5 (16.7) 12 (40) 8 (26.7)
financially affordable for you?
A

To what extent did you trust the

therapist through Internet 2 (6.7) 8 (26.7) 9 (30) 8 (26.7) 3 (10)
communication?
How easy was for you to access to
1 (3.3) 6 (20) 8 (26.7) 11 (36.7) 3 (10)
speech therapist in this way?
How much did this approach save
0 (0) 0 (0) 7 (23.3) 6 (20) 17 (56.7)
your time?
Table 4. Correlation matrix satisfaction score with variables gender, education, age and number
of treatment sessions.
Variable Overall Infrastructure Therapeutic
Satisfaction Satisfaction approach Satisfaction
*Sig Correlation Sig Correlation Sig Correlation
Gender 0.72 -0.055 0.67 0.066 0.86 0.026
Education 0.63 0.089 0.64 0.088 0.65 0.084

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Age 12 0.29 0.17 0.256 0.14 0.275
Number of treatment
0.06 0.349 **0.03 0.383 0.11 0.292
sessions

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*Significant
**P<0/05

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N
A
M
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TE
EP
CC
A