Evaluation of a Patient Experience Tool in Dietetic Practice: Validation and Clinical Usage of the Assessment of Registered Dietitian Care Survey (ARCS).

Purpose: The study aim was to evaluate a patient experience survey, the Assessment of Registered Dietitian Care Survey (ARCS), that is aligned with a nutrition counselling approach (NCA) and evidence-based chronic disease care for use in outpatient registered dietitian (RD) practice. Methods: Criterion and construct validity were examined using Pearson correlation coefficients and principal components analyses, respectively. Reliability was examined using Pearson correlations and Cronbach's α. Acceptability was evaluated by survey response rate and readability. Kruskall-Wallis test was used to detect differences between RD scores. Results: A total of 479 survey packages were returned (46% response rate). Criterion validity indices were high (r = 0.91 and 0.94, P < 0.001) between Patient Assessment of Chronic Illness Care (PACIC) and NCA subscales, respectively, and lower with overall patient satisfaction (r = 0.63-0.65, P < 0.001). Construct validity revealed 2 factors for PACIC and NCA subscales. There was high internal reliability for the PACIC, 5As, and NCA (Cronbach's α > 0.7) and test-retest reliability showed an adequate consistency over time (r = 0.70, P < 0.05). The tool was able to detect differences in scores between RDs (P < 0.05). Conclusions: More research is warranted to explore ceiling effects and sensitivity to intervention in similar practice settings. The NCA subscale has acceptable reliability and validity to measure patient experience of RD care.

Assessment of Registered Dietitians' Beliefs and Practices for a Nutrition Counselling Approach.

PURPOSE: This study describes registered dietitians' (RDs) perceptions and use of a nutrition counselling approach (NCA) as defined by the American Academy of Nutrition and Dietetics Nutrition Care Process terminology (NCPT). METHODS: A cross-sectional online survey was administered to approximately 500 RDs in Alberta, Canada. Items included demographics, job characteristics, perceived knowledge, competence, use of an NCA, training experience, and theory of planned behaviour salient beliefs. Descriptive analyses compared RDs who counselled "all or most" of their clients with those who counselled "some or none." Salient beliefs were analyzed using content analysis. RESULTS: Of the 349 RDs who completed the survey, 64.2% provided an NCA to "all or most" of their patients. RDs were supportive of using an NCA (mean = 8.7/10, SD = 1.9) and most RDs (84.5%) had received training on an NCA. Salient beliefs included advantages (e.g., improved behaviour change in patients) and disadvantages (e.g., inadequate time). Normative referents included colleagues (e.g., multidisciplinary team), managers, patients/clients, College of RDs of Alberta, and counsellors. The barriers and enablers were related to patients' situations, infrastructure, and RD supports. CONCLUSIONS: These results may enable decision makers to more effectively design and target training and implementation programs to improve RDs' NCA.

The spinal stenosis pedometer and nutrition lifestyle intervention (SSPANLI): development and pilot.

BACKGROUND CONTEXT: Owing to mobility limitations, people with lumbar spinal stenosis (LSS) are at risk for diseases of inactivity, including obesity. Therefore, weight management in LSS is critical. Body mass index is the strongest predictor of function in LSS, suggesting that weight loss may promote physical activity and provide a unique treatment option. We propose a lifestyle modification approach of physical activity and nutrition education, delivered through an e-health platform. PURPOSE: The purpose of this study was to develop and pilot an e-health intervention aimed at increasing physical activity and decreasing fat mass in people with LSS. STUDY DESIGN: The study design was based on intervention development and pilot. PATIENT SAMPLE: Ten overweight or obese individuals with LSS were confirmed clinically and on imaging. OUTCOME MEASURES: Self-reported measures were food record, Short-Form 36 (SF-36), pain scales, Swiss Spinal Stenosis Symptom and Physical Function Scales, Oswestry Disability Index (ODI), Pain Catastrophizing Questionnaire, Tampa Scale for Kinesiophobia, Center for Epidemiologic Studies(Depression) Scale, Behavioral Regular in Exercise Questionnaire, and Regulation for Eating Behavior Scale and physiologic measures were dual-energy X-ray absorptiometry (DXA), blood draw, 7-day accelerometry, self-paced walking test, and balance test. METHODS: The e-health platform was developed. INTERVENTION: during Week 1, participants received a pedometer and a personalized consultation with a dietitian and an exercise physiologist. For 12 weeks, participants logged on to the e-health Web site to access personal step goals, nutrition education videos, and a discussion board. Follow-up occurred at Week 13. RESULTS: Nine participants had a mean age of 67.5±6.7 years (60% women). Significant improvements were observed for fat mass (DXA), trunk fat mass, symptom severity (Swiss Symptom Scale), energy intake, maximum continuous activity (accelerometry), and mental health (SF-36) (p<.05). Nonsignificant improvements were observed for waist circumference, pain, ODI, and obesity biomarkers. Seventy percent lost weight, 50% increased walking capacity, and 60% increased quality of life. The mean increase in steps was 15%. CONCLUSIONS: The spinal stenosis pedometer and nutrition lifestyle intervention was shown to be feasible, attractive to participants, and effective in this small sample. This intervention provides people with LSS the opportunity to participate in their own health management, potentially improving access to care. Efficacy is currently being assessed in a randomized trial.

The spinal stenosis pedometer and nutrition lifestyle intervention (SSPANLI) randomized controlled trial protocol.

BACKGROUND: Because of symptoms, people with lumbar spinal stenosis (LSS) are often inactive, and this sedentary behaviour implies risk for diseases including obesity. Research has identified body mass index as the most powerful predictor of function in LSS. This suggests that function may be improved by targeting weight as a modifiable factor. An e-health lifestyle intervention was developed aimed at reducing fat mass and increasing physical activity in people with LSS. The main components of this intervention include pedometer-based physical activity promotion and nutrition education. METHODS/DESIGN: The Spinal Stenosis Pedometer and Nutrition Lifestyle INTERVENTION (SSPANLI) was developed and piloted with 10 individuals. The protocol for a randomized controlled trail comparing the SSPANLI intervention to usual non-surgical care follows. One hundred six (106) overweight or obese individuals with LSS will be recruited. Baseline and follow-up testing includes dual energy x-ray absorptiometry, blood draw, 3-day food record, 7-day accelerometry, questionnaire, maximal oxygen consumption, neurological exam, balance testing and a Self-Paced Walking Test. INTERVENTION: During Week 1, the intervention group will receive a pedometer, and a personalized consultation with both a Dietitian and an exercise specialist. For 12 weeks participants will log on to the e-health website to access personal step goals, walking maps, nutrition videos, and motivational quotes. Participants will also have access to in-person Coffee Talk meetings every 3 weeks, and meet with the Dietitian and exercise specialist at week 6. The control group will proceed with usual care for the 12-week period. Follow-up testing will occur at Weeks 13 and 24. DISCUSSION: This lifestyle intervention has the potential to provide a unique, non-surgical management option for people with LSS. Through decreased fat mass and increased function, we may reduce risk for obesity, chronic diseases of inactivity, and pain. The use of e-health interventions provides an opportunity for patients to become more involved in managing their own health. Behaviour changes including increased physical activity, and improved dietary habits promote overall health and quality of life, and may decrease future health care needs in this population. TRIAL REGISTRATION: Clinicaltrials.gov, NCT01902979.

Effect of storage conditions on the solubility and viscosity of ß-glucan extracted from bread under in vitro conditions.

UNLABELLED: The viscosity and solubility of ß-glucan in muffins have been shown to be reduced by certain storage conditions, though the effect of storage on bread fortified with barley ß-glucan concentrate has not been investigated. Therefore, this study investigated the effect of storage temperature and time (23 °C for 1, 4, and 7 d, 4 °C for 4, 7, and 14 d, and -20 °C for 1, 2, 4, and 8 wk) on the solubility and viscosity of ß-glucan upon incorporation into bread at levels corresponding to 0 or 1.5 g ß-glucan/serving, with or without vital gluten addition. The firmness and moisture content of bread following each storage treatment were also evaluated. The highest moisture and lowest firmness values were found in fresh bread, though these parameters were still maintained at appreciable levels upon room temperature storage of the 1.5 g ß-glucan/serving bread with added gluten and at either room temperature or frozen storage for the 1.5 g ß-glucan/serving bread for 4 d. If it is desirable to store bread for 7 d or more, frozen storage should be utilized in order to best maintain bread moisture and firmness levels. It is recommended that ß-glucan-fortified bread be consumed fresh for greatest ß-glucan solubility and viscosity, though ß-glucan solubility of approximately 40% is still achievable upon frozen storage of the bread for up to 2 wk. It is still unclear, however, as to what extent of reductions in the solubility and viscosity of ß-glucan would lower its physiological effectiveness. PRACTICAL APPLICATION: Previous research has demonstrated that solubility and thus viscosity of ß-glucan, which is an important property associated with its health benefits can be impacted by different storage conditions applied to some bakery products, like muffins. This study demonstrates the extent of changes in the solubility and viscosity of ß-glucan incorporated into bread. Therefore, storage time and temperature should be optimized to minimize changes in ß-glucan for maintaining its efficacy for its health benefits.