Lack of knowledge and availability of diagnostic equipment hinder the diagnosis of sarcopenia and its management

Background: Sarcopenia is an emerging clinical challenge in an ageing population and is associated with serious negative health outcomes. This study aimed to assess the current state of knowledge about the concept of sarcopenia, diagnostic strategy and management of sarcopenia in a cohort of Dutch healthcare professionals (physicians, physiotherapists, dietitians and others) attending a lecture cycle on sarcopenia. Methods: Healthcare professionals (n=223) were asked to complete a questionnaire before, directly after and five months after attending a lecture cycle on the pathophysiology of sarcopenia, diagnostic strategy and management of sarcopenia, i.e. interventions and collaboration. Results: Before attendance, 69.7% of healthcare professionals stated to know the concept of sarcopenia, 21.4% indicated to know how to diagnose sarcopenia and 82.6% had treated patients with suspected sarcopenia. 47.5% of the healthcare professionals used their clinical view as diagnostic strategy. Handgrip strength was the most frequently used objective diagnostic measure (33.9%). Five months after attendance, reported use of diagnostic tests was increased, i.e. handgrip strength up to 67.4%, gait speed up to 72.1% and muscle mass up to 20.9%. Bottlenecks during implementation of the diagnostic strategy were experienced by 67.1%; lack of awareness among other healthcare professionals, acquisition of equipment and time constraints to perform the diagnostic measures were reported most often. Before attendance, 36.4% stated not to consult a physiotherapists or exercise therapists (PT/ET) or dietitian for sarcopenia interventions, 10.5% consulted a PT/ET, 32.7% a dietitian and 20.5% both a PT/ET and dietitian. Five months after attendance, these percentages were 28.3%, 21.7%, 30.0% and 20.0% respectively. A lack of collaboration was experienced by 36.8%. Conclusion: The concept of sarcopenia is familiar to most healthcare professionals but application in practice is hampered, mostly by lack of knowledge, availability of equipment, time constraints and lack of collaboration. Introduction The clinical relevance of sarcopenia is increasingly being recognized and a clinical challenge in our ageing population. Sarcopenia is associated with negative health outcomes such as falls [1, 2], impaired standing balance [3], physical disability [4, 5] and mortality [6, 7]. Sarcopenia is a public health burden and entails high healthcare costs associated with hospitalization, outpatient clinic visits and home healthcare expenditure [8, 9]. According to survey data from the United States, direct costs of sarcopenia may be up to 1.5% of the total healthcare costs [9]. Prevalence rates of sarcopenia vary up to 34% in geriatric outpatients dependent on the used definition [10]. To date, no consensus definition of sarcopenia has been reached, however, most recent definitions are based on measures of muscle mass, muscle strength and gait speed [11-13]. Combined intervention of physical exercise and adequate protein intake is more effective in increasing muscle mass and muscle strength compared to either physical exercise or nutritional intervention alone [14-17]. Therefore, a multidisciplinary approach is required in which different healthcare professionals play a key role in the diagnostic strategy and management of sarcopenia. This requires common knowledge about the concept of sarcopenia, a diagnostic strategy and optimal management of sarcopenia including consultation and collaboration between diverse healthcare professionals. This study aimed to assess the current state of knowledge about the concept of sarcopenia, diagnostic strategy and management of sarcopenia in a cohort of different Dutch healthcare professionals attending the Sarcopenia Road Show, a postgraduate, multidisciplinary lecture cycle for healthcare professionals with different backgrounds (physicians, physiotherapists, dietitians and others). Methods Study design This longitudinal study included 223 medical and allied healthcare professionals attending the lecture cycle ‘Sarcopenia Road Show’. Healthcare professionals worked either in primary care, nursing homes or hospitals. Medical healthcare professionals included physicians (geriatricians, internists, internist-geriatricians, nursing home physicians, general practitioners (GP) and residents, considered as one group), nurses and GP assistants; allied healthcare 44654 Esmee Reijnierse.indd 128 20-02-17 15:14 Awareness on sarcopenia among healthcare professionals 129 8 Abstract Background: Sarcopenia is an emerging clinical challenge in an ageing population and is associated with serious negative health outcomes. This study aimed to assess the current state of knowledge about the concept of sarcopenia, diagnostic strategy and management of sarcopenia in a cohort of Dutch healthcare professionals (physicians, physiotherapists, dietitians and others) attending a lecture cycle on sarcopenia. Methods: Healthcare professionals (n=223) were asked to complete a questionnaire before, directly after and five months after attending a lecture cycle on the pathophysiology of sarcopenia, diagnostic strategy and management of sarcopenia, i.e. interventions and collaboration. Results: Before attendance, 69.7% of healthcare professionals stated to know the concept of sarcopenia, 21.4% indicated to know how to diagnose sarcopenia and 82.6% had treated patients with suspected sarcopenia. 47.5% of the healthcare professionals used their clinical view as diagnostic strategy. Handgrip strength was the most frequently used objective diagnostic measure (33.9%). Five months after attendance, reported use of diagnostic tests was increased, i.e. handgrip strength up to 67.4%, gait speed up to 72.1% and muscle mass up to 20.9%. Bottlenecks during implementation of the diagnostic strategy were experienced by 67.1%; lack of awareness among other healthcare professionals, acquisition of equipment and time constraints to perform the diagnostic measures were reported most often. Before attendance, 36.4% stated not to consult a physiotherapists or exercise therapists (PT/ET) or dietitian for sarcopenia interventions, 10.5% consulted a PT/ET, 32.7% a dietitian and 20.5% both a PT/ET and dietitian. Five months after attendance, these percentages were 28.3%, 21.7%, 30.0% and 20.0% respectively. A lack of collaboration was experienced by 36.8%. Conclusion: The concept of sarcopenia is familiar to most healthcare professionals but application in practice is hampered, mostly by lack of knowledge, availability of equipment, time constraints and lack of collaboration. Introduction The clinical relevance of sarcopenia is increasingly being recognized and a clinical challenge in our ageing population. Sarcopenia is associated with negative health outcomes such as falls [1, 2], impaired standing balance [3], physical disability [4, 5] and mortality [6, 7]. Sarcopenia is a public health burden and entails high healthcare costs associated with hospitalization, outpatient clinic visits and home healthcare expenditure [8, 9]. According to survey data from the United States, direct costs of sarcopenia may be up to 1.5% of the total healthcare costs [9]. Prevalence rates of sarcopenia vary up to 34% in geriatric outpatients dependent on the used definition [10]. To date, no consensus definition of sarcopenia has been reached, however, most recent definitions are based on measures of muscle mass, muscle strength and gait speed [11-13]. Combined intervention of physical exercise and adequate protein intake is more effective in increasing muscle mass and muscle strength compared to either physical exercise or nutritional intervention alone [14-17]. Therefore, a multidisciplinary approach is required in which different healthcare professionals play a key role in the diagnostic strategy and management of sarcopenia. This requires common knowledge about the concept of sarcopenia, a diagnostic strategy and optimal management of sarcopenia including consultation and collaboration between diverse healthcare professionals. This study aimed to assess the current state of knowledge about the concept of sarcopenia, diagnostic strategy and management of sarcopenia in a cohort of different Dutch healthcare professionals attending the Sarcopenia Road Show, a postgraduate, multidisciplinary lecture cycle for healthcare professionals with different backgrounds (physicians, physiotherapists, dietitians and others). Methods Study design This longitudinal study included 223 medical and allied healthcare professionals attending the lecture cycle ‘Sarcopenia Road Show’. Healthcare professionals worked either in primary care, nursing homes or hospitals. Medical healthcare professionals included physicians (geriatricians, internists, internist-geriatricians, nursing home physicians, general practitioners (GP) and residents, considered as one group), nurses and GP assistants; allied healthcare 44654 Esmee Reijnierse.indd 129 20-02-17 15:14