Does a multidisciplinary nutritional intervention prevent nutritional decline in hospital patients? A stepped wedge randomised cluster trial

Timothy J. Schultz, Alison L. Kitson, Stijn Soenen, Leslye Long, Alison Shanks, Rick Wiechula, Ian Chapman, Kylie Lange

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Abstract

Background & aims: The effectiveness of combining interventions (nutrition screening, provision of oral nutritional supplements, and flagging patients for feeding assistance) in preventing nutritional decline is unknown. Methods: We conducted a stepped wedge, randomised, cluster trial to evaluate a multifaceted nutritional intervention implemented across a metropolitan hospital. Change in body weight after the first, and second, week of stay; use of the Malnutrition Universal Screening Tool (MUST); and requests for feeding assistance for patients were measured across control (n=135) and intervention (n=240) time periods. Results: In the first week, patients lost 0.4±3.3% of their body mass, equivalent to 0.4±2.3kg and a reduction in body mass index (BMI) of 0.1±0.8kg/m2. Unadjusted analysis identified some reductions in nutritional decline in the intervention group, particularly in week 2 when 14% of patients in the intervention group experienced weight loss, compared to 33% of control patients (P=0.053).In week 1, significantly more intervention patients had a completed MUST (201/238, 84.5%, P=0.000) and a feeding assistance referral (48/240, 20%, P=0.004). 'At risk' patients with BMI <20 gained 0.6±4.4% of their body mass. Multivariable analysis of week 1 data found no relationship between weight loss outcomes and the treatment, the ward or time period. Conclusions: Weight loss after one week did not differ between control and intervention wards. Implementation of a multifaceted intervention was facilitated by the study design, however, the study reinforced difficulties in accurately weighing patients in hospital. Trail register: ACTRN12611000020987.

Original languageEnglish
Journale-SPEN Journal
Volume9
Issue number2
DOIs
Publication statusPublished - 1 Jan 2014
Externally publishedYes

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Weight Loss
Malnutrition
Body Mass Index
Body Weight Changes
Urban Hospitals
Referral and Consultation

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Schultz, Timothy J. ; Kitson, Alison L. ; Soenen, Stijn ; Long, Leslye ; Shanks, Alison ; Wiechula, Rick ; Chapman, Ian ; Lange, Kylie. / Does a multidisciplinary nutritional intervention prevent nutritional decline in hospital patients? A stepped wedge randomised cluster trial. In: e-SPEN Journal. 2014 ; Vol. 9, No. 2.
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abstract = "Background & aims: The effectiveness of combining interventions (nutrition screening, provision of oral nutritional supplements, and flagging patients for feeding assistance) in preventing nutritional decline is unknown. Methods: We conducted a stepped wedge, randomised, cluster trial to evaluate a multifaceted nutritional intervention implemented across a metropolitan hospital. Change in body weight after the first, and second, week of stay; use of the Malnutrition Universal Screening Tool (MUST); and requests for feeding assistance for patients were measured across control (n=135) and intervention (n=240) time periods. Results: In the first week, patients lost 0.4±3.3{\%} of their body mass, equivalent to 0.4±2.3kg and a reduction in body mass index (BMI) of 0.1±0.8kg/m2. Unadjusted analysis identified some reductions in nutritional decline in the intervention group, particularly in week 2 when 14{\%} of patients in the intervention group experienced weight loss, compared to 33{\%} of control patients (P=0.053).In week 1, significantly more intervention patients had a completed MUST (201/238, 84.5{\%}, P=0.000) and a feeding assistance referral (48/240, 20{\%}, P=0.004). 'At risk' patients with BMI <20 gained 0.6±4.4{\%} of their body mass. Multivariable analysis of week 1 data found no relationship between weight loss outcomes and the treatment, the ward or time period. Conclusions: Weight loss after one week did not differ between control and intervention wards. Implementation of a multifaceted intervention was facilitated by the study design, however, the study reinforced difficulties in accurately weighing patients in hospital. Trail register: ACTRN12611000020987.",
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Does a multidisciplinary nutritional intervention prevent nutritional decline in hospital patients? A stepped wedge randomised cluster trial. / Schultz, Timothy J.; Kitson, Alison L.; Soenen, Stijn; Long, Leslye; Shanks, Alison; Wiechula, Rick; Chapman, Ian; Lange, Kylie.

In: e-SPEN Journal, Vol. 9, No. 2, 01.01.2014.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Kitson, Alison L.

AU - Soenen, Stijn

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AU - Shanks, Alison

AU - Wiechula, Rick

AU - Chapman, Ian

AU - Lange, Kylie

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N2 - Background & aims: The effectiveness of combining interventions (nutrition screening, provision of oral nutritional supplements, and flagging patients for feeding assistance) in preventing nutritional decline is unknown. Methods: We conducted a stepped wedge, randomised, cluster trial to evaluate a multifaceted nutritional intervention implemented across a metropolitan hospital. Change in body weight after the first, and second, week of stay; use of the Malnutrition Universal Screening Tool (MUST); and requests for feeding assistance for patients were measured across control (n=135) and intervention (n=240) time periods. Results: In the first week, patients lost 0.4±3.3% of their body mass, equivalent to 0.4±2.3kg and a reduction in body mass index (BMI) of 0.1±0.8kg/m2. Unadjusted analysis identified some reductions in nutritional decline in the intervention group, particularly in week 2 when 14% of patients in the intervention group experienced weight loss, compared to 33% of control patients (P=0.053).In week 1, significantly more intervention patients had a completed MUST (201/238, 84.5%, P=0.000) and a feeding assistance referral (48/240, 20%, P=0.004). 'At risk' patients with BMI <20 gained 0.6±4.4% of their body mass. Multivariable analysis of week 1 data found no relationship between weight loss outcomes and the treatment, the ward or time period. Conclusions: Weight loss after one week did not differ between control and intervention wards. Implementation of a multifaceted intervention was facilitated by the study design, however, the study reinforced difficulties in accurately weighing patients in hospital. Trail register: ACTRN12611000020987.

AB - Background & aims: The effectiveness of combining interventions (nutrition screening, provision of oral nutritional supplements, and flagging patients for feeding assistance) in preventing nutritional decline is unknown. Methods: We conducted a stepped wedge, randomised, cluster trial to evaluate a multifaceted nutritional intervention implemented across a metropolitan hospital. Change in body weight after the first, and second, week of stay; use of the Malnutrition Universal Screening Tool (MUST); and requests for feeding assistance for patients were measured across control (n=135) and intervention (n=240) time periods. Results: In the first week, patients lost 0.4±3.3% of their body mass, equivalent to 0.4±2.3kg and a reduction in body mass index (BMI) of 0.1±0.8kg/m2. Unadjusted analysis identified some reductions in nutritional decline in the intervention group, particularly in week 2 when 14% of patients in the intervention group experienced weight loss, compared to 33% of control patients (P=0.053).In week 1, significantly more intervention patients had a completed MUST (201/238, 84.5%, P=0.000) and a feeding assistance referral (48/240, 20%, P=0.004). 'At risk' patients with BMI <20 gained 0.6±4.4% of their body mass. Multivariable analysis of week 1 data found no relationship between weight loss outcomes and the treatment, the ward or time period. Conclusions: Weight loss after one week did not differ between control and intervention wards. Implementation of a multifaceted intervention was facilitated by the study design, however, the study reinforced difficulties in accurately weighing patients in hospital. Trail register: ACTRN12611000020987.

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