TY - JOUR
T1 - Does a multidisciplinary nutritional intervention prevent nutritional decline in hospital patients? A stepped wedge randomised cluster trial
AU - Schultz, Timothy J.
AU - Kitson, Alison L.
AU - Soenen, Stijn
AU - Long, Leslye
AU - Shanks, Alison
AU - Wiechula, Rick
AU - Chapman, Ian
AU - Lange, Kylie
PY - 2014/1/1
Y1 - 2014/1/1
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.
UR - http://www.scopus.com/inward/record.url?scp=84896389878&partnerID=8YFLogxK
U2 - 10.1016/j.clnme.2014.01.002
DO - 10.1016/j.clnme.2014.01.002
M3 - Article
AN - SCOPUS:84896389878
SN - 1751-4991
VL - 9
JO - e-SPEN Journal
JF - e-SPEN Journal
IS - 2
ER -
