Interprofessional Treatment of Malnutrition and Sarcopenia by Dietitians and Physiotherapists: Exploring Attitudes, Interprofessional Identity, Facilitators, Barriers, and Occurrence

Registered Dietitian Nutritionists' Attitudes Toward Interprofessional Health Care Teams: A Cross-Sectional Survey

BACKGROUND

Registered dietitian nutritionists (RDNs) are important members of interprofessional health care teams; yet, there is limited research of RDN perspectives of interprofessional teams.

OBJECTIVE

To examine associations between the characteristics of RDNs and their attitudes of team-based care (TBC).

DESIGN

A cross-sectional electronic Qualtrics survey encompassing demographic questions, the Attitudes Toward Interdisciplinary Health Care Teams (ATIHCT) scale, and additional interprofessional-related items was distributed to RDNs during January 2020.

PARTICIPANTS/SETTING

A total of 5018 RDNs from various regions/specialties in the United States were recruited primarily via direct email from a random list of RDNs obtained through the Commission on Dietetic Registration. The final sample was N = 616; 12.3% of RDNs and 88.1% of RDNs who initiated the survey.

MAIN OUTCOME MEASURES

ATIHCT subscale scores, which measure attitudes regarding efficiency of TBC and service quality of TBC.

STATISTICAL ANALYSES PERFORMED

Multiple linear regression modeled area of specialty, time with RDN credential, location, sex, frequency of TBC, and how valued the RDN perceived him or herself to be as independent variables, with ATIHCT subscales as outcome variables. Data were subjected to confirmatory factor analysis to determine appropriate use of the ATIHCT scale in the sample.

RESULTS

Foodservice (β = -1.48; P = .004) and sports nutrition RDNs (β = -2.58; P = .014) had lower scores for attitudes regarding efficiency of TBC (subscale 1) than clinical RDNs. Greater perceived value of the RDN was associated with higher scores for attitudes regarding efficiency (β = .66; P < .001). Greater perceived value of the RDN (β = .13; P = .03) was associated with higher scores for attitudes regarding service quality of TBC (subscale 2).

CONCLUSIONS

Specialty and perceived RDN value are associated with more favorable interprofessional attitudes among RDNs. To support positive attitudes regarding interprofessional collaboration, efforts should be honed to foster appreciation and clarity of the RDN's role in TBC.

Current Practices of Irish Dietitians Assessing and Monitoring Muscle Strength, Mass and Function: A Cross-Sectional Survey

BACKGROUND AND AIMS

Measuring muscle mass, strength, and function is vital in nutritional assessment, offering valuable insights into overall health, including nutritional adequacy, metabolic function and physical well-being. Nonetheless, the use of these measures for nutritional assessment and monitoring in dietetic practice is not widely implemented, and gaps in care remain. This study aimed to explore Irish dietitians' current nutritional assessment practices related to muscle health.

METHODS

A cross-sectional descriptive 29-item online survey was adapted and distributed via link in email and social media to state-registered dietitians (N = 1340) in Ireland between 21 September 2023 and 26 October 2023. Data were analysed descriptively.

RESULTS

The majority of dietitians (84/85) agreed that musculature was important in the assessment of nutritional status, with 80% (n = 56/70) reporting the integration of at least one assessment of muscle health into their clinical practice. Handgrip strength (HGS) was viewed as the most important (95.7%; n = 67/70), frequently applied (64.3%; n = 45/70) and most useful for monitoring muscle health (77.1%; n = 54/70). Regardless, the frequency of muscle health assessment in routine practice was low. The muscle health assessments that are routinely ( > once/week) measured include body weight (82.9%; n = 58/70), BMI (81.4%; n = 57/70), HGS (25.7%; n = 18/70) and the Timed up and go test, chair stand test or short physical performance battery (10%; n = 7/70). The main barriers to muscle health assessment were 'lack of training/application experience' (61.4%, n = 43/70) and 'lack of device availability' (58.5%, n = 41/70).

CONCLUSION

This study provides insights into the application of muscle health assessments within nutritional assessment among Irish dietitians. Results indicate a gap between the recognised value of muscle health and its use in nutritional assessment. Despite an almost unanimous agreement on the importance of musculature, challenges such as insufficient training and lack of equipment hinder the widespread implementation of muscle health assessment as a standard component of nutritional assessment. These findings emphasise the need for further practical education and measures to improve the availability of equipment to bridge this gap and optimise nutritional care.

Clinical Competency in Managing Malnutrition-Sarcopenia Syndrome Among Physical Therapists: A Cross-Sectional Survey

BACKGROUND/OBJECTIVES

Malnutrition and sarcopenia are interrelated health concerns among the elderly. Each condition is associated with increased mortality, morbidity, rehospitalization rates, longer hospital stays, higher healthcare costs, and reduced quality of life. Their combination leads to the development of "Malnutrition-Sarcopenia Syndrome" (MSS), characterized by reductions in body weight, muscle mass, strength, and physical function. Despite being preventable and reversible through nutritional and physical interventions, the clinical competence of physical therapists (PTs) in managing MSS remains underexplored. This study aims to assess the clinical competency of PTs in MSS management.

METHODS

An anonymous cross-sectional survey was conducted from January to August 2024 among 337 certified PTs in Israel, using the "Qualtrics" platform. The survey assessed prior familiarity with MSS concepts, MSS knowledge levels, screening and treatment skills, attitudes and beliefs toward MSS management, and interprofessional collaboration practices.

RESULTS

While 52% of PTs were familiar with MSS, familiarity with diagnostic guidelines was low (EWGSOP2: 3.6%; GLIM: 0.6%). The MSS knowledge score was moderate, but screening and treatment skills were low. Attitudes toward MSS management were moderately positive, but self-belief in diagnosing and treating MSS was low. Interprofessional collaboration was limited, particularly in malnutrition care. PTs familiar with MSS had higher knowledge, better skills, more positive attitudes and beliefs, and greater interprofessional collaboration.

CONCLUSIONS

Significant gaps exist in the clinical competency of Israeli PTs in MSS management. Integrating MSS content into physical therapy curricula and providing continuing professional development are necessary to enhance competencies. Equipping PTs with essential tools, clarifying roles, and promoting interprofessional collaboration can optimize MSS management and improve patient outcomes.

Developing an interprofessional identity complementary to a professional identity - findings related to Extended Professional Identity Theory (EPIT)

Collaboration among various professions often faces barriers owing to divergent perspectives, priorities, and expertise shaped by distinct socialization processes. These differences can hinder effectiveness, efficiency, and workforce well-being. The Extended Professional Identity Theory (EPIT) addresses this issue by fostering an interprofessional identity without weakening professional identities. Drawing from psychological theories, EPIT explains the coexistence of interprofessional and professional identities, and predicts associated behaviors. It also emphasizes the importance of combining interprofessional identity formation with developing interprofessional competencies and adapting to environmental factors to achieve synergy in (temporary or permanent) mixed profession groups. Introduced in 2018, EPIT research initially relied on the measurement of congruent interprofessional behaviors as indirect indicators of interprofessional identity that could not yet be measured. An experiment demonstrated that enhancing social identification in mixed profession groups with interprofessional assignments reduced the social hierarchy within 6 h across three meetings. The 2020 development of the Extended Professional Identity Scale (EPIS) confirmed interprofessional identity as a three-dimensional social construct. So far, several scientific studies have supported many propositions of EPIT. These propositions are related to dimensionality and various psychometric properties, cross-cultural similarities, evidence and clues for interprofessional identity formation, and its predictive validity in interprofessional education and collaborative practice. Türkiye is among several countries (e.g., the Netherlands, Belgium, Germany, Lithuania, Finland, and Indonesia) where EPIT-based interprofessional identity is being investigated. To illustrate contextual differences and their potential cross-cultural implications, it is valuable to explore how interprofessional identity adds value in the Turkish context. This approach facilitates understanding the regional implications of interprofessional identity, including interprofessional education initiatives, increased university engagement, the development of measurement instruments, challenges and future directions, and national and international collaborations. This paper aims to explain and clarify EPIT propositions compared to other theories, describe current evidence, and outline future research directions, with a focus on developments within the Turkish context as a showcase.

EPIS-RI: Indonesian translation, cultural adaptation and construct validation of an interprofessional identity measure

Interprofessional Education (IPE) as a preparatory stage for Interprofessional collaboration (IPC) is overlooked in some low-and middle-income countries, including Indonesia. One of the driving forces behind IPC is the development of Interprofessional Identity (IPI), which has yet to be assessed in the Indonesian context. Our study aims were translating and culturally adapting the Extended Professional Identity Scale (EPIS) and confirming its construct validity. We invited third-year students from three programs (medicine, nursing, and dietetics) without previous IPE experience to participate in the study. Using Confirmatory Factor Analysis (CFA), we examined the construct validity, analyzed internal consistency, and conducted a Kruskal-Wallis test to identify variations across professions. Of 513 students approached, 335 participated (response rate 65.3%). The CFA showed factor loadings ranging between .59 and .86, while correlations among subscales varied from .55 to .86. All five goodness-of-fit indices were sufficient. The internal consistency of subscales interprofessional belonging, commitment, and beliefs was .82, .84 and .87, respectively, and .90 for the overall scale. Interprofessional belonging and commitment were different among various students (p-value = .009 and .004) and the dietetics students had lower scores than other students. The Indonesian EPIS (EPIS-RI) demonstrated reliability and construct validity.

Interprofessional identity and motivation towards interprofessional collaboration

INTRODUCTION

It is unknown whether interprofessional identity is able to explain interprofessional behaviours. Extended professional identity theory provides clues by combining two psychological identity approaches. The aim of this study is to investigate whether interprofessional identity is a source for intrinsic motivation towards interprofessional collaboration related to wider group membership.

METHODS

Participants of this double-blinded study were 47 dentistry and 41 dental hygiene students (86.3% response) without interprofessional education (IPE) experience. Group productivity was used as indicator of group effort and equal communication as indication for interprofessional direction. The extended professional identity scale (EPIS) was used to measure interprofessional identity eight weeks prior to a mandatory IPE course. Based on EPIS levels, students were assigned to a low or high interprofessional identity group condition. Subsequently, 12 interprofessional teams (four to five members) were randomly composed per condition. Each group received eight problems (regarding roles, responsibilities and collaborative practice) for which they were expected to provide up to 10 solutions. Six trained psychologists rated the validity of solutions after which the percentage of solutions per group was calculated. Additionally, the psychologists rated interprofessional direction by observing team communication (asking questions, topic control, prosocial formulations, and speech frequency) during the second group meeting.

RESULTS

No interprofessional identity differences were found with regard to gender and profession. The mean difference between groups with low versus high interprofessional identity was 0.5 (M = 3.4; SD = 0.5 and M = 3.9, SD = 0.4, respectively), t = -5.880, p < 0.001. Groups with high identity generated more solutions compared to low identity groups (91.5% vs. 86.4%), t = -2938, p = 0.004. The correlation between individual interprofessional identity and group effort was significant, r = 0.22, p = 0.036. Groups with high identity showed more interprofessional direction, t = -2.160, p = 0.034.

DISCUSSION

Interprofessional identity has a positive effect on congruent interprofessional behaviours after 10 weeks. More research is required to understand interprofessional identity in relation to performance in education and work.