Current practice and barriers in the implementation of ultrasound-based assessment of muscle mass in Japan: A nationwide, web-based cross-sectional study

Abstract

Muscle mass is an important factor for surviving an illness. Ultrasound has gained increased attention as a muscle mass assessment method because of its noninvasiveness and portability. However, data on the frequency of ultrasound-based muscle mass assessment are limited, and there are some barriers to its implementation. Hence, a web-based cross-sectional survey was conducted on healthcare providers in Japan, which comprised four parts: 1) participant characteristics; 2) general muscle mass assessment; 3) ultrasound-based muscle mass assessment; and 4) the necessity of, interest in, and barriers to its implementation. Necessity and interest were assessed using an 11-point Likert scale, whereas barriers were assessed using a 5-point Likert scale, in which “Strongly agree” and “Agree” were counted for the analysis. Of the 1,058 responders, 1,026 participants, comprising 282 physicians, 489 physical therapists, 84 occupational therapists, 120 nurses, and 51 dieticians, were included in the analysis. In total, 93% of the participants were familiar with general muscle mass assessment, and 64% had conducted it. Ultrasound-based muscle mass assessment was performed by 21% of the participants. Necessity and interest scored 7 (6–8) and 8 (7–10), respectively for ultrasound-based muscle mass assessment. The barriers to its implementation included lack of relevant education (84%), limited staff (61%), and absence of fixed protocol (61%). Regardless of the necessity of and interest in ultrasound-based muscle mass assessment, it was only conducted by one-fifth of the healthcare providers, and the most important barrier to its implementation was lack of education.

Incorporating ultrasonography to the nutritional assessment process in intensive care settings to improve the prescription of enteral and parenteral nutrition

“…In a survey-based study in Japan that investigated the barriers to implementing US as a tool to measure muscle mass indicated that 21% of healthcare practitioners conduct US-based muscle mass measurements, whereas only 6% of dietitians use US for muscle mass assessment. 35 The authors of the Japanese study also reported that the greatest barrier to the implementation and use of US is lack of education. 35 Lack of standardized protocols for assessing muscle mass by ultrasound might be an additional challenge.…”

“… 35 The authors of the Japanese study also reported that the greatest barrier to the implementation and use of US is lack of education. 35 Lack of standardized protocols for assessing muscle mass by ultrasound might be an additional challenge. 36 As this can result in variations in measurement techniques and inconsistency in reporting findings.…”

What the clinician needs to know about medical nutrition therapy in critically ill patients in 2023: A narrative review

“…Moreover, the availability of US devices and appropriate training of medical staff in measuring skeletal muscle mass using sonography are further determinants for the implementation in routine clinical practice. 45,47 Current recommendations and latest evidence on protein dosing in MNT Adequate protein supply within an energy-balanced MNT is of particular importance in the critical care setting to stimulate muscle protein synthesis, reduce muscle protein breakdown, and limit amino acid oxidation after disease-related alterations in substrate utilization and metabolism. 48 Besides targeted medication and exercise, protein intake higher than the amount…”

“…International, standardized protocols are required to assess qualitative muscle changes during the ICU stay of patients at high risk for developing neuromuscular acquired weakness (ICUAW), also taking into account method‐inherent limitations (eg, reliability may be affected by the fluid status and position of the patients when performing measurements). Moreover, the availability of US devices and appropriate training of medical staff in measuring skeletal muscle mass using sonography are further determinants for the implementation in routine clinical practice 45,47 …”

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“…Ultrasonography-based muscle mass assessment is applied in acute [19] or chronic diseases [20]; however, it is not widely used owing to a lack of technical skills. In a previous questionnaire survey, ultrasonography-based muscle mass assessment was conducted only in 14% of health care workers [21].…”