Conducting clinical research in the era of the COVID-19 pandemic: Challenges and lessons for Speech-Language Pathology and Audiology research

Abstract

Background: The novel coronavirus disease 2019 (COVID-19) presented new and unanticipated challenges to the academic training and performance of clinical research at undergraduate and postgraduate levels of training. This highlighted the need for reimagining research designs and methods to ensure continued generation of knowledge – a core function of a research-intensive university. Whilst adhering to government regulations geared towards protecting both the research participants and researchers, innovative research methods are required.Objective: The purpose of this scoping review is to explore published evidence on innovative clinical research methods and processes employed during COVID-19 and to document challenges encountered and lessons that the fields of Speech-Language Pathology and Audiology can learn.Methods: Electronic bibliographic databases including Science Direct, PubMed, Scopus, MEDLINE, ProQuest were searched to identify peer-reviewed publications, published in English, between 2019 and 2021, related to innovative clinical research methods and processes applied where in-person contact is regulated.Results: Significant challenges with conducting research in the COVID-19 era were identified, with important lessons learned and numerous opportunities that have relevance for this pandemic era and beyond. These findings are presented under 10 themes that emerged that highlight important considerations for research methods and processes during a pandemic and beyond. The findings of this study also raise implications for telehealth from which low- and middle-income countries (LMICs), where resource challenges exist, can benefit.Conclusion: Challenges and opportunities identified in this review have relevance for the field of Speech-Language Pathology and Audiology as far as current and future (beyond COVID-19) clinical research planning is concerned.

In pursuit of increasing the application of tele-audiology in South Africa: COVID-19 puts on the alert for patient site facilitator training

“…The current author believes that the use of audiologists or speech pathologists as well as students in these professions as PSFs is not cost-effective nor sensible in the long run as it fails to achieve the goal of increasing access. Audiologists and audiology students should be the ones managing the tele-audiology programmes and supervising PSFs, particularly within the South African context where capacity versus demand challenges have been well documented (Khoza-Shangase & Sebothoma, 2022 ; Pillay et al, 2020 ). Therefore, the decision of who can serve as PSFs is an important one that should carefully consider contextual realities.…”

“…Key to this re-imagining exercise is a paradigm shift that embraces the application of innovative service delivery models with the inclusion of paraprofessionals (Khoza-Shangase, 2021 ). The practical use of existing and emerging technologies for provision of clinical services as part of tele-practice has been documented to (1) increase and expand access to specialised expertise that is otherwise not readily available, (2) enrich clinicians’ efficiency and output and (3) increase access to quality services whilst maintaining costs (Khoza-Shangase & Sebothoma, 2022 ). Furthermore, telepractice in the form of tele-audiology within the South African context opens job opportunities where paraprofessionals are utilised in task-shifting roles where they serve as PSFs.…”

The impact of COVID-19 on speech–language and hearing professions in low- and middle-income countries: Challenges and opportunities explored

“…The included papers highlighted a general lack of research during COVID-19 as well as limited research on COVID-19 and its impact on SLH professions. Furthermore, solutions towards provision of services during this public health emergency were also identified as lacking (Barber & Sher, 2022 ; Khoza-Shangase, 2022a ; Khoza-Shangase et al, 2022 ; Madahana et al, 2022b; Tar-Mahomed & Kater, 2022 ;). For example, Madahana et al (2022b) lamented on the paucity of evidence as well as focused research into artificial intelligence (AI) as a machine learning (ML) option, particularly for the hearing-impaired population.…”

“…Moreover, Barber and Sher ( 2022 ) identified a challenge with limited research evidence into understanding how to facilitate throughput of SLH students during the pandemic. In their review, Khoza-Shangase et al ( 2022 ) performed a scoping review specifically on challenges encountered by health care researchers in conducting research during the COVID-19 pandemic, while highlighting lessons learnt for SLH research. Their review, which echoes challenges also reflected in the other articles included in the SAJCD Special Issue (2022), found the following: (1) an absence of processes that can be used to balance quality, priority and speed of research conducted during this time; (2) an overall need for research protocols and designs to be flexible during the pandemic, as well as the importance of this flexibility in participant recruitment and participation; (3) difficulties with securing informed consent from research participants remotely – where remote working had become the standard practice; (4) ICT challenges where telefunctioning had to be adopted because of a need to adhere to COVID-19 regulations; (5) significant difficulties with provision of research interventions during the research; (6) challenges with data capturing, analysis and storage; and (7) challenges with sharing and publishing research findings.…”

“…(5) significant difficulties with provision of research interventions during the research; (6) challenges with data capturing, analysis and storage; and (7) challenges with sharing and publishing research findings. These challenges seem to have an influence on the amount, type and quality of research conducted, produced and shared (Khoza-Shangase, 2022a; Khoza-Shangase et al, 2022). Khoza-Shangase (2022a), for example, specifically highlighted the lack of rigorous scientific standards as reflected in the research designs in studies on cochleovestibular features of COVID-19.…”