Implementing malnutrition screening in Pulmonary Rehabilitation (PR) – what is the impact?

Ms Katie Belobrajdic1

1Northern Adelaide Local Health Network, Elizabeth, Australia


Nutrition is a significant issue in chronic obstructive pulmonary disease (COPD) due to increased risk of malnutrition. Prior to May 2017, PR participants within Northern Adelaide Local Health Network did not have access to a Dietitian through the programs education series and referral rates to Dietetics were low. Malnutrition screening was not routinely conducted. The aim of this project was to 1) increase client access to Dietetics services and 2) implement malnutrition screening in 100% of participants.


A Dietitian was assigned to provide one group education session throughout each 6 week PR programs. The Mini Nutritional Malnutrition Assessment – Short Form was identified as the most relevant, validated tool and was implemented at initial screening or within the education sessions. Clients identified as ‘malnourished’, ‘at risk of malnutrition’ or with a ‘normal nutrition status’ with a BMI of =/>23 were offered an individual Dietetics referral.


– 100% of group participants were screened (n=58)

– Of these, 55% identified as malnourished/at risk (n=32) were offered a Dietetics referral and 50% of those accepted

– An additional 24 referrals were received directly from PR Physiotherapists following screening outside of the program

– Dietetic referrals from the PR team increased from a total of 5 referrals/year (May 2016/17) to 40 referrals/year (May 2017/18).


As a result of this project, clients now have access to evidence based Dietetic education and intervention through the implementation of malnutrition screening by PR Physiotherapists and Dietitians. Patients with COPD/other lung conditions were able to be identified earlier as malnourished, at risk, or with a BMI >23. Early identification allows for earlier intervention by a Dietitian to ensure no further deterioration in weight status (loss or gain), muscle wasting, micronutrient, protein and energy intake.


Katie Belobrajdic is an Accredited Practicing Dietitian with 16 years’ experience working as a Dietitian. Katie has focussed the majority of her career within the area of Chronic Disease prevention and management and has worked in both rural Victoria, South Australia and metropolitan Adelaide. She is currently the Clinical Lead for the Nutrition and Dietetics Department within Northern Adelaide Local Health Network, Intermediate Care Services. This work involves supporting client based self-management in the areas of Pulmonary Rehabilitation, Diabetes, Cardiac Rehabilitation and Non-Alcoholic Steato-hepatitis (NASH).

NAHC Conferences

2007, Hobart (7th NAHC)

2009, Canberra (8th NAHC)

2012, Canberra (9th NAHC)

2013, Brisbane (10th NAHC)

2015, Melbourne (11th NAHC)

2017, Sydney (12th NAHC)

2019, Brisbane (13th NAHC)

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