
==== Front
Health Sci Rep
Health Sci Rep
10.1002/(ISSN)2398-8835
HSR2
Health Science Reports
2398-8835
John Wiley and Sons Inc. Hoboken

10.1002/hsr2.70055
HSR270055
Original Research
Original Research
Identifying data elements and key features to design a telerehabilitation system for speech and language disorders in children with hearing impairments in Iran: A cross‐sectional study
EBRAHIMI et al.
Ebrahimi Saeid http://orcid.org/0000-0001-5446-5944
1
Zakerabbasali Somayeh http://orcid.org/0000-0002-0125-5473
2
Oryadi Majid http://orcid.org/0000-0002-0366-967X
3
Maryam Vahab http://orcid.org/0000-0002-1913-8232
4
Mahmoudzadeh‐Sagheb Zahra http://orcid.org/0000-0002-8330-5453
5 zm_222@yahoo.com

1 Student Research Committe, Department of Health Information Management School of Health Management and Information Sciences, Shiraz University of Medical Sciences Shiraz Iran
2 Department of Health Information Management Clinical Education Research Center, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences Shiraz Iran
3 Soroush Rehabilitation Center for Children With Hearing Impairments Shiraz Iran
4 Department of Speech Therapy Rehabilitation Sciences Research Center, School of Rehabilitation Sciences, Shiraz University of Medical Sciences Shiraz Iran
5 Department of Health Information Management Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
* Correspondence Zahra Mahmoudzadeh‐Sagheb, Department of Health Information Management, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
Email: zm_222@yahoo.com

10 9 2024
9 2024
7 9 10.1002/hsr2.v7.9 e7005520 7 2024
20 3 2024
16 8 2024
© 2024 The Authors. Health Science Reports published by Wiley Periodicals LLC.
https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Abstract

Background and Aims

Designing and implementing telerehabilitation systems would require the identification of data elements to meet disabled people's needs. An in‐depth study on the identification and validation of data elements can help design and implement telerehabilitation systems successfully. Therefore, this study aimed to identify and validate data elements to design a telerehabilitation system for the speech and language disorders of hearing‐impaired children in Iran.

Methods

This descriptive cross‐sectional study was conducted in three steps including literature review, focused group discussion, and Delphi technique implementation to extract and validate data elements. In the first step, the literature on electronic databases was reviewed to extract the data elements of telerehabilitation systems, and nine studies were selected based on the inclusion criteria. In the second step, a focused group discussion was held to review and classify the extracted data elements. Finally, the Delphi technique was employed to validate the drafted data elements.

Results

In total, 352 data elements were extracted from the literature review. Finally, 102 data elements in 10 categories (Demographic and Clinical information of the disabled person, Clinical history, Demographic information of the provider, Customization of exercises, Reminders, Online and offline counseling, and training, Reporting, Key features of the system, Evaluation of the progress of the disabled person) were classified and validated by experts as essential data elements to design a telerehabilitation system for the speech and language disorders of hearing‐impaired children.

Conclusions

The necessary data elements were proposed as the foundations to design a telerehabilitation system for the speech and language disorders of hearing‐impaired children. These data elements help design and implement telerehabilitation systems successfully so that such systems can easily be provided for children with hearing disabilities.

hearing disabilities
speech and language disorders
system
telerehabilitation
Vice‐Chancellor for Research Affairs of Shiraz University of Medical Sciences source-schema-version-number2.0
cover-dateSeptember 2024
details-of-publishers-convertorConverter:WILEY_ML3GV2_TO_JATSPMC version:6.4.8 mode:remove_FC converted:11.09.2024
Ebrahimi S , Zakerabbasali S , Oryadi M , Maryam Vahab , Mahmoudzadeh‐Sagheb Z . Identifying data elements and key features to design a telerehabilitation system for speech and language disorders in children with hearing impairments in Iran: a cross‐sectional study. Health Sci Rep. 2024;7 :e70055. 10.1002/hsr2.70055
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pmc1 INTRODUCTION

Known as the most common sensory disability, hearing impairment is the third leading cause of disability worldwide. 1 , 2 , 3 Approximately 5% of the world's population (i.e., 32 million adults and 34 million children and adolescents) suffer from hearing impairment and need rehabilitation interventions to resolve this disorder. Hearing impairment is defined as the hearing loss of more than 40 dB in the better hearing ear in adults and the hearing loss of more than 30 dB in the better hearing ear in children. 4 Moreover, hearing impairment in the early stages of child development can lead to speech and language disorders having serious effects on the development of children's speech‐related, lingual, and cognitive skills. 1 Speech disorders are defined as disorders in fluency, sound, and articulation of speech sounds. 5 The prevalence of speech and language disorders was estimated to be 2%–25% in children aged 5–7 years old and nearly 1% in schoolchildren. 6 Children with hearing impairment face various difficulties in learning opportunities, speech and language development, and social relationships. 7 , 8 Current speech and language interventions for deaf and hearing‐impaired children are based on interactionist perspectives, including a wide range of approaches and techniques. Given the importance of early years of life in the acquisition of speech and language skills, timely diagnosis and presentation of appropriate speech and language interventions are considered, 9 and demand for rehabilitation services is growing worldwide. 10 However, conventional methods of providing speech and language interventions fail to meet the growing needs of hearing‐impaired children due to the lack of trained specialists, economic conditions, geographical distances, cultural barriers, educational facilities, and information on national programs to determine their needs. Therefore, the methods of providing these services must be flexible and tailored to the needs of the disabled to benefit from effective, affordable, and timely rehabilitation interventions. 6 , 11 , 12 , 13 Information technology has now affected all aspects of human life. With advances in science and technology, the health system has also evolved, and the use of technology in rehabilitation programs is one aspect of this evolution. 14 Telerehabilitation systems are employed to provide rehabilitation services through communication technologies and can provide a wide range of rehabilitation services, for example, assessment, monitoring, prevention, intervention, surveillance, training, and counseling. 15 Therefore, these systems can minimize the barriers to providing services for the disabled. 16 Due to the focus of speech and language rehabilitation systems on auditory and visual communication instead of physical examination, these services can be provided via remote rehabilitation technology. 15 Several studies have indicated that telerehabilitation services can be used as an effective and satisfactory way to provide speech and language rehabilitation for children with hearing impairments. 11 , 12 , 13 , 16 , 17 , 18 , 19 , 20 , 21 According to the literature review, social networks and messaging applications are often employed to provide remote hearing‐speech rehabilitation interventions. However, previous studies have not considered the development of telerehabilitation systems based on the needs of hearing‐impaired children. 12 , 13 , 14 Furthermore, developing computer‐based therapeutic speech systems to meet the specific needs of people with speech and language disorders can help overcome barriers to accessing efficient rehabilitation interventions. 22 Therefore, the first step in developing information systems is to determine their information needs. 23 In other words, their data elements and useful functions must be identified to develop and employ efficient systems. Therefore, the identification of relevant literature, determination of data elements, and acquisition of necessary functions are essential for the successful implementation of a novel system. 24 , 25 Atwell et al. proposed a three‐level reference model containing essential functions and data elements to design computer‐based systems for speech and language. The architecture had a three‐level interface for patients, providers, and system managers. 5 Langaranizadeh and Gholinezhad also stated that the definition of datasets in laboratory reports would play a key role in designing better laboratory information systems. 26 According to the literature review, essential data elements were identified and validated for the first time in this study to design and implement telerehabilitation systems for hearing‐impaired children's speech and language disorders. Therefore, this study aimed to identify and validate the data elements and functions required to design and implement a telerehabilitation system for the speech and language disorders of children with hearing impairments in Iran.

2 METHODS

This descriptive cross‐sectional study was conducted in 2023–2024 to identify, classify, and validate the data elements required to design a telerehabilitation system for the speech and language disorders of children with hearing disabilities. The research method included conducting the literature review, implementing the focus group discussion, and employing the Delphi technique (Figure 1).

Figure 1 Flowchart of data elements determination.

2.1 Step 1: Literature review

In this step, the research literature was reviewed to identify the data elements regarding the speech and language impairments of children with hearing disabilities and design telerehabilitation systems from January 1, 2010 to October 31, 2023. Five databases (i.e., PubMed, Scopus, Web of Sciences, IEEE, and PubMed Central) were used in this study. To extract the relevant studies, the titles and abstracts of studies were searched for by using a combination of keywords and search strategies shown in Table 1. Additionally, a manual search process was implemented on patient forms, similar systems, and the Google Scholar search engine (by analyzing the first 10 pages).

Table 1 The search strategy.

Strategy: #1 and #2	
#1	telerehabilitation OR telemedicine OR “home‐based rehabilitation” OR Telehealth OR “Remote rehabilitation” OR “Internet‐based intervention” OR “online rehabilitation” OR “Remote intervention “OR “tele practice” OR “tele therapy” OR tele*	
#2	“Hearing loss” OR “Speech‐language Disabilities” OR “Hearing impairment” OR “speech and language disorder” OR “auditory training” OR “speech therapy”	
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2.2 Inclusion and exclusion criteria

The inclusion criteria encompassed the papers published in English, access to the full texts of papers, availability of keywords in the texts and abstracts of papers, and the presence of data elements and clinical information on speech and language disorders in children with hearing disabilities.

The exclusion criteria included conference papers, papers that did not mention the design and development of telerehabilitation systems, and papers that did not contain clear information on data elements. Furthermore, letters to editors and conference abstracts were excluded.

2.3 Selection and classification of papers

As per the search strategy, 1088 papers were retrieved from five databases and entered into Mendeley software version 2.118.0. Four hundred eighty‐five studies from PubMed, 428 from Scopus, 142 from Web of Sciences, 27 from IEEE, and six from PubMed Central were retrieved. However, 929 papers were excluded after duplicates were reviewed. The exclusion of papers was based on the exclusion criteria. The titles, abstracts, and keywords of the residual 159 papers were then carefully analyzed. Finally, nine papers 5 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 were included in the study. Furthermore, 10 similar systems were searched and reviewed to extract data elements. The full texts of these papers were reviewed to extract the data elements required for the design and implementation of a telerehabilitation system for the speech and language disorders of children with hearing disabilities. In this step, a data extraction form was used for data collection. This form was validated through the opinions of one expert in medical informatics, two experts in speech therapy, and one expert in health information management. This form included fields, for example, data element and reference.

2.4 Step 2: Focused group discussion

In the first step, the data elements and key features were extracted from various sources but were not classified. Therefore, a focused group discussion was held to review, classify, and tailor the initial drafts of data elements and key features of the system to the specific needs of children with hearing impairments and to prepare a questionnaire. According to similar papers, 35 , 36 during this focused group discussion, four experts (i.e., two speech therapists with sufficient knowledge of speech and language disorders in hearing‐impaired children), one medical informatics specialist, and one health information management expert were selected through convenience sampling. The list of data elements extracted from the literature review was first emailed to those experts. Based on the feedback received from the experts, an in‐person meeting was then arranged. Afterward, a focused group discussion was held to review, adapt, and classify the initial drafts of data elements and system requirements at the School of Health Management and Information Sciences in the presence of experts. This meeting lasted 3 h. At this step, the experts were provided with only a list of data elements. They were also asked to express their opinions on the approval or rejection of each data element and its placement in the relevant dimension. Finally, the data elements checklist was designed. The face validity of the checklist was confirmed using the opinions of one speech therapy expert, two medical informatics experts, and two health information management experts (n = 5). The content validity of the checklist was calculated using the content validity ratio (CVR) and the content validity index (CVI). For this purpose, three medical informatics specialists, three information management specialists, and four speech therapy specialists completed the checklist. According to Lawshe's criterion for CVR, when the focus group consists of 10 members, the minimum acceptable value for each item is 0.62. 37 CVR was confirmed with a value of 0.86. Also, CVI was confirmed with a value of 0.97. The reliability of the checklist was evaluated by Cronbach's α and confirmed with a value of 0.94.

2.5 Step 3: Delphi technique

The questionnaire consisted of two parts: demographics of specialists (five items) and essential data elements (88 items). Data elements were classified under 10 main categories (demographics of the disabled (21 items), clinical information of the disabled (16 items), clinical history of the disabled (five items), demographics of the therapist (eight items), customization of exercises (nine items), reminders (four items), online and offline counseling and training (six items), reporting (four items), key capabilities of the system (nine items), and evaluation of the progress by the disabled (six elements). Moreover, a 5‐point Likert scale (totally unnecessary = 1, unnecessary = 2, no opinion = 3, necessary = 4, and totally necessary = 5) was employed to score each element. The Delphi technique was adopted in two rounds to reach a consensus, validate the drafted questionnaire of data elements, and receive suggestions from experts. The Delphi technique is an appropriate method in contexts where statistical model‐based evidence is unavailable, knowledge is uncertain and incomplete, and human expert judgment is better than individual judgment. 38 In most Delphi‐based surveys, 15 –20 experts are invited to complete questionnaires. Therefore, in this study, purposive sampling was employed to select 22 experts including speech therapy specialists (12 people), health information management experts (five people), and medical informatics experts (five people) to review the drafted data elements. 39 Also, informed consent was obtained orally from the participants during the study, before participating in the study. The following inclusion criteria were used for the participants: Employment as a member of the faculty of medical sciences universities of the country.

Having more than 5 years of work experience in the field of rehabilitation of speech and language disorders of hearing‐impaired children.

Being committed to the implementation of the second round of Delphi.

The questionnaire was designed electronically and emailed to the experts. It provided a brief explanation of the research purpose. In addition, to identify other important data elements, an open‐ended question was considered at the end of each section titled Other Data Elements. After the distribution and completion of the questionnaires in the first and second rounds of the Delphi technique, the data were entered into SPSS software version 23 (IBM). The frequency, mean score, and standard deviation of each data element were then analyzed and reported.

Decisions about data elements were then made to remove the data elements with an agreement level of below 50% (mean less than 2.5) in the first round of the Delphi technique. The data elements with an agreement level of 50%–75% (mean 2.5–3.75) entered the second round of Delphi for further review, and the data elements with an agreement level of more than 75% (mean more than 3.75) were considered the final data elements.

3 RESULTS

Table 2 reports the demographic characteristics of the experts. Female participants account for 59.1%, higher than men. The largest age group included participants aged 35–44 years old. The frequency of speech therapists (54.5%) was higher than the other two specialties.

Table 2 Frequency of demographic information of study participants.

Variables	Frequency	Percentage	
Gender			
Male	9	40.9	
Female	13	59.1	
Age			
25–34	7	31.8	
35–44	9	40.9	
45–54	2	9.1	
>54	4	18.2	
Level of education			
PhD	16	72.7	
Master	6	27.3	
Specialty			
Health information management	5	22.7	
Medical informatics	5	22.7	
Speech–language pathologist	12	54.5	
Work experience			
1–10	8	36.4	
11–21	10	45.5	
>21	4	18.2	
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According to Figure 1, during the literature review, 352 data elements and key features were identified and extracted from peer‐reviewed papers, similar systems, and patient record forms. During the focused group discussion, the experts discussed the list of extracted data elements. Finally, after duplicates and unnecessary items were eliminated, 88 data elements were confirmed as relevant and necessary elements. They were then classified under 10 categories. As per the findings of the first Delphi round, 83 data elements with an average above 3.75 (75%) were validated, and five elements entered the second round due to an average of 2.5–3.75 (50%–75%) (Table 3).

Table 3 Categories of essential data elements.

		First round Delphi	Second round Delphi		
Category	The number of data elements	<50%	50%–75%	>%75	<50%	50%–75%	>75%	The final number of data elements	
Demographic information of the disabled person	21	0	4	17	4	0	0	17	
Clinical information of the disabled person	16	0	0	16	0	0	0	16	
Clinical history of the disabled person	5	0		5	0	0	0	5	
Demographic information of the provider	8	0	1	7	0	0	0	7	
Customization of exercises	9	0	0	9	0	0	0	9	
Reminders	4	0	0	4	0	0	0	4	
Online and offline counseling and training	6	0	0	6	0	0	0	6	
Reporting	4	0	0	4	0	0	0	4	
Key features of the system	9	0	0	9	0	0	0	9	
Evaluation of the progress of the disabled person	6	0	0	6	0	0	0	6	
John Wiley & Sons, Ltd.

According to the findings in the second round of the Delphi technique, these five elements were excluded from the data element list because they achieved a mean of less than 3.75 (75%). These data elements included the mother's name, number of brothers, number of sisters, and home phone number (Table 4). In the open‐ended question section or other data elements, the experts proposed 21 data elements based on Table 4, of which 19 data elements were validated because of obtaining a mean over 75% in the second round of the Delphi technique. Moreover, two other data elements were removed. Table A1 presents the number of 102 validated data elements along with their means and standard deviations at the end of the research.

4 DISCUSSION

This study extracted and validated the essential data elements required to design a telerehabilitation system for speech and language disorders in children with hearing disabilities. The data elements of this system were determined by employing a three‐step method including the literature review, a focused group discussion, and the Delphi technique.

After the literature review, relevant data elements were extracted to design the aforementioned system. In the second step, a focused group discussion was held, and the unnecessary duplicate elements were removed. There were then 88 data elements classified under 10 main categories: demographics of the disabled, clinical information of the disabled, clinical history of the disabled, demographics of the therapist, customization of exercises, reminders, online and offline counseling and training, reporting, key capabilities of the system, and evaluation of the progress in the disabled. After the first round of the Delphi technique was completed, the data elements including the mother's name, number of brothers, number of sisters, and home phone number from the demographics category of the disabled as well as personnel number from the demographics category of the therapist did not receive enough points. For further investigation, they were entered into the second round of the Delphi technique, in which all five data elements were removed by experts. In addition, due to the existence of the medical council number as an official identifier of speech therapists in Iran, experts recognized the existence of a personnel code as unnecessary.

In the second round of the Delphi technique, the data elements suggested by experts in the open‐ended question section (e.g., determining the first and second languages in bilingualism status, type of communication, level of ability to use sign language, IQ level, gender, cochlear implant status, received rehabilitation interventions, source of hearing loss (congenital or acquired), medical council number of the therapist, and the ability to design special tests to assess the progress in the disabled) were validated (Table A1). Furthermore, all data elements of clinical information regarding the disabled, clinical history of the disabled, customization of exercises, reminders, online and offline counseling and training, reporting, key capabilities of the system, and evaluation of progress in the disabled person were classified as the essential elements of the rehabilitation system. Moreover, all data elements of clinical information of the disabled person, clinical history of the disabled person, customization of exercises, reminders, online and offline counseling and training, reporting, key capabilities of the system, and evaluation of progress in the disabled were recognized as the essential elements for designing a telerehabilitation system for speech and language disorders in children with hearing disabilities. These results indicate the importance of these data elements in designing and implementing a telerehabilitation system for speech and language disorders in children with hearing disabilities.

Atwell et al. designed a reference architecture for computer‐based speech therapy systems. They suggested different data elements, for example, feedback (audio, video, and text), therapeutic exercises, reporting, monitoring, scheduling, evaluation of patient's progress, and personal data to design online speech therapy systems. 5 In the present study, these data elements also existed. Damanaby et al. proposed a minimal data set for speech therapy centers. Their MDS included different data elements, for example, bilingual status, first and second languages in bilingual status, demographics, child turns, therapist's education level, disease history, long‐term and short‐term treatment goals, and reporting, 40 which were consistent with the results of our study. The American Speech and Language Association categorizes the essential elements for documenting speech and language services based on the social information of the medical history, clinical and patient status assessment, and treatment plans (short‐term and long‐term goals). 41 According to Silva et al., determining software requirements is the first step in software development in addition to describing the target system functions. Therefore, for the development of the AACVOX software, program functions were collected by reviewing the scientific literature. The capabilities of this software included voice and video communication. 42 Moulaei et al. created a data set to design and implement the upper limb disability registry by using a literature review through the Delphi technique. This data set included the elements of demographic data, clinical manifestations, and past medical history. 43 Langarizadeh et al. identified and validated the educational need for creating a celiac disease self‐care system. They recognized the need for demographic information as an essential element for designing a self‐care system. 44 Furthermore, Heidari et al. identified and validated the data elements and key features of a mobile‐based self‐care application for COVID‐19 patients. These elements included demographics (e.g., race, gender, etc.), educational texts and images, user profiles, help, reminders, drugs used, patient monitoring, and the ability to receive feedback from patients. 45

This study with its comprehensive methodology can be a suitable model for studies in other countries. In this research, data elements were extracted in three different phases and shared with specialists in the fields of speech therapy, medical informatics and health information management for confirmation. In the process of extracting data elements, we used a scope literature review and extracted all relevant studies, similar systems, guidelines, and reports. Then, to extract data items for the design of remote rehabilitation system for speech and language disorders of hearing impaired children, we used the studies, guidelines and systems available in different countries. In addition, the items used in the patients' files are based on international guidelines. Because the items extracted from the studies and similar systems in other countries have the ability to be used in the design and development of rehabilitation systems in other countries. The focus group method was used to categorize the elements. The group process helps people to identify and clarify their views is considered to be an important advantage of focus groups compared with individual interviews. 46 We also used the Delphi method to confirm the elements. Delphi studies are useful for gathering first impressions about phenomena and are often used to investigate an area with limited empirical research and/or for cases where there are questions that may not have definitive answers. 47 The items approved in this study can be used to design and develop remote rehabilitation systems in other countries.

Therefore, concerning the data elements in the design of telerehabilitation systems, we can improve the effectiveness and quality of care programs and help the disabled receive efficient and cost‐effective rehabilitation interventions without needing to pass geographical distances. One advantage of this study was the use of speech therapists familiar with the field of speech and language disorders in hearing‐impaired children. According to the literature review, no studies have provided data elements and clinical and management parameters associated with speech and language disorders in children with hearing impairment to design a telerehabilitation system. Furthermore, similar studies should be conducted to determine the needs of hearing‐impaired children in every country. In addition, organizations that provide rehabilitation services for patients with speech and language disorders can design systems and applications for the rehabilitation of speech and language disorders in hearing‐impaired children by using the elements extracted from this study.

4.1 Limitations

Among the limitations of this study is that, according to the authors' preliminary review, no previous telerehabilitation system for children with hearing impairment has been specifically proposed so far, and we have not used other systems related to deafness other than speech and language disorders for We acquired basic knowledge. Therefore, it is suggested that similar studies be conducted according to the culture, needs, clinical facilities, laws, and health care system of each country to provide effective information items in the management and treatment of speech and language disabilities in hearing‐impaired children. Due to time constraints and lack of access to experts, we only used local experts to conduct the Delphi study and did not consider the views, preferences, interests, and knowledge of experts from other countries. Therefore, it is recommended to use experts from other countries in addition to local experts in future studies. Since the Delphi study relies on the judgment of experts and is potentially susceptible to exploitation, it caused limitations in conducting the study. We therefore carefully selected a diverse panel of qualified experts using a structured process, neutrally framed questions, and, finally, explicitly asked panel experts to rate the desirability of their predictions.

5 CONCLUSION

In this study, the necessary data elements and essential capabilities were identified and validated to design and implement a telerehabilitation system for speech and language disorders in children with hearing impairment. Policymakers, planners, software experts, and rehabilitation center managers can better perceive the information they need to design high‐quality software systems or programs by presenting these data elements as a framework based on the needs of children with hearing disabilities. Moreover, speech and language rehabilitation centers for children with hearing impairment using telerehabilitation systems designed through the foregoing data elements can provide speech and language rehabilitation interventions without geographical constraints, receive continuous feedback, monitor children with hearing disabilities, involve families in children's treatment process, receive cost‐effective services, and collect clinical and managerial data.

AUTHOR CONTRIBUTIONS

Saeid Ebrahimi: Conceptualization; investigation; methodology; validation; software; formal analysis; data curation; visualization; writing—original draft; writing—review and editing. Somayeh Zakerabbasali: Conceptualization; methodology; data curation; validation; writing—review and editing; writing—original draft. Majid Oryadi: Data curation; validation; formal analysis; writing—original draft; writing—review and editing. Maryam Vahab: Conceptualization; data curation; investigation; writing—original draft; writing—review and editing. Zahra Mahmoudzadeh‐Sagheb: Conceptualization; investigation; writing—original draft; methodology; validation; writing—review and editing; supervision; project administration.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

ETHICS STATEMENT

The study was approved by the ethics review board of Shiraz University of Medical Sciences (ethical code: IR.SUMS.NUMIMG.REC.1402.122). All methods were performed according to the relevant guidelines and regulations. Informed consent was obtained from all participants.

TRANSPARENCY STATEMENT

The lead author Zahra Mahmoudzadeh‐Sagheb affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

ACKNOWLEDGMENTS

The authors sincerely acknowledge all the experts who spent their time answering the questionnaire. The present article was extracted from Saeid Ebrahimi (PhD) dissertation in Health Information Management Faculty of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. The authors would like to thank the Research Vice‐Chancellor of Shiraz University of Medical Sciences for funding this research (grant no: 27614).

DATA AVAILABILITY STATEMENT

All data are presented in the manuscript submission.

APPENDIX A A.1 See Table A1.

Table A1 Data elements associated with the design of a telerehabilitation system for speech and language disorders in children with hearing impairment.

Category	Data elements	First round Delphi	Second round Delphi	
		Mean (±SD)	Decision	Mean (±SD)	Decision	
Demographic Items of disabled person	Name	4.73 (0.767)	√			
	Last name	4.73 (0.767)	√			
	Father's name	4.05 (1.25)	√			
	Mother's name	3.73 (1.34)	*	3.00 (1.19)	×	
	National Code	4.36 (1)	√			
	Bilingual status (native and Persian)	4.77 (0.685)	√			
	Date of birth	4.86 (0.351)	√			
	Date of medical commission	4.09 (0.921)	√			
	Welfare record number	4.14 (0.990)	√			
	Number of sisters	3.64 (1.25)	*	2.91 (1.19)	×	
	Number of brothers	3.64 (1.25)	*	2.91 (1.19)	×	
	Address	4.09 (1.23)	√			
	Postal code	4.05 (1.09)	√			
	Father's cell phone	4.59 (0.796)	√			
	Mother's cell phone	4.50 (0.740)	√			
	Home phone	3.45 (1.01)	*	3.14 (1.20)	×	
	A relative's cell phone	4.23 (0.973)	√			
	Mother's job	4.23 (0.598)	√			
	Mother's education	4.05 (1.10)	√			
	Father's job	4.23 (0.922)	√			
	Father's education	4.00 (1.11)	√			
	Gender		+	4.50 (0.598)	√	
	Race		+	3.55 (0.963)	×	
	Stepchild status		+	3.55 (1.143)	×	
	Birth order		+	3.86 (0.834)	√	
Clinical data elements of disabled person	The age of hearing loss diagnosis	4.95 (0.213)	√			
	The age of receiving hearing aid device	4.95 (0.213)	√			
	The age of cochlear implantation	4.95 (0.213)	√			
	The age of a disabled child when referred to a rehabilitation center	5.00 (0.000)	√			
	The age of starting rehabilitation training for a disabled person	4.73 (0.631)	√			
	Medications used	4.91 (0.294)	√			
	ICD‐10 diagnosis code	4.86 (0.351)	√			
	Associated disorders	4.45 (0.739)	√			
	The possibility of storing scanned documents of a disabled person	4.73 (0.456)	√			
	The possibility of creating a short‐term and long‐term treatment plan	4.68 (0.477)	√			
	The possibility of storing the audio version of the child's speech	4.77 (0.429)	√			
	The possibility of storing a scan of the child's written sample	4.68 (0.477)	√			
	Degree of hearing loss	4.64 (0.492)	√			
	Status of hearing aids (1‐ single earpiece, 2‐ two earpieces)	4.77 (0.429)	√			
	Type of hearing loss (1‐ sensorineural, 2‐ mixed)	4.82 (0.395)	√			
	Presence of auditory neuropathy	4.77 (0.429)	√			
	Which is the first and second language in the two linguistic situations?		+	4.45 (0.671)	√	
	Which language is better to master?		+	4.45 (0.510)	√	
	Type of communication		+	4.55 (0.596)	√	
	Level of ability to use sign language		+	4.50 (0.512)	√	
	IQ level		+	4.00 (0.926)	√	
	Cochlear implantation status (double ear and single ear)		+	4.77 (0.429)	√	
	Combination of cochlear implant and hearing aid (each in one ear)		+	4.73 (0.456)	√	
	Received rehabilitation programs		+	4.73 (0.456)	√	
	The type of hearing aid used and its brand and model		+	4.45 (0.596)	√	
	Cause of hearing loss(Congenital or acquired)		+	4.82 (0.395)	√	
	The possibility of storing scanned documents referring the disabled person to other specialists		+	4.64 (0.492)	√	
	Store scans of other specialists answers		+	4.64 (0.492)	√	
Clinical history of the disabled person	Possibility of inserting a brief description of the medical history of the disabled person by the therapist	4.82 (0.395)	√			
	It is possible to insert the speech development history of the disabled person by the therapist	4.91 (0.294)	√			
	The possibility of inserting the language development history of the disabled person by the therapist	4.95 (0.213)	√			
	The possibility of inserting the hearing development history of the disabled person by the therapist	4.95 (0.213)	√			
	It is possible to insert the history of psychomotor development of the disabled person by the therapist	4.86 (0.468)	√			
Demographic information of therapist	Name	4.86 (0.468)	√			
	Last name	4.86 (0.351)	√			
	Level of Education	4.86 (0.351)	√			
	Specialty	4.73 (0.631)	√			
	Phone number	4.59 (0.908)	√			
	Address	4.64 (0.581)	√			
	Work experience	4.36 (1.09)	√			
	Personnel code	3.73 (1.12)	*	3.64 (1.136)	×	
	Medical education number		+	4.36 (0.727)	√	
	Fields of study (from bachelor to doctorate)		+	4.09 (0.684)	√	
	Specialized field of clinical activity in speech and language and swallowing		+	4.14 (0.774)	√	
	Gender		+	4.14 (0.941)	√	
Customization of exercises	Ability to manage exercises (homework) (creating, assigning to a specific person or to all people, editing, recording the points of the exercises performed based on the required ranges and deleting the exercise)	4.05 (1.25)	√			
	The possibility of adjusting the exercises based on the progress of the disabled person (type, date, schedule, intensity, number)	4.82 (0.395)	√			
Customization of exercises (cont.)	Classification of exercises based on the type of treatment and severity of the disabled person's disease	4.86 (0.351)	√			
	The possibility of sending exercises to the disabled person in the form of photos, voice and video	4.82 (0.395)	√			
	The ability to present and display exercises and educational content to the disabled person and record their real‐time scores during the online session by the therapist	4.82 (0.395)	√			
	It is possible to provide guidance for doing exercises for disabled people	4.77 (0.528)	√			
	The possibility of sending and storing feedback related to the exercises performed by the able‐bodied person in the form of voice, text and video	4.82 (0.395)	√			
	Sound settings (including repeating sound, raising and lowering the volume)	4.77 (0.528)	√			
	The possibility of taking notes of daily activities based on standard patterns by the therapist	4.86 (0.351)	√			
Reminders	Reminding of homework and the time of online therapy sessions through program notifications for disabled people	4.59 (0.734)	√			
	Providing encouragement for the disabled person based on the level of his task performance	4.68 (0.716)	√			
	Reminding of the time of online therapy sessions through program notifications for disabled people	4.82 (0.395)	√			
	Ability to display virtual classes, assessments, assignments and future conversations in the form of a notification in the dashboard of the therapist and disabled person	4.64 (0.581)	√			
Online and offline counseling and training	The possibility of creating, editing and deleting an online therapy session individually or in a group (meeting type—treatment type—time/date—length of the session) by the therapist	4.64 (0.581)	√			
	The possibility of using video conferencing to communicate between the disabled person and the therapist with the ability to share the screen	4.77 (0.429)	√			
	Recording online sessions by the therapist	4.59 (0.734)	√			
Online and offline counseling and training (cont.)	The ability to view and replay recorded videos without downloading for the disabled person	4.45 (0.963)	√			
	The possibility of providing counseling through sending text messages and online chat between the disabled person and the therapist	4.73 (0.456)	√			
	The possibility of creating a discussion forum or forum	4.09 (0.971)	√			
Reporting	Report of all the activities of each therapist	4.64 (0.902)	√			
	The possibility of preparing a report from the registered information of a specific person, including clinical, demographic and treatment measures performed for him	4.73 (0.703)	√			
	Report on the progress of patients based on standard tests performed in a diagram	4.91 (0.294)	√			
	The possibility of providing a list of disabled people in a certain period of time (according to class level, age, gender)	4.64 (0.658)	√			
Key features of the system	Log in and log out	4.82 (0.395)	√			
	Define username and password	4.82 (0.501)	√			
	Two‐step authentication (send confirmation SMS to mobile number)	4.59 (0.796)	√			
	Ability to interact with external devices such as speakers and mobile headphones	4.91 (0.294)	√			
	Cloud support for data storage	4.55 (0.671)	√			
	The possibility of defining a guide for using the system (help)	4.82 (0.395)	√			
	The possibility of periodically backing up the system database	4.86 (0.351)	√			
	The possibility of creating announcements and news section	4.86 (0.351)	√			
	The ability to define system users (therapist, disabled person) by the system administrator	4.82 (0.501)	√			
Assessing the progress of the disabled person	It is possible to implement and record the final result of the standard test of TAVANA (Test for Evaluation of Auditory Skills of 3–4 Year‐Old Hearing‐Impaired Persian Children) for the disabled person	4.73 (0.767)	√			
	It is possible to implement and register the final result of the standard of the age and stage standard test (latest edition) for the disabled person	4.82 (0.588)	√			
	The possibility of implementing and recording the final result of the standard test of the listening behavior in everyday life (ABEL) for the disabled person	4.73 (0.703)	√			
	The possibility of implementing and recording the final result of the standard test of production test of infant evaluation scale (PRISE) for the disabled person	4.73 (0.703)	√			
	The possibility of implementing and recording the final result of the standard test of nonverbal cognitive behaviors of childhood (CNCS) for the disabled	4.73 (0.703)	√			
	It is possible to implement and record the final result of the standard test of application skills (MacGenis) for the disabled person		√			
	The possibility of designing and recording the result of any other test		+	4.59 (0.503)	√	
Note: √, high average of 3.75 and final approval, *, average between 2.5 and 3.75 and getting to the second round, ×, elimination in the second round, +, recommended by experts in the first round.

John Wiley & Sons, Ltd.
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