title: 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 (±SD) age of 55 ± 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.
  
  
  METHODS
  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% (κ = 0.70; SE = 0.058, P < 0.001). For the 2-category classification (low risk, medium + high risk), agreement was 93% (κ = 0.78, SE = 0.057, P < 0.001). Disagreements were not systematically under- or overcategorized. Test-retest reliability was almost perfect (κ = 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute of Human Nutrition, University of Southampton, Southampton, United Kingdom. a.l.cawood@soton.ac.uk
authors.forename: Abbie L
authors.initials: AL
authors.lastname: Cawood
authors.forename: Marinos
authors.initials: M
authors.lastname: Elia
authors.forename: Sarah Ke
authors.initials: SK
authors.lastname: Sharp
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Stratton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis*; D008875:Middle Aged; D015596:Nutrition Assessment; D010045:Outpatients; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D055815:Young Adult