Can dieticians assess physical fat and muscles stores via video conferencing for the purpose of malnutrition diagnosis in the home rehabilitation setting?

Mrs Cassandra Lawless1, Ms Alex Christie, Mr Owen Kuhr3,4,5, Professor Michelle Miller2, Dr Jolene Thomas2

1Southern Adelaide Local Health Network, Flinders Medical Centre, Rehab, Aged & Palliative Care, Adelaide, Australia, 2Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia, 3Central Local Health Network, Queen Elizabeth Hospital, Adelaide, Australia, 4Sprout Cooking School & Health Studio, Adelaide , Australia, 5Wilson Nutrition, Adelaide, Australia

There is significant demand for innovation to meet the increasing requirement for nutrition services in rehabilitation. Tele consultations may allow remote diagnosis of malnutrition; however, no valid method to perform the physical examination, a critical component of assessing nutritional status, via video conferencing exists.

This study aims to compare the agreement between the in-person and video-based overall physical assessment using the scored Patient Generated Subjective Global Assessment (PG-SGA).

Cross-sectional diagnostic accuracy study.

Adults aged ≥ 18 years old admitted to the home rehabilitation program at Flinders Medical Centre in Adelaide, South Australia between August 2019- November 2019 and August 2020- October 2020, were eligible. The in-person and video-based PG-SGA’s were collected from 71 participants.

Main outcome measures
The physical examination component of the PG-SGA was completed at one in-person encounter and one encounter over a video-call by trained dietitians blinded to the other assessment to determine the agreement between both methods.

Statistical analyses performed
Percentage agreement, weighted kappa, sensitivity and specificity were calculated.

The overall video-based physical examination rating achieved a percentage agreement of 69.0% against the in-person assessment, with a weighted kappa agreement of 0.658 (95% CI: 0.530-0.786 ; P<0.05), sensitivity of 87.9% and specificity of 81.6%.

The substantial weighted kappa, good sensitivity and specificity supports the use of the physical assessment in diagnosing malnutrition via video conferencing in the home rehabilitation setting. Future training of dietitians who utilise Telehealth could see this method adopted into clinical practise and ultimately better address malnutrition in patients who live remotely or who are unable to attend an outpatient appointment.


Cassandra Lawless is an Accredited Practising Dietitian who is devoted to using science and client-centered coaching methods in order to help her patient’s achieve their goals. She has worked in hospital-based rehabilitation services with her multidisciplinary team for over six years and has extensive expertise when it comes to the use of telehealth. She has an entrepreneurial approach to her work and loves innovation with the purpose of improving patient care. She developed a “High Calorie High Protein” application, which is currently being used in rehabilitation for interactive, self-directed education and she has recently undertaken her Honours degree which investigated the validity of diagnosing malnutrition over a video-call. Cassandra also works privately in the online space, where she is co-founder of the Health Code Company with her cousin; together they coach women around the globe to be their healthiest selves. Cassandra has co-authored and published a book “Meet the Macros”, which is sold in bookstores around Australia and is currently working on a health and fitness application, which will be launched worldwide.

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