Summary

What it measures:

This summary presents 4 different screening tools that assess an individual's dietary habits through patient-reported data. Note: To identify risk of malnutrition among older adults (aged 65+), consider use of the Mini Nutritional Assessment (MNA).¹

Presented here is information regarding the:

1. Nutrition Screening Protocol, composed of 2 questions that gauge dietary risk.²
2. Starting the Conversation (STC) tool, which measures dietary intake.²
3. Raid Eating Assessment for Participants, Shortened Version (REAP-S), which assesses diet quality.²
4. Mediterranean Diet Adherence Screener (MEDAS), which estimates adherence to the Mediterranean diet. This tool has been translated and culturally validated for use with several different populations.^3,4
   
   Note: The Mediterranean Eating Pattern for Americans (MEPA), has been developed, but further testing is recommended.⁵

International Classification of Functioning, Disability and Health (ICF)

Domain: Activities and Participation

Category: d5701 Managing diet and fitness

Target Population:

• Individuals aged 18 and above, at risk for diet-related chronic disease.²
  • Prevalence of cardiovascular disease among adults in the United States (US) is approximately 48%.⁶

Taskforce Recommendations:

An APTA position statement supports collaboration between physical therapists and registered dieticians to promote the health and well-being of society.⁷ Through appropriate screening, counseling, and referrals, physical therapists can play a role in supporting the nation's Healthy People 2030 goal to "improve health by promoting healthy eating and making nutritious foods available."⁸

• The US Preventive Services Task Force provides a Grade B recommendation for clinicians to take the following actions:
  • For adults with cardiovascular disease risk factors, offer or refer behavioral counseling interventions to promote a healthy diet and physical activity.⁹
  • For adults without cardiovascular disease risk factors, individualize the decision to offer or refer to behavioral counseling interventions to promote a healthy diet and physical activity.⁹

Clinical Insights

• Physical therapists should incorporate diet/nutrition screening and education into routine care because diet is a key modifiable factor in the development and progression of diet-related chronic disease, especially cardiovascular disease.^2,10-13
  • The information in the 3 charts below can assist clinicians in their selection of a tool for use.
• State Laws: Physical therapists may always screen for nutritional concerns and refer patients as appropriate; however, the provision of nutrition-related advice may be restricted by state law. Because the jurisdictional scope of physical therapy practice varies by state, physical therapists should review applicable statutes and consult their state licensing boards to clarify permissible activities prior to providing nutritional counseling.¹⁴
• If a diet/nutritional screen is positive (patient's score indicates poor dietary habits), the physical therapist should:
  • Provide general education about healthy eating and the benefits of healthy nutrition. (See the Resources section at the end of this document.)
  • Determine the patient's readiness to change.¹⁵
  • Refer the patient to a registered dietitian for personalized nutrition counseling as appropriate.¹⁶ Use the Find a Nutrition Expert tool from the Academy of Nutrition and Dietetics to find credentialed nutrition and dietetics practitioners by location, specialty, language, or insurance and payment options.