Malnutrition self-screening by using MUST in hospital outpatients: validity, reliability, and ease of use

Abstract

Background: Although nutritional screening with a tool such as the Malnutrition Universal Screening Tool (MUST) is recommended for outpatients, staff are under pressure to undertake a variety of other tasks. Little attention has been paid to the validity of patient self-screening with MUST.Objective: This study in 205 outpatients with a mean (6SD) age of 55 6 17 y (56% male) assessed the practicalities of self-screening, its agreement with screening undertaken by a trained health care professional (HCP), and its test-retest reliability. Design: After the participants provided consent, screening was undertaken by the patients themselves and then by a trained HCP who was unaware of the self-screening results. All patients completed an ease-of-use questionnaire. Test-retest reliability of self-screening was established in a subset of 60 patients. Results: A total of 19.6% of patients categorized themselves as "at risk" of malnutrition (9.8% medium, 9.8% high). For the 3-category classification of MUST (low, medium, high), agreement between self-screening and HCP screening was 90% (k = 0.70; SE = 0.058, P , 0.001). For the 2-category classification (low risk, medium + high risk), agreement was 93% (k = 0.78, SE = 0.057, P , 0.001). Disagreements were not systematically under-or overcategorized. Test-retest reliability was almost perfect (k = 0.94, P , 0.001). Most patients (71%) completed self-screening in ,5 min. Patients found the tool easy or very easy to understand (96%) and complete (98%), with 94% reporting that they were happy to screen themselves. Conclusion: Self-screening involving MUST in outpatients is acceptable to patients, user-friendly, reliable, and associated with good agreement with HCP screening. This trial was registered at clinicaltrials.gov as NCT00714324.Am J Clin Nutr 2012;96:

Self‐Screening for Malnutrition Risk in Outpatient Inflammatory Bowel Disease Patients Using the Malnutrition Universal Screening Tool (MUST)

“…9 For IBD, little attention has been paid to the possibility that patients can screen themselves for malnutrition. 10,11 IBD is associated with a significant reduction in quality of life, severely affects dietary choices, and is common in younger persons. 12 As such, this population may be inclined to self-screen and eager to be involved in developing their own nutrition care plan.…”

Use of self-administered Malnutrition Universal Screening Tool (MUST) is not a valid means of identifying inpatients at risk for malnutrition on the Clinical Teaching Unit

“…Reasons for not completing the MUST were not specifically tracked; however, the commonest voiced concern on the ease-of-use questionnaire was that font was too small to read." A further observation is that inpatients required approximately double the time to complete the MUST than those in outpatient studies (13). This delay may reflect comprehension difficulties and/or physical challenges that were not captured by the exclusion criteria.…”

“…Several potential explanations exist for why inpatient self-screening failed where outpatient self-screening succeeded; first, outpatients are more likely to be ambulatory, which simplifies self-weighing. Second, in outpatient trials by Mitchell (2014) and Cawood (2012), the average age of participants (43 and 55 years, respectively) was significantly younger than the average CTU inpatient (66 years; range 19-98 years) (13,15). Given that age itself is a risk factor for the cognitive and physical barriers to self-screening, inpatient screening must be tailored to a more functionally limited population.…”

“…Given the time constraints on healthcare providers (HCP), empowering patients to screen themselves for malnutrition is an appealing proposition. Previous work has demonstrated the efficacy of patients self-administering the MUST to screen for malnutrition in a variety of outpatient environments (13,15). The goal of this study was to determine the validity of self-screening with the MUST as a means of identifying inpatients at risk for malnutrition on the acute medicine unit.…”

“…Screening tools, such as the Malnutrition Universal Screening Tool (MUST), can generate scores that correspond with low, medium, or high risk for malnutrition (11,12). The MUST has been validated to detect malnutrition in inpatient and outpatient settings, as well as being a reliable predictor of length-of-stay and mortality in elderly patients (13,14). Given the time constraints on healthcare providers (HCP), empowering patients to screen themselves for malnutrition is an appealing proposition.…”