Outpatient speech and language therapy via videoconferencing in Germany during the COVID-19 pandemic: Experiences of therapists / Videotherapie in der ambulanten Logopädie/Sprachtherapie in Deutschland während der COVID-19 Pandemie: Erfahrungen von Therapeut/innen

Abstract

During the COVID-19 pandemic, videoconferencing as a synchronous form of telepractice service delivery models received a boost. In Germany, online-only sessions are not a standardised means of healthcare provision, while telepractice is already well established internationally. This study examines videoconferencing in outpatient speech and language therapy during the first period of the COVID-19 pandemic in Germany. The experiences of therapists are reported in this study.
For this quantitative study, data were collected by an online survey. Speech and language therapists in Germany were surveyed (n = 816). Data were analysed using descriptive statistics.
The results demonstrated that 87% of participants used videoconferencing in the early days of the COVID-19 pandemic. Videoconferencing was conducted with patients of different ages and disorder indications. In their use of videoconferencing, 78% of therapists described benefits. The mentioned benefits and limitations are similar to international findings, showing the potential for synchronous speech and language therapy via videoconferencing. German therapists display a general acceptance of the sustainable use of videoconferencing, and the majority of therapists can imagine transferring videoconferencing to standard healthcare.

Full text

Silke Wittmar1*, Maria Barthel2,
Juliane Leinweber2, Bernhard Borgetto1
During the COVID-19 pandemic, videoconferencing as a synchronous form of telepracce service delivery models received a boost. In Germany,
online-only sessions are not a standardised means of healthcare provision, while telepracce is already well established internaonally. This
study examines videoconferencing in outpaent speech and language therapy during the rst period of the COVID-19 pandemic in Germany.
The experiences of therapists are reported in this study.
For this quantave study, data were collected by an online survey. Speech and language therapists in Germany were surveyed (n = 816). Data
were analysed using descripve stascs.
The results demonstrated that 87% of parcipants used videoconferencing in the early days of the COVID-19 pandemic. Videoconferencing
was conducted with paents of dierent ages and disorder indicaons. In their use of videoconferencing, 78% of therapists described benets.
The menoned benets and limitaons are similar to internaonal ndings, showing the potenal for synchronous speech and language
therapy via videoconferencing. German therapists display a general acceptance of the sustainable use of videoconferencing, and the majority
of therapists can imagine transferring videoconferencing to standard healthcare.
COVID-19 – telepractice – videoconferencing – speech-language therapy
Keywords
Abstract
Received 17 May 2022, accepted 9 March 2023
1HAWK Hochschule für angewandte Wissenscha und Kunst
Hildesheim/Holzminden/Göngen,
Fakultät Soziale Arbeit und Gesundheit, 31134 Hildesheim,
Deutschland
2HAWK Hochschule für angewandte Wissenscha und Kunst
Hildesheim/Holzminden/Göngen,
Fakultät Ingenieurwissenschaen und Gesundheit, 37075
Göngen, Deutschland
* silke.wimar@hawk.de
Volume 10, Issue 1, 2023, Pages 1–10, ISSN 2296-990X, DOI: 10.2478/ijhp-2023-0001
INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
Outpatient speech and language therapy via
videoconferencing in Germany during the COVID-19
pandemic: Experiences of therapists
Videotherapie als synchrone Form von Teletherapie bekam durch die COVID-19 Pandemie einen Schub. In Deutschland war Videotherapie in
dieser Zeit keine Standardleistung der Gesetzlichen Krankenkassen, während sie internaonal bereits gut etabliert ist. Die Studie untersucht
Videotherapie während der ersten Zeit der Corona-Pandemie in der ambulanten logopädischen/sprachtherapeuschen Versorgung. In dieser
quantaven Querschniserhebung wurden Logopäd/innen/Sprachtherapeut/innen (n = 816) in Deutschland miels Onlinefragebogen
befragt. Die Daten wurden deskripv anhand von Häugkeitsverteilungen ausgewertet.
Die Ergebnisse zeigen, dass 87% der Teilnehmenden Videotherapie zu Beginn der COVID-19 Pandemie durchführten. Von den Therapeut/innen,
die Videotherapie nutzten, sahen 78% darin Vorteile. Die Ergebnisse zeigen Übereinsmmungen mit den Erkenntnissen aus der internaonalen
Forschung. Die genannten Vorteile und Herausforderungen decken sich mit internaonalen Erkenntnissen. Die Studie verdeutlicht das Potenal
von Videotherapie in der therapeuschen Versorgung. Die Therapeut/innen in Deutschland zeigen eine hohe Bereitscha zur Weiterführung
von Videotherapie in der Zukun. Die Mehrheit der Therapeut/innen kann sich eine Überführung von Videotherapie in die Regelversorgung
vorstellen.
Abstract
Videotherapie in der ambulanten Logopädie/Sprachtherapie in
Deutschland während der COVID-19 Pandemie: Erfahrungen
von Therapeut/innen
COVID-19 – Teletherapie – Videotherapie – Logopädie
Keywords
Open Access. © 2023 Silke Wittmar et al., published by Sciendo. This work is licensed under the Creative Commons
Attribution-NonCommercial-NoDerivatives 4.0 License.
OR 1

INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
INTRODUCTION
Telehealth services and the use of telepractice in the
eld of allied health professions are well established
internationally. Nevertheless, COVID-19 created a
worldwide surge in speech and language therapists
using synchronous videoconferencing (ASHA, 2020). In
Germany, however, videoconferencing is not a standard
of health service delivery model. During the COVID-19
pandemic, the use of videoconferencing received a
boost in speech and language therapy in Germany from
the beginning. Initially, after contact restrictions were
imposed, it was unclear whether therapy could take
place at all, and if so, under what conditions. Because
of contact restrictions, many patients did not come to
their outpatient practices. In addition, many therapy
sessions were cancelled because therapists had no access
to nursing homes and day care centres. Therapists used
videoconferencing to maintain needed therapeutic care.
Many therapists in Germany had their rst experience
with videoconferencing during the COVID-19 pandemic.
In March 2020, the Federal Joint Committee (G-
BA) approved a preliminary permit to temporarily
include videoconferencing in the healthcare provision
(GKV Spitzenverband, 2021). Since September 1,
2022, videoconferencing can be provided within a
transitional arrangement in Germany. At the time of
writing (September 2022), proceedings are underway to
determine the contract on the provision of speech and
language therapy and its remuneration (dbl e. V., 2022).
International reviews show that videoconferencing can
be conducted with, among other groups, adults who
have various speech, language, and voice disorders
(Rangarathnam et al., 2016; Theodoros et al., 2019;
Weidner & Lowman, 2020); children and adults who
stutter (McGill et al., 2019); children with autism
spectrum disorder and their parents (Sutherland et al.,
2018); and children between four to twelve years old
with speech or language disorders (Wales et al., 2017).
Comparisons between speech and language therapy
via videoconferencing and face-to-face therapy show
similar outcomes (Coleman et al., 2015; McGill et al.,
2019; Rangarathnam et al., 2016; Sutherland et al., 2018;
Theodoros et al. 2019; Weidner & Lowman, 2020).
Previous research reports benets from the use of
videoconferencing in speech and language therapy.
Eliminating travel time and travel expenses, enabling
therapy for non-mobile individuals, and allowing for a
holistic view of individuals in their living environment,
including social, health-related, and economic factors
in patients’ lives, are some of the benets reported
(Leinweber & Dockweiler, 2020; Rangarathnam et al.,
2016; Sutherland et al., 2018; Theodoros et al., 2019;
Wales et al., 2017).
The biggest hurdle for videoconferencing is a lack of
network capacity leading to unstable internet connections
(McGill et al., 2019; Weidner & Lowman, 2020). Even
in urban areas, but especially in rural areas, unstable or
insufcient internet connections result in poor to no sound or
image transmission, limiting videoconferencing massively
or making it impossible (Benda et al., 2020). Other
challenges are reported on a personal level, which include
problems of attention (Wales et al., 2017) and difculties in
implementing exercises involving children’s parents while
using videoconferencing (Sutherland et al., 2018).
However, patients and relatives are very satised with
and show a high acceptance of videoconferencing.
Patient satisfaction questionnaires have been used to
collect information on audio-video quality, the online
platform used, the method of therapy and its feasibility,
the structure of the therapy session, comfort level, and
symptom reduction (Coleman et al., 2015; McGill et al.,
2019; Rangarathnam et al., 2016; Sutherland et al., 2018;
Theodoros et al., 2019; Wales et al., 2017). Therapists also
report increasing satisfaction with the implementation of
videoconferencing in outpatient speech and language
therapy (McGill et al., 2019).
Especially during the pandemic, research of
videoconferencing has been initiated in Germany
(Barthel et al., 2021; Beushausen & Sippel, 2021; Bilda
et al., 2020; Bürkle et al., 2021; Mörsdorf & Beushausen,
2021). The study ‘Videoconferencing in outpatient speech
and language therapy’ (ViTaL) — reported in this article
— focused on the opportunity of videoconferencing
during the rst COVID-19 pandemic lockdown in the
spring/summer of 2020. This study examined the use
of videoconferencing in outpatient speech and language
therapy and derived recommendations for this innovation
in the German healthcare system. An online survey with
40 questions was distributed to explore how speech and
language therapists implemented videoconferencing
during the COVID-19 pandemic. The survey addressed
the following research questions: (1) Is videoconferencing
being used in the outpatient speech and language therapy
at the beginning of the COVID-19 pandemic? and (2) If
so, how and to what extent is videoconferencing being
used at that time?
METHOD
The study report follows the CHERRIES reporting
guidelines for reporting web-based surveys (Eysenbach,
2004).
Study design and participants
Within this quantitative study, data were collected cross-
sectionally by an open online survey (SoSciSurvey
2 3

INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
GmbH). In this random sample, the only inclusion criterion
was that respondents provided speech and language
therapy service in the outpatient sector in Germany.
The participants were recruited via the German Federal
Association of Speech and Language Therapy (dbl e. V.).
The association has about 10,000 members (dbl e. V., n.
s.). Participation was voluntary, and no incentives were
offered. The members and newsletter subscribers were
informed via print, website, newsletter, and social media
about the study and the survey link. The print medium
was the quarterly journal for the members of the dbl e. V.
The website is used by both members and non-members
to obtain information about speech and language therapy.
The survey was offered online from June 3 to July 1,
2020. Prior to the online survey, an application for ethical
approval was submitted to the committee for research
ethics of the University of Applied Sciences and Arts
(HAWK) Hildesheim/Holzminden/Göttingen. A positive
ethics vote was issued. On the rst page of the online
survey, all participants were informed about the study
content and data privacy and gave their informed consent.
No data were collected without prior consent. The survey
was conducted via the online freeware SoSciSurvey
(Leiner, 2019). Until the end of data collection, the
data were stored on the SoSciSurvey server. After data
collection, the data were deleted from the server. A data
backup will be kept on the university’s own server until
June 30, 2030. Persons outside the project team and
temporary staff have no access to the data.
Measures
The survey was constructed in German. Furthermore, it was
in accordance with literature about technology acceptance,
technology functionality, and technology use (Hastall et
al., 2017; Molini-Avejonas et al., 2015; Tyagi et al., 2018),
and the expertise of the research group on this area. The
nal version consisted of 40 questions. The questions were
organised within six categories: (1) overall implementation
of videoconferencing, (2) sociodemographic data of patients
and therapists, (3) resources used for videoconferencing,
(4) technology use, (5) current implementation of
videoconferencing, and (6) adoption of videoconferencing
in future healthcare delivery.
The rst category, ‘Overall implementation of
videoconferencing’, contained two questions about
whether respondents carried out videoconferencing
during the rst lockdown, and if not, for what reasons.
Sociodemographic data of the participants were requested
in category two, with seven questions regarding personal
information about the therapists and their workplace. In the
third category, ‘Resources used for videoconferencing’,
seven questions dealt with the used channels to
inform about how to implement videoconferencing
and about the used and needed hard- and software.
The fourth category, “Technology use”, included ve
questions about experiences in the implementation of
videoconferencing and any technical problems that
occurred. The fth category contained 21 questions about
the current implementation of videoconferencing in the
outpatient sector. In addition to the perceived advantages
and disadvantages of videoconferencing for therapists
and patients, respondents were asked here for whom
videoconferencing was used and how the transfer of the
therapy content to everyday life took place. Within the
last theme, “Adoption of videoconferencing in future
healthcare delivery”, therapists were asked nine questions
about their opinion of the use of videoconferencing in the
future. Within the last single question, therapists could
share information about videoconferencing that they felt
was not covered in the survey.
Some questions, especially the questions on
sociodemographic information and certain others, only
allowed for the selection of one answer. In questions
about the therapists’ experiences and assessments,
it was often possible to select multiple answers. The
respondents were asked to select from a list of options,
with a free text box at the end, and could select any
that applied to them. Therefore, the percentages of our
reported data do not total 100. In the presentation of
results, multiple answer options are indicated in brackets
for the questions concerned. Moreover, not all questions
had to be answered in order to proceed in the survey,
and depending on the answers to other questions, non-
applicable questions were omitted, or supplementary
questions were asked. Therefore, not all questions were
answered by the total of 816 participating therapists. The
total number of responding participants is then given as
a supplement.
The items were presented to each participant in the same
order, with one item per page. Participants were able to
change their answers through a back button. No check
for completeness was made before transmission. No
registration or cookies were used. A pre-test was carried
out based on three speech and language therapists from
the outpatient practice as well as three persons from the
cooperating professional association. The test persons
received a link to the pre-test. Based on the feedback, nal
adjustments were made, e.g. to the wording of questions
and response items.
Data analysis
Data were analysed using descriptive statistics performed
with IBM SPSS® version 26 (IBM, 2019). A total
of 841 participants completed the online survey. 25
questionnaires were excluded from further analysis: the
data sets of participants who denied the informed consent
INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
2 3

INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
(n = 22), two data sets with invalid data (age = 0, all open
answers = ‘else’), and one data set of a participant who
was an occupational therapist.
To prove data validity, an inconsistency check was made
by proong content and time-related aspects within
the data (Schrepp, 2016). For the time-related test, the
minimum processing time of 165 seconds (self-testing)
was considered. On the other hand, the ratio of the median
of the processing time from all answered questionnaires
on a page to the individual processing time of this page
was used. Since no irregularities occurred in any of the
cases, no additional data were excluded.
As a result, 816 completed questionnaires were included
for further analysis. Descriptive statistics were used to
evaluate the frequencies of all parameters.
RESULTS
Participants’ characteristics
The characteristics of the participating therapists are
summarised in Table 1. Persons from all sixteen German
states participated in the survey. Most participants were
female (94.5%), had an average age of 44 years (± 11
years), and an average professional experience of 17
years (± 10 years). Most of the participants in the online
survey were practice owners (64.1%).
Conducting videoconferences
The results demonstrated that 87% of the participants
used videoconferencing during the rst lock-down in
spring 2020, while 13% did not. Speech and language
therapy was most frequently conducted with children
who had language development disorders, with children
who had articulation disorders, and with adults who had
aphasia or dysphasia. Therapists considered therapy via
videoconferencing to be unsuitable predominantly for
individuals who had dysphagia, speech disorders in high
degree hearing loss or deafness, or damage to the head
and neck section. Table 2 contrasts the indications used
by the therapists and those mentioned as inappropriate
(multiple responses possible).
When asked for which phase of therapy the therapists
had used videoconferencing so far (multiple responses
possible), 40% answered anamnesis, and 34% answered
diagnostics, out of 707 respondents. 38% used
videoconferencing for goal agreements, and 99% for
therapy. 66% provided counselling for relatives, and
61% did for patients, via videoconferencing. The nal
consultation was conducted by videoconference by 34%
of respondents. 3% also used videoconferencing for
other purposes, e. g. interdisciplinary exchange or re-
diagnostics. Similarly, 707 participants responded to the
question about the setting for which videoconferencing
Table 1: Parcipants´ characteriscs.
Item Response Frequency (%) Mean (SD)
Gender (n = 816) Female 771 (94.5)
Male 45 (5.5)
Age in years (n = 815) 44 (± 11)
Years of working experience (n = 812) 17 (± 10)
Professional status (n = 816) Pracce owner 523 (64.1)
Employee 259 (31.7)
Freelancer 20 (2.5)
Other 14 (1.7)
Parcipaon by state (n = 816) Bavaria 165 (20.2)
North Rhine-Westphalia 149 (18.3)
Baden-Würemberg 99 (12.1)
Lower Saxony 81 (9.9)
Hesse 66 (8.1)
Rhineland-Palanate 61 (7.5)
Berlin 48 (5.9)
Hamburg 39 (4.8)
Saxony 23 (2.8)
Brandenburg 21 (2.6)
Schleswig-Holstein 19 (2.3)
Saarland 14 (1.7)
Mecklenburg-West Pomerania 12 (1.5)
Thuringia 8 (1)
Saxony-Anhalt 8 (1)
Bremen 3 (0.4)
4 5

INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
was used (multiple responses possible): 100% of
therapists used videoconferencing for one-to-one therapy,
and 40% used it for for one-to-one counselling. Group
therapy via videoconferencing was offered by only 3% of
respondents, and group counselling via videoconferencing
was offered by only 1% of respondents. 1% answered
‘others’ to this question.
Out of 707 therapists, 90% reported involving relatives in
videoconferencing. Of these 639 therapists who answered
the question about how to involve relatives (multiple
responses possible), 91% stated that relatives supported
the therapy when necessary. In 79% of videoconference
sessions, the relatives took part in the nal conversation
of the session. In 65%, they took part in the initial
Table 2: Use and suitability of videoconferencing. (Please note: The specicaon in parentheses corresponds to the indicaon codes of the German
‘Heilmielkatalog’ (therapeuc remedies catalogue). The dashes in the rst column indicate that the answer opons were not available for this
queson.
Disorder Frequency used (%)
n = 707
Frequency inappropriate (%)
n = 816
Language development disorder (SP1) 565 (80) 139 (17)
Arculaon disorder (SP3) 484 (70) 139 (13)
Aphasia or dysphasia (SP5) 299 (42) 75 (9)
Oral swallowing disturbance (SCZ) 271 (38) 160 (20)
Speech motor dysfuncon (SP6) 270 (38) 89 (11)
Funconal voice disorder (ST2) 262 (37) 121 (15)
Orofacial dysfuncon (OFZ) 236 (33) 107 (13)
Speech disorder (SPZ) 188 (27) 57 (7)
Stuering (RE1) 184 (26) 88 (11)
Auditory perceptual disorder (SP2) 174 (25) 207 (25)
Organic voice disorder (ST1) 163 (23) 136 (17)
Rumbling (RE2) 50 (7) 88 (11)
Speech disorders in high degree hearing loss or deafness
(SP4) 42 (6) 346 (42)
Psychogenic dysphonia (ST4) 32 (5) 218 (27)
Rhinophony (SF) 32 (5) 117 (14)
Psychogenic aphonia (ST3) 26 (4) 239 (30)
Dysphagia (SC1) -435 (53)
Damage to the head and neck secon (SC2) -291 (36)
Nothing applies -227 (28)
Figure 1: Benets of videoconferencing for therapists.
4 5

INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
conversation of the session. 10% of therapists stated that
the relatives only watched the therapy. 5% stated ‘other’,
e.g. relatives provided technical support or acted as co-
therapists.
Benets, limitations, and di󰀩culties for therapists
Out of 707 respondents, 78% see benets for therapists in
conducting videoconferencing. 14% see no benets, while
8% answered ‘I don’t know’. Nevertheless, the latter group
indicated concrete benets. Thus, out of 609 therapists
who answered the question about concrete benets
(multiple responses possible), almost all mentioned
health protection as a benet of videoconferencing, while
the short preparation time required was only mentioned
by a few. The benets mentioned are shown in Figure 1.
707 therapists answered the question about the limitations
of videoconferencing. While 64% of therapists see
limitations, 29% do not, and 7% of therapists responded
that they ‘don’t know’ if videoconferencing has
limitations for therapists. Nevertheless, the latter group
indicated concrete limitations. Thus, 501 participants
answered the question about concrete limitations of
videoconferencing for therapists (Figure 2, multiple
Figure 1: Limitations of videoconferencing for therapists.
Figure 2: Limitaons of videoconferencing for therapists.
Figure 3: Personal dicules in conducng videoconferencing.
6 7

INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
responses possible). The most frequently mentioned
limitation was a limited choice of methods that could be
used via videoconferencing.
The question about personal difculties in conducting
videoconferencing was also answered by 707 participants
(Figure 3, multiple responses possible). More than half
of respondents mentioned technical problems, e.g. due
to software crashes or slow internet connection. Lack of
software knowledge and high distraction by technology
were mentioned by less than 10%.
Of 707 participants who answered the question about
how they dealt with personal difculties in conducting
videoconferencing (multiple responses possible),
therapists solved the difculties on their own (45%),
got support from another person (40%), got used to the
problem (24%), had no difculties (16%), dropped out of
videoconferencing (6%), or stated something else (14%).
Future prospects of videoconferencing
In order to evaluate the future use of videoconferencing,
the therapists were asked for their opinion on the possible
use of videoconferencing in standard healthcare. Table
3 illustrates their opinions. Remarkably, there was high
consent that videoconferencing can be conducted without
endangering the therapy´s success, and even with the
enablement of a better and faster success for the therapy.
816 therapists answered the question of how
videoconferencing should be implemented in the case of
integrating videoconferencing into standard healthcare.
68% considered videoconferencing in combination
with presence therapy (complementary applicability).
16% preferred videoconferencing as an independent
individual service. 10% had a different idea, while 6% of
the respondents ‘did not care’ about the implementation.
816 participants answered the question of which
preconditions must be fullled for the adoption of
videoconferencing in standard healthcare (multiple
responses possible). Therapists named equivalent
payment as a precondition (56%) or higher payment than
face-to-face therapy (32%). Some therapists imagined
separate payment modalities for videoconferencing (32%)
and considered the implementation of this mode without
additional qualications to be important (38%). Therapists
considered research results conrming the effect of
videoconferencing as a basis for the implementation of
videoconferencing in standard healthcare (30%). Some
also mentioned other preconditions (8%), e.g. quality
management or data privacy.
DISCUSSION
The aim of our study was to investigate whether and how
speech and language therapists used videoconferencing
during the initial lockdown during the COVID-19
pandemic in Germany. The reported results show that
87% of the respondents conducted videoconferencing
in the outpatient practice. The high percentage of
videoconferencing use during the COVID-19 pandemic
shows that a large proportion of therapists were able
to continue to provide care via videoconferencing as a
delivery service in the short term. It also reveals a high
level of acceptance of videoconferencing among the
therapists.
The therapists reported that videoconferencing was used
with almost all indications except dysphagia. Indeed,
dysphagia therapy was excluded from the temporary
permission to perform videoconferencing in Germany
during the COVID-19 pandemic. On the whole, the
other indications are in line with the indications for
videoconferencing in the international literature.
Moreover, the prevalent rating, that videoconferencing
does not affect the therapy success and even provides the
possibility of a better and faster therapy success, gives
a rst clue for the effectiveness of videoconferencing in
Germany. This nding corroborates research ndings
of international studies (e.g., Mashima & Doarn, 2008;
Weidner & Lowman, 2020).
Most therapists reported good experiences in the use
of videoconferencing, even though technical problems
occurred for more than half of the participants. The
benets and obstacles of videoconferencing for
Table 3: Future prospects of videoconferencing, N = 816.
Queson ‘Yes’ (%) ‘No’ (%) ‘I don’t know’ (%)
Do you see any useful applicaons for videoconferencing in outpaent
speech and language therapy? 661 (81) 89 (11) 66 (8)
Can you imagine using videoconferencing in addion to frequency
enhancement if this would enable beer and/or faster therapy success? 646 (79) 113 (14) 57 (7)
Can you imagine conducng some therapy sessions in the therapy process
online, without aecng therapy success? 676 (83) 82 (10) 58 (7)
Can you imagine conducng some therapy sessions in the therapy process
online, without aecng the relaon between you and your paent? 662 (81) 96 (12) 58 (7)
‘Yes’ (%) ‘No’ (%) ‘I don’t care’ (%)
Should videoconferencing be included in standard healthcare? 636 (78) 137 (17) 43 (5)
6 7

INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
therapists and patients that were mentioned by therapists
correspond with those in the international literature. For
example, increased efciency, cost savings, and reduced
travel times are among the benets most indicated
internationally (Coleman et al., 2015; Mashima & Doarn,
2008; McGill et al., 2019; Sutherland et al., 2018).
Consistent with the ndings of the systematic review by
Hall et al. (2013), therapists most frequently reported
difculty during videoconferencing due to technology
use, e.g. poor internet connections (McGill et al., 2019;
Weidner & Lowman, 2020;). Not surprisingly, therapists
reported obstacles associated with videoconferencing
regarding attention problems, a nding that was also
reported in Wales et al. (2017). As a limiting factor of
videoconferencing, therapists frequently reported the
lack of real-life encounters that they usually experience
in face-to-face encounters with their patients. This is a
newly reported aspect, but it is understandable due to the
COVID-19 situation in which everyone had to reduce
their personal contacts. Both the limitations mentioned
and the difculties in conducting videoconferencing
could inuence the quality of therapy.
The reported results above and the answers to the future-
oriented questions about the use of videoconferencing
show a general readiness of therapists to adopt the
sustainable use of videoconferencing for future healthcare
services. This is an important and necessary nding for
speech and language therapy in Germany, especially
in order not to miss the international connection to
developments in the eld of telehealth services. The belief
of clinicians that the acceptance of telehealth will continue
to grow underscores this important pandemic-induced
development in Germany (Campbell & Goldstein, 2021,
2022). However, the provision of speech and language
services remotely is not seen as a substitute for in-person
care, but rather as a viable option for conducting therapy
(Campbell & Goldstein, 2022). Also, in relation to the
model of Hastall et al. (2017), the results imply a good
basis for expanding the use of videoconferencing in
speech and language therapy in Germany.
Videoconferencing received a boost during the COVID-19
pandemic, and also in other therapy professions like
occupational therapy or physical therapy. Within these
professions, as well, these were the rst experiences
with videoconferencing in Germany. The transferability
of the results of our survey can certainly be achieved in
some respects. However, each therapy profession should
also be considered separately, especially with regard to
methodological peculiarities. For example, in speech
and language therapy, hands-on methods are not as
prominent as in physical therapy or occupational therapy.
However, videoconferencing also enables other health
professionals to gain an insight into the home environment
and everyday life of patients as well as the inclusion of
relatives on site. This can positively inuence the success
of the therapy. The openness to videoconferencing and
the general technology readiness to adopt the sustainable
use of videoconferencing that were perceived among the
speech and language therapists in this study may also be
applicable to the other therapy professions. Certainly,
the reported difculties with videoconferencing due to
technology use and the demand for a major improvement
of the digital infrastructure are transferable. However,
here too, there is a need to create new structures and make
adjustments.
Overall, the results of this survey in conjunction
with international evidence support the adoption of
videoconferencing in standard healthcare services in
Germany. Therefore, policymakers should include
videoconferencing in future healthcare delivery models.
There is also a need for further research, e.g. on method and
concept transfer for videoconferencing or on ensuring the
quality of implementation. One very important aspect is the
development of concepts of blended therapy to overcome
the limitations and difculties of both approaches. As a
next step, the advantages and disadvantages of face-to-
face therapy and videoconferencing should be compared
to combine the best of both approaches. The limitations
and benets from videoconferencing only make it
possible to show the limitations of face-to-face therapy.
The initial ndings on the use of videoconferencing in
Germany, from the therapist’s perspective as presented
here, can serve as a basis for further research.
LIMITATIONS
The present study exclusively includes the therapist’s
perspective. For further evaluation of the implementation
of videoconferencing, it also requires the inclusion of
patients’ and relatives’ perspectives. The focus of this
survey was on the basic frame conditions, e.g. technology
use and characteristics of technology use for the rst time
that videoconferencing was approved by a medical panel
in Germany. No data were collected on the application
and suitability of therapeutic methods and concepts.
The gender distribution of the study participants shows
consistent trends with federal health reporting data in
Germany. In 2019, 93% of the individuals working
in professions corresponding to speech and language
therapy were female (Statistisches Bundesamt, 2021). In
our study, 96% of participants classied themselves as
female. Similar gender distribution in terms of participant
structure is shown in another online survey study in
speech and language therapists about telepractice (Kuvač
Kraljević et al., 2020).
8 9

INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
A selection bias can be suspected in the sample, as more
individuals with an interest in videoconferencing may have
participated in the survey. It is possible that individuals
who had not been exposed to videoconferencing during
COVID-19 did not take the survey in the rst place. Also,
in terms of technology afnity, it could be assumed that
participants with a high technology readiness took part in
the online survey. A rate of return could not be calculated
because of the distribution method of the survey link.
This study was a rst step to build a basis for future
investigation and future in-depth analyses on the use of
videoconferencing in outpatient speech and language
therapy.
ACKNOWLEDGMENTS
The authors would like to thank the German Federal
Association of Speech and Language Therapy (dbl e.
V.) for cooperating in this project, the therapists for
giving their time to respond to the questionnaire, and
Ann-Kathrin Einfeldt for performing data analysis. The
authors would also like to thank Dr. Roger Skarsten for
his support in the linguistic revision of this article.
ETHICAL APPROVAL
This study was approved by the committee for research
ethics of the University of Applied Sciences and Arts
(HAWK) Hildesheim/Holzminden/Göttingen on May
27, 2020.
CONFLICTS OF INTEREST
The authors declare no conict of interests.
FUNDING
The authors disclose receipt of the following nancial
support for the research, authorship, and/or publication
of this article: This work was supported by the German
Federal Association of Speech and Language Therapy
(dbl e. V.).
References
American Speech-Language-Hearing Association (2020).
ASHA
COVID-19 survey results—May 2020
[Data le]. https://www.
asha.org/siteassets/uploadedfiles/COVID-19-Tracker-Survey-
May-2020.pdf
Barthel, M., Schwinn, S., Einfeldt, A., Borgetto, B., & Leinweber,
J. (2021). Digitalisierungschancen nutzen! Kernaussagen
und Empfehlungen für die Nutzung von Videotherapie in der
ambulanten logopädischen/sprachtherapeutischen Versorgung
(Kurzfassung).
Forum Logopädie
,
35
(2), 49–50.
Benda, N. C., Veinot, T. C., Sieck, C. J., & Ancker, J. S. (2020).
Broadband Internet access is a social determinant of health!
American Journal of Public Health, 110
(8), 1123–1125. https://doi.
org/10.2105/AJPH.2020.305784
Beushausen, U., & Sippel, S. (2021). Videotherapie vs. Präsenztherapie
in der Stimmfunktionstherapie: Klinische RCT-Studie zum
Vergleich der Wirksamkeit.
Forum Logopädie
,
35
(3), 12–15.
https://doi.org/10.2443/skv-s-2021-53020210302
Bilda, K., Urban, K., Dörr, F., & Tschuschke, B. (2020). Digitale
logopädische Therapie. Ergebnisse einer Befragung zum aktuellen
Ist-Stand aus Sicht von LogopädInnen.
LOGOS, 3
(1),
76–138.
Bürkle, L., Collasius, V., Djuric, A., Hecht, A., Krämer, J., Kraus,
C., Mauer, M., Mörsdorf, L., Müller, C., Petry, J. & Beushausen,
U. (2021). PatientInnen-Zufriedenheit: mit der Videotherapie
bei Sprach-, Sprech-und Stimmstörungen während der COVID-
19-Pandemie - Eine Zwischenbilanz der Studie PaZu-Video.
Forum Logopädie, 35
(3),
316–319. https://doi.org/10.2443/
skv-s-2021-53020210303
Campbell, D. R., & Goldstein, H. (2021). Genesis of a new generation
of telepractitioners: The COVID-19 pandemic and pediatric
speech-language pathology services.
American Journal of
Speech-Language Pathology, 30
(5), 2143–2154. https://doi.
org/10.1044/2021_AJSLP-21-00013
Campbell, D.R., & Goldstein, H. (2022). Evolution of telehealth
technology, evaluations, and therapy: Effects of the COVID-19
pandemic on pediatric speech-language pathology services.
American Journal of Speech-Language Pathology, 31
, 271–286.
https://doi.org/10.1044/2021_AJSLP-21-00069
Coleman, J. J., Frymark, T., Franceschini, N. M., & Theodoros, D.G.
(2015). Assessment and treatment of cognition and communication
skills in adults with acquired brain injury via telepractice: A
systematic review.
American Journal of Speech-Language
Pathology, 24
(2), 295–315. https://doi.org/10.1044/2015_
AJSLP-14-0028
Deutscher Bundesverband für Logopädie (dbl) e. V. (n. s.). Der
Verband. [Webpage]. https://www.dbl-ev.de/der-dbl/der-verband
Deutscher Bundesverband für Logopädie (dbl) e. V. (2022).
Telemedizinische Leistungen jetzt bei Logopädie/Sprachtherapie
möglich. [Webpage]. https://www.dbl-ev.de/service/meldungen/
meldung/telemedizinische-leistungen-tml-jetzt-auch-im-bereich-
logopaedie-sprachtherapie-moeglich?&no_cache=1
Eysenbach, G. (2004). Improving the quality of web surveys: the
checklist for reporting results of internet e-surveys (CHERRIES).
Journal of Medical Internet Research, 6
(3), e34. https://doi.
org/10.2196/jmir.6.3.e34
GKV Spitzenverband (2021).
Regelungen für den Heilmittelbereich
aufgrund der COVID-19-Pandemie, gültig ab 01.01.2021
, Stand:
06.07.2021 [Data le]. https://www.gkvspitzenverband. de/
media/dokumente/krankenversicherung_1/ambulante_leistungen/
heilmittel/20210706_Corona-Regelungen_Heilmittelbereich_
ab_01-01-2021.pdf
Hall, N., Boisvert, M., & Steele, R. (2013). Telepractice in the
assessment and treatment of individuals with aphasia: a systematic
review.
International Journal of Telerehabilitation, 5
(1), 27–38.
https://doi.org/10.5195/ijt.2013.6119
8 9

INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS
Hastall, M., Dockweiler, C., & Muehlhaus, J. (2017). Achieving end
user acceptance: Building blocks for an evidence-based user-
centered framework for health technology development and
assessment. In Antona, M., & Stephanidis, C. (Eds.),
Universal
access in human–computer interaction: Human and technological
environments
(pp. 13–25)
.
Springer. https://doi.org/10.1007/978-
3-319-58700-4
IBM Corp. (2019). IBM SPSS Statistics for Windows, Version 26.0
[Computer software]. IBM Corp.
Kuvač Kraljević, J., Matić, A., & Pavičić Dokoza, K. (2020).
Telepractice as a reaction to the COVID-19 crisis: Insights from
Croatian SLP settings.
International Journal of Telerehabilitation,
12
(2), 93–104. https://doi.org/10.5195/ijt.2020.6325
Leiner, D. J. (2019). SoSci Survey (Version 3.1.06) [Computer
software]. https://www.soscisurvey.de
Leinweber, J., & Dockweiler, C. (2020). Perspektiven der Digitalisierung
in der Logopädie/Sprachtherapie.
Forum Logopädie, 34
(3),
6–9.
https://doi.org/10.2443/skv-s-2020-53020200301
Mashima, P. A., & Doarn, C. R. (2008). Overview of telehealth activities
in speech-language pathology.
Telemedicine and e-Health, 14
(10),
1101–1117. https://doi.org/10.1089/tmj.2008.0080
McGill, M., Noureal, N., & Siegel, J. (2019). Telepractice treatment of
stuttering: A systematic review.
Telemedicine and e-Health, 25
(5),
359–368. https://doi.org/10.1089/tmj.2017.0319
Mörsdorf, L., & Beushausen, U. (2021). Teletherapie und Telemedizin
in Deutschland. Studienlage zur Wirksamkeit sprachtherapeutischer
Teletherapie im neurologischen Bereich.
Neurologie &
Rehabilitation, 27
(2), 111–118. https://doi.org/10.14624/
NR2102004
Molini-Avejonas, D. R., Rondon-Melo, S., Amato, C. A., & Samelli, A.
G. (2015). A systematic review of the use of telehealth in speech,
language and hearing sciences. J
ournal of Telemedicine and Telecare,
21
(7), 367–376. http://doi.org/10.1177/1357633X15583215
Rangarathnam, B., Gilroy, H., & McCullough, G. H. (2016). Do patients
treated for voice therapy with telepractice show similar changes
in voice outcome measures as patients treated face-to-face?
EBP
Briefs, 11
(5), 1–6.
Schrepp, M. (2016). Datenqualität bei Online-Fragebögen sicherstellen.
In Hess, S., & Fischer, H. (Eds.),
Mensch und Computer 2016 –
Usablity Professionals, 4–7 September 2016, Aachen
[Data
le]. https://dl.gi.de/bitstream/handle/20.500.12116/5470/
Schrepp_2016.pdf?sequence=2&isAllowed=y
Statistisches Bundesamt (2021, September 13).
Gesundheitsberichterstattung des Bundes -
Gesundheitspersonalrechnung – Berufe in der Sprachtherapie
.
https://www.gbebund.de/gbe/!pkg_olap_tables.prc_set_
orientation?p_uid=gast&p_aid=77781176&p_sprache=D&p_
help=2&p_indnr=89&p_ansnr=66255607&p_version=5&D.000=
1&D.003=1&D.734=3&D.489=2)
Sutherland, R., Trembath, D., & Roberts, J. (2018). Telehealth
and autism: A systematic search and review of the literature.
International Journal of Speech-Language Pathology, 20(3)
, 324–
336. https://doi.org/10.1080/17549507.2018.1465123
Theodoros, D., Aldridge, D., Hill, A. J., & Russell, T. (2019). Technology-
enabled management of communication and swallowing disorders
in Parkinson’s disease: A systematic scoping review.
International
Journal of Language & Communication Disorder, 54
(2), 170–188.
https://doi.org/ 10.1111/1460-6984.12400
Tyagi, S., Lim, D. S., Ho, W. H., Koh, Y. Q., Cai, V., Koh, G. C.,
& Legido-Quigley, H. (2018). Acceptance of telerehabilitation
by stroke patients: perceived barriers and facilitators.
Archives of
Physical Medicine and Rehabilitation, 99
(12), 2472–2477. https://
doi.org/10.1016/j.apmr.2018.04.033
Wales, D., Skinner, L. & Hayman, M. (2017). The efcacy of
telehealth-delivered speech and language intervention for primary
school-age children: A systematic review.
International Journal
of Telerehabilitation, 9
(1), 55–70. https://doi.org/10.5195/
ijt.2017.6219
Weidner, K., & Lowman, J. (2020). Telepractice for adult speech-
language pathology services: A systematic review.
Perspectives of
the ASHA Special Interest Groups, SIGs, 5
(1),
326–338. https://
doi.org/10.1044/2019_PERSP-19-00146
10 OR