Development of nTMS-PREM

Background Patient-reported experience measures (PREMs) are a unique measure of experience of patients which can help address the quality of care of the patients.Objective Our aim of the study is to collect quality of care outcomes with our newly navigated transcranial magnetic stimulation patient-reported experience measure (nTMS-PREMs) questionnaire among neurosurgical patients undergoing nTMS.MethodsA single-centre prospective nTMS-PREMs 19-item questionnaire study was performed between February 2018 and December 2018 on patient referred for nTMS at our hospital. The Data was analysed using Likert scale, linear and logistic regression using statistical software (STATA 13.0®).ResultsFifty patient questionnaires were collected (30 males, 20 females, mean age of 47.6 ± 2.1 years) among which 74% of patients underwent both motor and language mapping with a mean duration of 103.3 ± 5.1 min. An overall positive response was noted from the results of the questionnaire, tiredness and anxiety being the common effects noted. Patients with the left-sided disease appreciated more the conditions provided in our laboratory (Q4, p = 0.040) and increasing age was related to less confidence and trust (Q6, p = 0.038) in the staff performing the exam. Younger patients tolerated nTMS better than older patients (> 65 years). PubMed literature search resulted in no relevant articles on the use of PREMs in nTMS patients.ConclusionnTMS is a well-tolerated non-invasive tool and nTMS-PREMS provides a promising role in identifying the unmet needs of the patients and improving the quality of their care.

Introduction Navigated Transcranial Magnetic Stimulation (nTMS) is a non-invasive adjunct used in surgical planning for lesions in eloquent brain. However, its patient tolerability and effect on their overall healthcare experience is still unknown. To our knowledge, there is no other literature available evaluating patient experience with nTMS. Methods A single-institution prospective cohort study carried out between February 2018 and December 2018 at King’s College Hospital. All patients were supplied with a PREMs-TMS questionnaire to evaluate the different domains of the nTMS experience. Results Feedback was obtained from 50 patients. 26% of patients underwent motor mapping (MM), whilst 74% underwent both motor and language mapping (MLM). The former group reported a better overall experience (p=0.020). The mean exam duration was 103.3±5.1 min (MM 85.8±6.1 min; MLM 106.9±5.9 min). The whole experience of nTMS received positive feedback (94%), particularly with confidence in the staff (95%). Unsurprisingly, the exam domain received a poorer rating (70% as good) with significant anxiety and pain reported in 26% and 24% of patients respectively. None of the studied variables influenced the way patients rated the overall experience of nTMS (p>0.05). Conclusions nTMS is a non-invasive investigative tool, which allows patients to better understand their condition and symptoms related to their lesion. Serial assessment and feedback using a PREM tool, can only improve and enhance this experience. Departmental collaboration may be useful in comparing patient experience with nTMS in different centres.

Objectives: Navigated Transcranial Magnetic Stimulation (nTMS) for brain mapping is becoming increasingly frequent for pre-surgical non invasive brain mapping. No data about Patient Reported Outcome Measure is currently available about TMS, which can be associated with anxiety or discomfort. Therefore patient collaboration and understanding of TMS is crucial for the success of the examination. Design: Single-centre cohort study with an enrolment period between February and July 2018. Subjects: Patients undergoing nTMS for Oncology and Neurovascular surgery. Methods: An anonymised TMS Patient Reported Outcome Measure Questionnaire was developed and distributed post nTMS by King’s TMS Laboratory. It composed of 19 items, rated from 1 (very negative) to 5 (very positive) and covering a range of procedural and examiner related questions. An adjusted model to analyse the responses was developed with further subgroup analysis for lobar location, hemisphere and duration. Results: 25 patients completed PROM-Q. The mean exam duration was 111.3 ± 8.25 minutes. 88% rated an overall positive nTMS experience. When the RMTs are included in the adjusted model in the subgroup analysis, the overall assessment of the nTMS experience is negatively influenced by increasing RMT in both frontal and left side lesions groups (p = .007 and p = .003). Conclusions: Patients reported an overall positive experience with nTMS. Findings suggest that increasing age, left sided lesions, increasing exam duration, and increasing RMT may negatively influence patient experience.