Telehealth Speech Pathology and OT: Does the Evidence Support Remote Therapy?

Telepractice — speech pathology and occupational therapy delivered remotely by video — is now an established service-delivery model, not just a stopgap. The evidence is best described as limited but promising: for many speech and OT goals, remote therapy produces outcomes comparable to in-person care when sessions are well set up and clients are suitable. It is not a universal substitute, and the research base still has gaps (Speech Pathology Australia, 2022).

Key takeaways

• A systematic review of telehealth-delivered speech and language intervention for primary school-age children found telehealth and in-person participants made "significant and similar improvements" on most outcome measures — evidence the authors called "limited but promising" (Wales, Skinner & Hayman, 2017).
• In occupational therapy, a matched case-control study of hand and upper-limb rehabilitation found a hybrid telehealth model was "not inferior to standard care" (Harper et al., 2022).
• Telepractice is explicitly within scope for speech pathology and is recognised as a way to reduce inequity of access (Speech Pathology Australia, 2022).
• Evidence quality is still uneven — small samples, limited randomisation and under-representation of OT and physiotherapy — so claims should be measured (Grant, Jones & Land, 2022).
• Suitability is individual: technology, the home environment, and trained on-site support all shape whether telepractice works for a given person.

Does telehealth work for speech pathology?

The clearest synthesis for children comes from a 2017 systematic review in the International Journal of Telerehabilitation. After screening 132 articles, seven met inclusion criteria. Across five of six outcome measures, telehealth and in-person participants "made significant and similar improvements", with more positive results when standardised assessments were used. The authors concluded there is "limited but promising evidence to support telehealth for delivering speech-language pathology intervention services to school-age children", while noting methodological limitations: small and unequal samples, inconsistent randomisation, varying intervention intensity, and most studies occurring in clinical rather than home settings (Wales, Skinner & Hayman, 2017).

For practice, this means telepractice is a reasonable default to consider for many speech goals — speech sound work, language intervention, fluency support — rather than an automatic second-best. The caveat about home-versus-clinic settings is relevant to NDIS work, where therapy often happens in the participant's own environment.

Speech Pathology Australia's position is consistent. Its 2022 Telepractice Position Statement defines telepractice as the application of telecommunications technology to deliver speech pathology services at a distance, affirms that telepractice is within the scope of practice, and states that it "may address some of the issues of inequity of access to speech pathology services in Australia" given the country's geographically dispersed population (Speech Pathology Australia, 2022).

Does telehealth work for occupational therapy?

The OT evidence points the same direction with similar caveats. A 2022 matched case-control study of 102 patients receiving hand and upper-limb rehabilitation compared a hybrid telehealth model with in-person care and found telehealth "was not inferior to standard care", with comparable discharge outcomes and fewer service withdrawals (Harper et al., 2022).

Telehealth also reaches into OT's signature territory — function in the person's real environment. A feasibility study of telehealth OT home-modification interventions found improvements in occupational performance and home safety, concluding remote delivery was viable enough to warrant larger trials (Renda & Lape, 2018). A framework paper argues OT is "well-positioned to serve as a leader in demonstrating the benefits of services delivered through telehealth", precisely because OT focuses on authentic contexts and meaningful participation — which a video link into the home can capture directly (Little et al., 2021).

When does telehealth work well — and when does it not?

Telepractice is a tool, and its fit depends on the person, the goal and the setup.

Telehealth tends to work well when:

• The therapy is interactive and coachable by video (many language, speech sound, fluency, and OT skill-building goals).
• A capable communication partner, parent or support worker is present to assist in the room.
• The technology and environment are stable — reliable connection, a quiet, well-lit space, and appropriate devices.
• The client is comfortable with the format and engaged.

Telehealth is harder, or needs adaptation, when:

• Hands-on assessment or physical facilitation is essential and cannot be guided to an on-site helper.
• Connectivity is poor or devices are inadequate — a real barrier in some rural and remote areas.
• The participant cannot sustain attention or engagement on screen without substantial in-room support.
• Privacy or a safe, suitable physical space cannot be assured.

The 2022 Telepractice Position Statement reinforces that suitability is a clinical judgement: the service environment should be safe, confidential and modified for lighting and background noise, and suitably trained staff, carers or others may be needed to support the individual during sessions (Speech Pathology Australia, 2022).

What about equity and access for rural and regional NDIS participants?

This is where telepractice earns its place. Allied-health workforce density falls as remoteness increases, and children in rural and remote areas have reduced access to early-intervention services and consequently poorer outcomes (Grant, Jones & Land, 2022). For NDIS participants outside major centres, telepractice can mean the difference between consistent therapy and long gaps between visiting clinicians.

The honest qualification is that telehealth can also widen inequity if it assumes connectivity and digital access that some participants lack. Equity-focused frameworks therefore treat technology access, digital literacy and translation needs as design considerations, not afterthoughts (Little et al., 2021). A blended model often serves rural participants best.

On the strength of the evidence: a 2022 systematic review of clinician perspectives across speech pathology, OT and physiotherapy found the same factors (technology, relationships, access, family-centred care) act as both barriers and facilitators, and concluded the evidence could not be generalised, with a high risk of bias and under-representation of OT and physiotherapy (Grant, Jones & Land, 2022). Telepractice is well supported as an option; it is not proven equivalent for every goal and population, and that distinction matters when setting participant expectations.

How should clinicians deliver telepractice well?

Practical delivery follows from the evidence and the position statements:

1. Screen for suitability — the goal, the client, in-room support, and the technology and space.
2. Set up the environment — stable connection, suitable device, quiet and private space, good lighting; brief the family on what to prepare (Speech Pathology Australia, 2022).
3. Coach the partner — train parents, carers or support workers to facilitate, especially where hands-on support is needed.
4. Blend modalities — combine remote sessions with periodic in-person contact for assessment or hands-on work.
5. Review and adjust — monitor outcomes and switch modality if telepractice is not delivering for that participant.

Our speech pathology team and occupational therapists use telepractice where it suits the participant and the goal, and in-person care where that is the better fit.

Evidence at a glance

Frequently asked questions

Is telehealth speech therapy as effective as in-person?

For many goals the evidence is encouraging. A systematic review of school-age children found telehealth and in-person participants made similar improvements on most outcome measures, though the authors described the evidence as "limited but promising" and noted methodological limits (Wales, Skinner & Hayman, 2017). Effectiveness depends on the goal, the client and the setup.

Does telehealth work for occupational therapy?

Yes for many purposes. A matched study of hand and upper-limb rehabilitation found hybrid telehealth was not inferior to standard care (Harper et al., 2022), and telehealth OT home-modification interventions have shown feasibility and benefit (Renda & Lape, 2018). Some hands-on tasks still require in-person contact.

Can NDIS participants in rural or remote areas use telepractice?

Yes, and it is often where telepractice adds the most value, given reduced allied-health access outside major centres (Grant, Jones & Land, 2022). The caveat is connectivity and device access; a blended model with trained on-site support usually works best.

When is in-person therapy the better choice?

When hands-on assessment or facilitation is essential, connectivity or devices are inadequate, the participant cannot engage on screen without heavy in-room support, or a safe, private space cannot be assured. Suitability is a clinical judgement (Speech Pathology Australia, 2022), and telepractice is affirmed as within a speech pathologist's scope of practice.

To discuss whether telepractice or in-person therapy suits a participant's goals, contact Align Network. Speak with Align Network's speech pathology and occupational therapy team.