Current status of Tele-speech language therapy by type and support for patients with post-stroke aphasia: A scoping review

Yuhei Kodani; Shinsuke Nagami; Ayaka Yokozeki; Shinya Fukunaga; Katsuya Nakamura; Hikaru Nakamura

doi:10.1371/journal.pone.0319805

Peer Review History

Original SubmissionApril 6, 2024
6 Apr 2024 Author Response https://doi.org/10.1371/journal.pone.0319805.r001
8 Oct 2024 Decision Letter - Josep Vidal-Alaball, Editor PONE-D-24-13841Current status of tele-speech language therapy by type and support for patients with post-stroke aphasia: a scoping reviewPLOS ONE Dear Dr. Nagami, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Nov 22 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Thank you for stating the following financial disclosure: “The authors wish to acknowledge the financial support that facilitated the research, writing, and publication of this paper. Specifically, YK received funding from the Scientific Research Grant (KAKENHI 21K21154), whereas HN was supported through the Scientific Research Grant (KAKENHI 23K09604).” Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. 3. When completing the data availability statement of the submission form, you indicated that you will make your data available on acceptance. We strongly recommend all authors decide on a data sharing plan before acceptance, as the process can be lengthy and hold up publication timelines. Please note that, though access restrictions are acceptable now, your entire data will need to be made freely accessible if your manuscript is accepted for publication. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If you are unable to adhere to our open data policy, please kindly revise your statement to explain your reasoning and we will seek the editor's input on an exemption. Please be assured that, once you have provided your new statement, the assessment of your exemption will not hold up the peer review process. 4. As required by our policy on Data Availability, please ensure your manuscript or supplementary information includes the following: A numbered table of all studies identified in the literature search, including those that were excluded from the analyses. For every excluded study, the table should list the reason(s) for exclusion. If any of the included studies are unpublished, include a link (URL) to the primary source or detailed information about how the content can be accessed. A table of all data extracted from the primary research sources for the systematic review and/or meta-analysis. The table must include the following information for each study: Name of data extractors and date of data extraction Confirmation that the study was eligible to be included in the review. All data extracted from each study for the reported systematic review and/or meta-analysis that would be needed to replicate your analyses. If data or supporting information were obtained from another source (e.g. correspondence with the author of the original research article), please provide the source of data and dates on which the data/information were obtained by your research group. If applicable for your analysis, a table showing the completed risk of bias and quality/certainty assessments for each study or outcome. Please ensure this is provided for each domain or parameter assessed. For example, if you used the Cochrane risk-of-bias tool for randomized trials, provide answers to each of the signalling questions for each study. If you used GRADE to assess certainty of evidence, provide judgements about each of the quality of evidence factor. This should be provided for each outcome. An explanation of how missing data were handled. This information can be included in the main text, supplementary information, or relevant data repository. Please note that providing these underlying data is a requirement for publication in this journal, and if these data are not provided your manuscript might be rejected. Additional Editor Comments: Dear Authors, I would like to commend you on the overall quality of the manuscript, which is well-written and addresses a topic of relevance. Based on the feedback received, two reviewers have suggested only minor revisions, while one has recommended rejection. I believe that the suggestions provided by the reviewers are constructive and can be addressed effectively with some adjustments. I encourage you to carefully review the feedback and make the necessary revisions, as I think these changes will further improve the manuscript and enhance its chances of acceptance upon resubmission. I look forward to seeing the revised version. Best regards, Dr Josep Vidal-Alaball [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: N/A Reviewer #3: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: I really enjoyed reading this manuscript. The idea of scoping review on such a less researched area was interesting and can provide insightful findings. There are some points that can help improve the paper: 1. in review papers, it is common to mention the reason(s) why the criteria regarding the study quality for selection of papers are the way they are. it is recommended to mention on what basis such criteria are adopted as the generalizations of findings are under question. 2. it is suggested to include more articles as the number of articles (i.e., 15 articles) may not provide a comprehensive picture of what is going on in that area. So, if it is possible, widen the scope of this scoping review. As it was mentioned in the manuscript, out of 1,484, only 15 met our strict inclusion criteria. 3. because of the low number of the studies, in the discussion section, biases in the number of studies are explained on and because of the strict criteria, the discussion cannot be convincing. the method section was rigorous as the the degree of agreement was mentioned and coding seems to have been done correctly. In the method, only the inclusion criteria is recommended to change, if possible. the APA was observed. Furthermore, the manuscript was smooth to follow and erroneous grammatical structures were not observed. Reviewer #2: Although the topic [Current status of tele-speech language therapy by type and support for patients with post-stroke aphasia: a scoping review] is quite interesting, the article is only a review paper offering very limited insights which I believe are not significant enough to be considered for publication at a journal like PlosOne. The authors could perhaps consider either adding experimental data / case studies, or submitting the paper to a lower level journal. Reviewer #3: Limited to English and Japanese language studies, potentially missing relevant research in other languages The methods section is generally well-described. The use of the PRISMA-ScR guidelines is appropriate. However, the authors could provide more detail on how disagreements in the screening process were resolved. Consider including a flow diagram of the study selection process (PRISMA flow diagram) Provide more details on the data extraction process and how data were synthesized Discuss the potential impact of excluding non-English and non-Japanese studies on the review's findings ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #1: No Reviewer #2: No Reviewer #3: Yes: Yasser Alrefaee ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0319805.r002
Revision 1
22 Nov 2024 Author Response Reviewer 1 1. in review papers, it is common to mention the reason(s) why the criteria regarding the study quality for selection of papers are the way they are. It is recommended to mention on what basis such criteria are adopted as the generalizations of findings are under question. Response to the reviewer: Thank you for your valuable feedback regarding our research quality selection criteria. We recognize that the rationale for the selection criteria described in the Methods section requires further clarification. To address this, we have revised the "Selection Criteria" subsection in the Methods section (Pages 6–7: Lines 105–112). “Selection criteria We included studies that investigated the assessment or training methods of Tele-SLT for PWA following a stroke. Studies were excluded if they: 1) involved participants under 18 years of age; 2) combined Tele-SLT with in-person SLT; or 3) were review articles (e.g., systematic reviews, scoping reviews, narrative reviews), case reports, qualitative studies, cost-effectiveness analyses, books, conference proceedings, or study protocols. Full details of the inclusion and exclusion criteria are provided in Table 1.” 2. it is suggested to include more articles as the number of articles (i.e., 15 articles) may not provide a comprehensive picture of what is going on in that area. So, if it is possible, widen the scope of this scoping review. As it was mentioned in the manuscript, out of 1,484, only 15 met our strict inclusion criteria. Response to the reviewer: Thank you for your insightful comments regarding the comprehensiveness of the review. In response, we have revised the study selection criteria to encompass a broader range of research trends. The following changes were made: 1. We removed the restriction on the minimum sample size (n = 20) and reevaluated the selection criteria. This adjustment allowed the inclusion of smaller-scale studies that were previously excluded. Consequently, 20 additional studies were incorporated, increasing the total from 15 to 35—a 133% increase. 2. Despite expanding the scope of the analysis, as detailed in the Methods (Pages 6–10, Lines 89–163) and Results (Pages 10–31, Lines 165–281), the key research trends in tele-rehabilitation for speech-language therapy remain consistent. This consistency further reinforces the reliability of our findings. 3. because of the low number of the studies, in the discussion section, biases in the number of studies are explained on and because of the strict criteria, the discussion cannot be convincing. the method section was rigorous as the the degree of agreement was mentioned and coding seems to have been done correctly. In the method, only the inclusion criteria is recommended to change, if possible. Response to the reviewer: Thank you for your thoughtful evaluation of the rigor of our methodology. We agree with your observation that while the reliability of the methodology was ensured through stringent measures, the strict inclusion criteria may have narrowed the scope of the analysis and reduced the persuasiveness of the discussion. To address this issue, we have made the following improvements: 1. As detailed in the Methods section (Pages 6–10, Lines 89–163), we removed the sample size criterion (n ≥ 20) and included smaller-scale studies in our analysis. This revision increased the number of studies from 15 to 35 (Fig 1, Page 11). 2. In the Results section (Pages 10–31, Lines 165–280), we have added a detailed description of the findings based on the expanded dataset. 3. In the Discussion section (Pages 32–38, Lines 291–389), we broadened our interpretation to reflect the expanded evidence base and provided a more thorough examination of the generalizability of the findings. Additionally, we have preserved the rigor of other methodological aspects, such as the reliability of the coding process, in accordance with established procedures. Reviewer 2 Although the topic [Current status of tele-speech language therapy by type and support for patients with post-stroke aphasia: a scoping review] is quite interesting, the article is only a review paper offering very limited insights which I believe are not significant enough to be considered for publication at a journal like PlosOne. The authors could perhaps consider either adding experimental data / case studies, or submitting the paper to a lower level journal. Response to the reviewer: Thank you for your thoughtful feedback. We have addressed your concerns by expanding our study scope and conducting a comprehensive additional literature review. As a result, 20 new studies were included, increasing the total to 35. We also performed an exploratory meta-analysis on the training effects of telepractice speech-language therapy (Tele-SLT). The 20 additional papers are listed in Tables and Fig. 1, while the results of the meta-analysis are detailed in the "Training Effects of Tele-SLT" section of the Results (Page 31, Lines 265–280, Figs. 4–6). Our findings revealed that asynchronous training positively impacted language functions in individuals with aphasia, whereas synchronous training did not show a significant effect on communication skills. Based on these insights, we have significantly enhanced the discussion to provide a more comprehensive analysis. A scoping review including 35 studies on support for individuals with aphasia is uncommon, even among recent similar studies (e.g., Currie, S. S., et al., 2024; Hernandez, N. J., et al., 2024). Furthermore, meta-analyses specifically focused on Tele-SLT training remain extremely limited. We believe this study offers a valuable contribution by providing a broader and more detailed analysis compared to prior research. We sincerely hope that the revisions meet your expectations. “Training effects of Tele-SLT (Page 31, Lines 265–280) We performed a meta-analysis of Tele-SLT training effects using data from four RCTs. Two studies examined synchronous training using the CAL and CETI as outcome measures [38, 41], and two examined asynchronous training using the WAB as the outcome measure [44, 55]. For synchronous training, there was no significant difference between the intervention and control groups in combined CAL and CETI scores (fixed-effects model, SMD = -0.10, 95% CI = -0.57 to 0.37, P > 0.05) (Figure 4). For asynchronous training, analysis of the WAB-AQ showed no significant difference between groups (fixed-effects model, MD = 8.55, 95% CI = -4.59 to 21.70, P > 0.05) (Figure 5). However, a significant difference was found in the combined WAB subscales (Comprehension, Naming, Repetition) (fixed-effects model, MD = 0.70, 95% CI = 0.03 to 1.37, P < 0.05). Despite the significant result for the combined subscales, no significant differences were observed for individual subscales: Comprehension (fixed-effects model, MD = 0.46, 95% CI = -0.42 to 1.34, P > 0.05), Naming (fixed-effects model, MD = 1.21, 95% CI = -0.23 to 2.65, P > 0.05), and Repetition (fixed-effects model, MD = 0.83, 95% CI = -0.61 to 2.28, P > 0.05) (Fig 6)” Reviewer 3 1. Limited to English and Japanese language studies, potentially missing relevant research in other languages Response to the reviewer: Thank you for raising these important points. In this study, we followed the methodology of prior reviews in the field of aphasia (e.g., Wang, G., et al., 2020) and limited our scope to studies written in the authors' native language, Japanese, and in English, which encompass a significant portion of relevant research. However, as you rightly pointed out, excluding studies published in other languages may have introduced selection bias. Although directly addressing this issue within the scope of this study is challenging, we have acknowledged it as a limitation in the Limitations section (Page 37, Lines 383–385). “Second, while we performed a comprehensive literature search, the exclusion of non-English and non-Japanese articles and the absence of hand-searching of grey literature or specific databases may have introduced selection bias.” 2. The methods section is generally well-described. The use of the PRISMA-ScR guidelines is appropriate. However, the authors could provide more detail on how disagreements in the screening process were resolved. Response to the reviewer: Thank you very much for your valuable feedback. We appreciate your recognition of the appropriateness of the Methods section and the application of the PRISMA-ScR guidelines. As you correctly pointed out, our original description lacked sufficient detail on how disagreements during the screening process were resolved. To address this, we have revised the "Screening Method" and "Data Extraction Process" subsections in the Methods section to provide a more detailed explanation (Pages 8–9, Lines 115–136). “Screening method Two authors (YK and SN) independently screened titles and abstracts of identified articles. Subsequently, two other authors (YK and AY) independently reviewed the full texts of the selected articles for inclusion. Any discrepancies between authors during the screening process were resolved through discussion. If a consensus could not be reached, a third author (HN) made the final decision. Data extraction process Two authors (YK and AY) independently reviewed the full texts of articles selected in the second screening and extracted data. Discrepancies in data extraction were resolved through discussion between the two authors. If consensus could not be reached, a third author (HN) made the final decision. For studies on tele-assessment methods, the following information was collected: author, year of publication, country of the first author, participant characteristics (e.g., gender, age), number of participants, domains covered (e.g., language function, communication, well-being, QOL), software used, electronic devices used, and scale accuracy (e.g., reliability, validity). For studies on tele-training methods, the following information was collected: author, year of publication, study design, participant characteristics (gender, age), number of participants, domains covered (language function, communication, well-being, QOL), software used, electronic devices used, and training outcomes. One author (YK) managed the data using Rayyan reference management software and compiled the data into tables using Excel. Any missing articles were obtained by contacting the corresponding authors.” 3. Consider including a flow diagram of the study selection process (PRISMA flow diagram) Response to the reviewer: Thank you very much for your valuable suggestion. We agree that including a PRISMA flow diagram is essential for clearly presenting the study selection process. In response, we have incorporated a PRISMA flow diagram into the manuscript (Fig. 1, Page 11), which visually depicts the literature search and selection process. We believe this addition significantly enhances the clarity, transparency, and reproducibility of our study. Once again, we sincerely appreciate your insightful advice. 4. Provide more details on the data extraction process and how data were synthesized Response to the reviewer: We sincerely thank you for your valuable feedback. We agree that our explanation of the data extraction process and data integration methods was insufficient for readers. In response to your suggestion, we have added further details to the "Data Extraction Process" subsection in the Methods section and revised it accordingly (Pages 8–9, Lines 121–136). Additionally, for the 90 papers subjected to secondary screening, both the evaluator's ratings and the final ratings are now presented in Table S3. Once again, we greatly appreciate your insightful suggestions, which have helped us improve the clarity and transparency of our study. “Data extraction process Two authors (YK and AY) independently reviewed the full texts of articles selected in the second screening and extracted data. Discrepancies in data extraction were resolved through discussion between the two authors. If consensus could not be reached, a third author (HN) made the final decision. For studies on tele-assessment methods, the following information was collected: author, year of publication, country of the first author, participant characteristics (e.g., gender, age), number of participants, domains covered (e.g., language function, communication, well-being, QOL), software used, electronic devices used, and scale accuracy (e.g., reliability, validity). For studies on tele-training methods, the following information was collected: author, year of publication, study design, participant characteristics (gender, age), number of participants, domains covered (language function, communication, well-being, QOL), software used, electronic devices used, and training outcomes. One author (YK) managed the data using Rayyan reference management software and compiled the data into tables using Excel. Any missing articles were obtained by contacting the corresponding authors. 5. Discuss the potential impact of excluding non-English and non-Japanese studies on the review's findings Response to the reviewer: Thank you very much for your valuable feedback. As you rightly pointed out, our discussion did not sufficiently address the potential impact of excluding studies published in languages other than English and Japanese on the results of this review. To address this, we have added a detailed discussion of this issue in the Limitations section (Pages 37–38, Lines 380–389). We sincerely appreciate your insight, which has helped us enhance the depth and transparency of our discussion. “Second, while we performed a comprehensive literature search, the exclusion of non-English and non-Japanese articles and the absence of hand-searching of grey literature or specific databases may have introduced selection bias.” Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0319805.r003
5 Jan 2025 Decision Letter - Josep Vidal-Alaball, Editor PONE-D-24-13841R1 Current status of tele-speech language therapy by type and support for patients with post-stroke aphasia: a scoping review PLOS ONE Dear Dr. Nagami, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Feb 19 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols . We look forward to receiving your revised manuscript. Kind regards, Josep Vidal-Alaball, MD, PdD, MPH Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The manuscript has significantly improved, and the authors have addressed all the comments provided. The number of articles has increased, which offers more insightful information. Additionally, a meta-analysis has been incorporated into the study. However, the scope remains limited, as the focus was primarily on two languages and the inclusion criteria were quite strict. There is also potential for an increase in the number of studies included in the meta-analysis. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #1: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0319805.r004
Revision 2
31 Jan 2025 Author Response Response to the reviewer Comment 1: The manuscript has significantly improved, and the authors have addressed all the comments provided. The number of articles has increased, which offers more insightful information. Additionally, a meta-analysis has been incorporated into the study. However, the scope remains limited, as the focus was primarily on two languages and the inclusion criteria were quite strict. There is also potential for an increase in the number of studies included in the meta-analysis. Response to the reviewer: Thank you for your valuable feedback on the revised manuscript, which includes additional studies and new analyses. We appreciate your insightful comments regarding the meta-analysis. Our initial stringent inclusion criteria resulted in a small sample size. Therefore, following your suggestion, we incorporated the Western Aphasia Battery-Revised (WAB-R) as an outcome measure and included the results from Braley M., et al. [62] in the analysis of asynchronous speech-language therapy (SLT). While the addition of the WAB-R and the study by Braley et al. did not reveal a significant effect of asynchronous SLT on the Aphasia Quotient or the subtests of either the Western Aphasia Battery or the WAB-R, we did observe an overall effect. This finding remains consistent with our previous conclusion and is reflected in the Results section and Figures 5 and 6. We acknowledge the limitations of the meta-analysis due to the small number of included studies and the potential lack of optimal standardization regarding inclusion criteria, outcome measures, and interventions provided to the control groups. We have added a statement addressing these limitations to the "Study Limitations" subsection of the Discussion. (Page 31–32, Line 267–284) Training effects of Tele-SLT We performed a meta-analysis of Tele-SLT training effects using data from four RCTs. Two studies examined synchronous training using the CAL and CETI as outcome measures [39, 42], and three examined asynchronous training using the WAB, WAB-R as the outcome measure [45, 56, 62]. For synchronous training, there was no significant difference between the intervention and control groups in combined CAL and CETI scores (fixed-effects model, SMD = -0.10, 95% CI = -0.57 to 0.37, P > 0.05) (Figure 4). For asynchronous training, analysis of the WAB-AQ showed no significant difference between groups (fixed-effects model, SMD = 0.24, 95% CI = -0.17 to 0.65, P > 0.05) (Figure 5). However, a significant difference was found in the combined WAB subscales (Spontaneous speech, Comprehension, Repetition, Naming) (fixed-effects model, SMD = 0.23, 95% CI = 0.02 to 0.44, P < 0.05). Despite the significant result for the combined subscales, no significant differences were observed for individual subscales: Spontaneous speech (fixed-effects model, SMD = 0.20, 95% CI = -0.26 to 0.67, P > 0.05), Comprehension (fixed-effects model, SMD = 0.28, 95% CI = -0.13 to 0.69, P > 0.05), Repetition (fixed-effects model, SMD = 0.13, 95% CI = -0.28 to 0.54, P > 0.05) and Naming (fixed-effects model, SMD = 0.31, 95% CI = -0.11 to 0.72, P > 0.05) (Fig 6) (Page 37–38, Line 385–398) Limitations of this Review This review has five main limitations. First, the failure to use specific checklists for the quantitative quality assessment of the included studies may introduce uncertainty regarding the consistency of the study quality in this scoping review design. Second, while a comprehensive literature search was conducted, the exclusion of articles in languages other than English and Japanese, as well as gray literature and manual searches of specific databases, may have led to selection bias. Third, the exclusion of articles in languages other than English and Japanese in the meta-analysis limited the number of studies included for analysis, and we could not conduct subgroup analyses based on participant characteristics or details of interventions. Therefore, caution is needed when interpreting the results of the meta-analysis. Fourth, as we focused on studies that included multiple participants with aphasia, single-case study designs were excluded. Finally, as with all database searches, it is impossible to completely eliminate publication bias. [78] Attachments Attachment Submitted filename: Response_to_Reviewers_auresp_2.docx https://doi.org/10.1371/journal.pone.0319805.r005
4 Feb 2025 Decision Letter - Josep Vidal-Alaball, Editor PONE-D-24-13841R2Current status of tele-speech language therapy by type and support for patients with post-stroke aphasia: a scoping reviewPLOS ONE Dear Dr. Nagami, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Mar 21 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols . We look forward to receiving your revised manuscript. Kind regards, Josep Vidal-Alaball, MD, PdD, MPH Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments : Please address the reviewers' comments (reviewer 3). [Note: HTML markup is below. Please do not edit.] Reviewers' comments: [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0319805.r006
Revision 3
6 Feb 2025 Author Response Response to the reviewer Comment 1: The manuscript has significantly improved, and the authors have addressed all the comments provided. The number of articles has increased, which offers more insightful information. Additionally, a meta-analysis has been incorporated into the study. However, the scope remains limited, as the focus was primarily on two languages and the inclusion criteria were quite strict. There is also potential for an increase in the number of studies included in the meta-analysis. Response to the reviewer: Thank you for your valuable feedback on the revised manuscript, which includes additional studies and new analyses. We appreciate your insightful comments regarding the meta-analysis. Our initial stringent inclusion criteria resulted in a small sample size. Therefore, following your suggestion, we incorporated the Western Aphasia Battery-Revised (WAB-R) as an outcome measure and included the results from Braley M., et al. [62] in the analysis of asynchronous speech-language therapy (SLT). While the addition of the WAB-R and the study by Braley et al. did not reveal a significant effect of asynchronous SLT on the Aphasia Quotient or the subtests of either the Western Aphasia Battery or the WAB-R, we did observe an overall effect. This finding remains consistent with our previous conclusion and is reflected in the Results section and Figures 5 and 6. We acknowledge the limitations of the meta-analysis due to the small number of included studies and the potential lack of optimal standardization regarding inclusion criteria, outcome measures, and interventions provided to the control groups. We have added a statement addressing these limitations to the "Study Limitations" subsection of the Discussion. (Page 31–32, Line 267–284) Training effects of Tele-SLT We performed a meta-analysis of Tele-SLT training effects using data from four RCTs. Two studies examined synchronous training using the CAL and CETI as outcome measures [39, 42], and three examined asynchronous training using the WAB, WAB-R as the outcome measure [45, 56, 62]. For synchronous training, there was no significant difference between the intervention and control groups in combined CAL and CETI scores (fixed-effects model, SMD = -0.10, 95% CI = -0.57 to 0.37, P > 0.05) (Figure 4). For asynchronous training, analysis of the WAB-AQ showed no significant difference between groups (fixed-effects model, SMD = 0.24, 95% CI = -0.17 to 0.65, P > 0.05) (Figure 5). However, a significant difference was found in the combined WAB subscales (Spontaneous speech, Comprehension, Repetition, Naming) (fixed-effects model, SMD = 0.23, 95% CI = 0.02 to 0.44, P < 0.05). Despite the significant result for the combined subscales, no significant differences were observed for individual subscales: Spontaneous speech (fixed-effects model, SMD = 0.20, 95% CI = -0.26 to 0.67, P > 0.05), Comprehension (fixed-effects model, SMD = 0.28, 95% CI = -0.13 to 0.69, P > 0.05), Repetition (fixed-effects model, SMD = 0.13, 95% CI = -0.28 to 0.54, P > 0.05) and Naming (fixed-effects model, SMD = 0.31, 95% CI = -0.11 to 0.72, P > 0.05) (Fig 6) (Page 37–38, Line 385–398) Limitations of this Review This review has five main limitations. First, the failure to use specific checklists for the quantitative quality assessment of the included studies may introduce uncertainty regarding the consistency of the study quality in this scoping review design. Second, while a comprehensive literature search was conducted, the exclusion of articles in languages other than English and Japanese, as well as gray literature and manual searches of specific databases, may have led to selection bias. Third, the exclusion of articles in languages other than English and Japanese in the meta-analysis limited the number of studies included for analysis, and we could not conduct subgroup analyses based on participant characteristics or details of interventions. Therefore, caution is needed when interpreting the results of the meta-analysis. Fourth, as we focused on studies that included multiple participants with aphasia, single-case study designs were excluded. Finally, as with all database searches, it is impossible to completely eliminate publication bias. [78] Attachments Attachment Submitted filename: Response letter.docx https://doi.org/10.1371/journal.pone.0319805.r007
9 Feb 2025 Decision Letter - Josep Vidal-Alaball, Editor Current status of tele-speech language therapy by type and support for patients with post-stroke aphasia: a scoping review PONE-D-24-13841R3 Dear Dr. Nagami, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Josep Vidal-Alaball, MD, PdD, MPH Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0319805.r008
Formally Accepted
Acceptance Letter - Josep Vidal-Alaball, Editor PONE-D-24-13841R3 PLOS ONE Dear Dr. Nagami, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Josep Vidal-Alaball Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0319805.r009

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