A Leap Forward – Equity for Receiving Transcranial Magnetic Stimulation Service in Tuen Mun Hospital

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Authors (including presenting author) :
Wong KH(1), Tse YPM(2), Ma BFC(1), Mak MMY(1), Chow ESL(2)
Affiliation :
1 Physiotherapy Department, 2 Division of Rehabilitation, Department of Medicine and Geriatrics, Tuen Mun Hospital, New Territories West Cluster.
Introduction :
Attaining functional recovery of upper limb (UL) in stroke patient is a challenge which inspires novel intervention. Tuen Mun Hospital (TMH) is one of the pioneers in using new technology – repetitive Transcranial Magnetic Stimulation (TMS) to promote UL recovery in stroke patients. Majority of TMS service was provided to patients in In-patient and Day Rehabilitation settings due to limited number of operators and medical screening coverage for patients in Out-Patient Department (OPD). With increasing service demand from OPD, TMS service requires further enhancement in order to provide equal opportunity to patients from all settings.
Objectives :
1. To increase number of operators in TMS team in Physiotherapy (PT) Department; 2. To enhance accessibility and safety of TMS service to stroke patients in PT OPD through the Joint Clinic platform.
Methodology :
The PT Department’s TMS team previously has 5 operators. In 2018, a TMS training program was arranged for 13 physiotherapists in order to increase number of operators. Participants received recognized 2-days training conducted by overseas trainer. After 2-days training, they received practical training conducted by a physiotherapist specialized in TMS treatment to further consolidate their practical skills. To improve accessibility of TMS service to OPD patients, a pilot TMS Joint Clinic was set up by Rehabilitation Doctors and Physiotherapists for screening and recruitment of patients from OPD since October 2018. Through this platform, Doctors and physiotherapists discussed the suitability of potential patients for TMS service. Thorough screening was conducted during the Joint Clinic to ensure the safety of patients. OPD physiotherapists were encouraged to refer patients for TMS service after commencement of the Joint Clinic.
Result & Outcome :
After the TMS training program, the TMS team’s size expanded by 260% (from 5 operators to 18 operators). All participants reported that the training significantly enhanced their competence in TMS operation. Coverage of TMS service was extended from In-patient and Day Rehabilitation settings to OPD. 4 TMH OPD patients were referred from TMS Joint Clinic and received TMS service in 2 months. Number of cases referred from OPD was increased by 100%. Positive feedback from patients on the joint clinic arrangement were received and no adverse effect was reported after TMS application. The TMS training program and TMS Joint Clinic built a strong foundation for TMS service advancement in TMH. Stroke patients from various settings will have access to this advance technology and benefit from it in the years ahead.

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