UWL: Screening and Assessment Methods (2009)
- To assess whether concordance between MNA-SF scores and biological nutrition parameters also exists among a cohort of elderly patients suffering from a severe injury such as hip fracture
- To evaluate the ability of MNA-SF scores to detect higher in-hospital mortality, nosocomial infection or new pressure ulcer occurrence
- Patients more than 64 years of age admitted for osteoporotic hip fracture following minor trauma to a 1,000-bed teaching hospital between January 2002 and March 2002
- All fractures had to be radiographically confirmed and considered suitable for surgical repair.
- Patients who received conservative therapy (N=2)
- Those with pathological fractures (N=2) or multiple fractures (N=7)
- Terminally ill patients with a presumed life expectancy of less than six months (N=5)
- Those for whom surgery was delayed for 48 hours or more (N=6)
- Those who were taking lipid-lowering drugs (N=5).
Recruitment
100 consecutive elderly people who were admitted for hip fracture and who underwent surgery complemented by rehabilitation therapy.
Design
Prospective cohort study.
Intervention
- MNA-SF nutritional scale and laboratory values were assessed within three days after hip fracture surgery
- According to hospital guidelines, all patients received antibiotic and antithrombotic prophylaxis, and protein supplements (20g per day)
- Spinal anesthesia was used
- Patients were mobilized early and rehabilitation was started as soon as possible.
Statistical Analysis
- Chi-square and Student's T-test were applied
- Pearson correlation coefficients were calculated
- All statistical test were two-sided.
Timing of Measurements
MNA-SF nutritional scale and laboratory values were assessed within three days after hip fracture surgery.
Dependent Variables
- Weight, height and BMI
- Serum albumin, cholesterol and total lymphocyte count
- Functional status assessed by Barthel Index
- Comorbidity measured by Charlson score
- Complications arising from hospital stay (nosocomial infection and pressure ulcers) were recorded.
Independent Variables
- Nutritional status measured with MNA-SF nutritional scale, consisting of six items extracted from MNA: BMI, appetite, weight loss, mobility, current illness and neuropsychological problems
- Interviewed about their prior residential status (nursing home or community), social status and ability to perform activities of daily living.
- Initial N: 100 consecutive patients. 73 remained after application of exclusion criteria.
- Attrition (final N): 73 patients [61 female (84%), 12 male]
- Age: Mean age 81.5±7.1 years
- Location: Spain.
Variables |
Values | MNA-SF Pearson Correlation Coefficients |
P-Value |
Serum total cholesterol (mmol per L) |
4.35±1.1 | R=0.099 | 0.4 |
Serum albumin (g per L) |
30.6±3.6 |
R=0.082 |
0.4 |
Serum total lymphocytes per mm3 | 1,278±463 | R=0.147 | 0.2 |
Previous Barthel Index | 78.2±19 | R=-0.59 | 0.6 |
Charlson Score | 1.6±0.3 | R=0.31 | 0.7 |
Other Findings
- Inhospital mortality was 10%. MNA-SF scores of these patients pointed toward a higher risk of malnutrition (8.8 vs. 10.1) but this difference did not reach statistical significance.
- The mean MNA-SF score was 11±0.5 (range, three to 14); according to these values, 39 patients (53%) were at risk of malnutrition
- MNA-SF scores were not significantly correlated to patients' laboratory values
- Seven (9.5%) patients with normal MNA-SF scores had albumin levels less than 30g per L
- MNA-SF values did not correlate either with previous functional status or with comorbidity
- 14 episodes of nosocomial infection were diagnosed in 11 patients, and six patients developed pressure ulcers during hospitalization. The MNA-SF values were not useful in predicting the development of nosocomial infection (P=0.3) or those at risk for pressure ulcers (P=0.2).
MNA-SF test scale values reflect a clinical process in post-operative hip-fractured patients that is different from serum albumin, cholesterol or lymphocyte count. In conclusion, we believe that the MNA-SF and the biochemical nutrition values applied reflect different clinical processes.
University/Hospital: | Hospital Universitari de Bellvitge |
Authors note that the MNA-SF questionnaire is the first of a two-step process, that if the MNA-SF is negative, there is no need to answer the remaining MNA questions. Authors note the following:
- Lack of predictive value may be attributed to the following: A low MNA-SF score does not represent a risk to those patients in whom hypoalbuminemia is not present, provided that they are correctly managed with good medical care
- Two possible limitations: Short duration of follow-up and small sample size.
Quality Criteria Checklist: Primary Research
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Relevance Questions | |||
1. | Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) | Yes | |
2. | Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? | Yes | |
3. | Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? | Yes | |
4. | Is the intervention or procedure feasible? (NA for some epidemiological studies) | Yes | |
Validity Questions | |||
1. | Was the research question clearly stated? | Yes | |
1.1. | Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? | Yes | |
1.2. | Was (were) the outcome(s) [dependent variable(s)] clearly indicated? | Yes | |
1.3. | Were the target population and setting specified? | Yes | |
2. | Was the selection of study subjects/patients free from bias? | Yes | |
2.1. | Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? | Yes | |
2.2. | Were criteria applied equally to all study groups? | Yes | |
2.3. | Were health, demographics, and other characteristics of subjects described? | Yes | |
2.4. | Were the subjects/patients a representative sample of the relevant population? | Yes | |
3. | Were study groups comparable? | N/A | |
3.1. | Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) | N/A | |
3.2. | Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? | N/A | |
3.3. | Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) | N/A | |
3.4. | If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? | N/A | |
3.5. | If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) | N/A | |
3.6. | If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? | N/A | |
4. | Was method of handling withdrawals described? | Yes | |
4.1. | Were follow-up methods described and the same for all groups? | Yes | |
4.2. | Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) | Yes | |
4.3. | Were all enrolled subjects/patients (in the original sample) accounted for? | Yes | |
4.4. | Were reasons for withdrawals similar across groups? | N/A | |
4.5. | If diagnostic test, was decision to perform reference test not dependent on results of test under study? | N/A | |
5. | Was blinding used to prevent introduction of bias? | Yes | |
5.1. | In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? | N/A | |
5.2. | Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) | Yes | |
5.3. | In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? | Yes | |
5.4. | In case control study, was case definition explicit and case ascertainment not influenced by exposure status? | N/A | |
5.5. | In diagnostic study, were test results blinded to patient history and other test results? | N/A | |
6. | Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? | Yes | |
6.1. | In RCT or other intervention trial, were protocols described for all regimens studied? | N/A | |
6.2. | In observational study, were interventions, study settings, and clinicians/provider described? | Yes | |
6.3. | Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? | Yes | |
6.4. | Was the amount of exposure and, if relevant, subject/patient compliance measured? | N/A | |
6.5. | Were co-interventions (e.g., ancillary treatments, other therapies) described? | Yes | |
6.6. | Were extra or unplanned treatments described? | Yes | |
6.7. | Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? | N/A | |
6.8. | In diagnostic study, were details of test administration and replication sufficient? | N/A | |
7. | Were outcomes clearly defined and the measurements valid and reliable? | Yes | |
7.1. | Were primary and secondary endpoints described and relevant to the question? | Yes | |
7.2. | Were nutrition measures appropriate to question and outcomes of concern? | Yes | |
7.3. | Was the period of follow-up long enough for important outcome(s) to occur? | Yes | |
7.4. | Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? | Yes | |
7.5. | Was the measurement of effect at an appropriate level of precision? | Yes | |
7.6. | Were other factors accounted for (measured) that could affect outcomes? | Yes | |
7.7. | Were the measurements conducted consistently across groups? | N/A | |
8. | Was the statistical analysis appropriate for the study design and type of outcome indicators? | Yes | |
8.1. | Were statistical analyses adequately described and the results reported appropriately? | Yes | |
8.2. | Were correct statistical tests used and assumptions of test not violated? | Yes | |
8.3. | Were statistics reported with levels of significance and/or confidence intervals? | Yes | |
8.4. | Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? | N/A | |
8.5. | Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? | N/A | |
8.6. | Was clinical significance as well as statistical significance reported? | Yes | |
8.7. | If negative findings, was a power calculation reported to address type 2 error? | N/A | |
9. | Are conclusions supported by results with biases and limitations taken into consideration? | Yes | |
9.1. | Is there a discussion of findings? | Yes | |
9.2. | Are biases and study limitations identified and discussed? | Yes | |
10. | Is bias due to study's funding or sponsorship unlikely? | Yes | |
10.1. | Were sources of funding and investigators' affiliations described? | Yes | |
10.2. | Was the study free from apparent conflict of interest? | Yes | |