Doctor and patient perceptions of sarcopenia in community-based primary care clinics: A questionnaire survey

doi:10.21203/rs.3.rs-3573427/v1

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Research Article

Doctor and patient perceptions of sarcopenia in community-based primary care clinics: A questionnaire survey

https://doi.org/10.21203/rs.3.rs-3573427/v1

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Background

Early detection and management of sarcopenia in community-based primary care clinics that provide care for community-dwelling older patients are important to prevent related complications.

Methods

We analyzed nine matched items from separate surveys with 80 doctors working at community-based primary care clinics and 80 community-dwelling older patients who visited 6 of the 80 primary care clinics. Both questionnaires were self-administered and consisted of sections on sarcopenia awareness, willingness to treat sarcopenia, and demand for management methods.

Results

28 patients (35.4%) reported having heard about sarcopenia. Only 19 physicians (23.8%) responded that they knew the diagnostic criteria of sarcopenia. The proportion of patients who believed that they had sarcopenia was higher than that of patients with sarcopenia assumed by the doctors (patients, 35%; doctors, 16.9%; P = 0.0039). Patients desired more frequent and extensive exercise and nutritional education than doctors. More patients preferred receiving regular text messages than doctors (for exercise: patients 16.5%, doctors 5.8%, P = 0.0428; for nutrition: patients 17.1%, doctors 4.4%, P = 0.0154). More patients than doctors did not know what community services were available for managing sarcopenia (patients 48.8%, doctors 10.0%, P < 0.001).

Conclusion

Both patients and doctors at community-based primary care clinics were poorly informed about sarcopenia. The preference for exercise and nutritional education showed significant differences between patients and doctors. These results will be beneficial for developing programs to manage sarcopenia in community-based primary care clinics.

Sarcopenia

Community-dwelling older adults

Survey

Primary Health Care

Medical needs

Sarcopenia is a geriatric syndrome characterized by decreased skeletal muscle mass, muscle strength, and physical performance with aging (1). This syndrome reduces quality of life and increases frailty, falls, fractures, healthcare burden, and mortality in older adults (2). In addition, hospitalization and productivity losses due to sarcopenia have adverse economic effects (3). Early detection and management of sarcopenia can prevent progression to frailty and reduce the occurrence of complications related to sarcopenia, which is considered reversible when provided with nutritional counseling and personalized exercise programs (4). Community-based primary care doctors who are familiar with patients’ clinical problems and lifestyle behaviors can play an active role in diagnosing and managing sarcopenia (5).

This corresponds with the Asian Working Group for Sarcopenia (AWGS) 2019, which suggested the term “possible sarcopenia” for the early identification of older adults at risk of sarcopenia to facilitate necessary interventions in primary care settings without advanced diagnostic equipment (1). Because no drugs are recommended to treat sarcopenia yet (6), managing sarcopenia through consistent exercise and nutritional management is essential (7). Practicing exercise and nutritional education for patients with possible sarcopenia at a primary care clinic close to their homes could provide added convenience. Management of sarcopenia through consistent exercise and nutritional management can be better performed in community-based primary care settings, to which patients have better access, than in general hospitals.

For the early detection and management of sarcopenia in community-based primary care clinics, a comprehensive understanding of sarcopenia is important not only for primary care doctors but also for patients cared for by doctors. There have been various studies on the awareness of sarcopenia and its management (8–10). However, no studies have investigated what community-based primary care doctors and their patients think about sarcopenia and its management. Assessing the perspectives of doctors and patients on sarcopenia and its management will help manage sarcopenia in primary care services. Understanding the gap in the perception of sarcopenia and the need for managing it between primary care doctors and their patients may help develop strategies in primary care settings. Hence, we used a questionnaire survey to examine the perspectives of primary care doctors and older patients regarding sarcopenia. We investigated their preferences for sarcopenia management methods and explored the disparities between the two groups.

Participants

The survey was conducted between March 2022 and February 2023. For doctors, eligible participants were those who had participated in the Primary Health Care Chronic Diseases Management Pilot Program in community-based primary healthcare clinics in Seoul. The primary healthcare chronic disease management pilot program was initiated by the Ministry of Health and Welfare of Korea. It is a comprehensive hypertension and diabetes management service centered on local clinics and linked with community resources. A recruitment notice was issued to eligible doctors, and those who expressed a desire to participate voluntarily were recruited by distributing consent forms and questionnaires online or offline. Eighty doctors (44 online and 36 offline) agreed to participate in this study.

Eligible participants were outpatients aged 65 years and older receiving medical services from 6 of the 80 primary care clinics. Eighty patients agreed to participate in this survey and were outpatients aged 65 years and older and community-dwelling older adults. Most patients were recruited from four of these clinics. The number of participants recruited for each clinic was 24, 26, 13, 13, 2, and 2.

2.2 Questionnaires and questionnaire matching

The questionnaire scheme was developed based on previous literature (8, 10, 11) and modified after discussion with three geriatric/gerontology professors and five community-based primary care physicians. The questionnaire for patients consisted of 35 questions. It included sociodemographic characteristics, sarcopenia awareness, willingness to treat sarcopenia, and demands for its management. Additionally, two components were assessed for defining possible sarcopenia (1) (calf circumference and five times sit-to-stand). The questionnaire for the doctors consisted of 28 items and included questions about the doctor's career, sarcopenia awareness, and demands for exercise and nutrition education. The diagnostic definition of sarcopenia was based on the AWGS 2019 criteria (1).

Responses to the questions assessing the level of agreement were recorded on a 5-point Likert scale (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree). Some questions allowed multiple choices from among the options listed. We identified and matched similar surveys to compare the two groups’ responses. Nine survey questions were selected for matching. Details of the questions are provided in Supplement Table 1.

Statistical analysis

Pearson’s chi-square tests were performed for nominal variables, and Fisher’s exact test was performed if the expected frequency of cells was < 5 in more than 20% of the cases. Student’s t-test was performed to determine the difference in the frequency of each variable. Fisher’s exact test and t-test were performed for each response for possible multiple-response survey questions. Statistical significance was defined as P < 0.05. Data were analyzed using STATA version 15 (Stata Corp., College Station, TX, USA).

Characteristics of the participating doctors and patients

Tables 1 and 2 present the basic characteristics of doctors and outpatients who participated in the survey.

(Table 1 is here)

(Table 2 is here)

Among the doctors, 82.5% were men, and the mean age was 58.3 years. Of these 80 doctors, 40 (50%) were from Dobong-gu, Seoul, Korea. Thirty-three doctors (41.3%) were from the other 12 districts in Seoul, and seven doctors (8.7%) were from regions outside Seoul, including Ilsan, Yongin, Suwon, and Bucheon, located in Gyeonggi-do Province, Daegu, and Gwangju, Korea. Most participating doctors had over 20 years of experience (n = 50, 62.5%). Doctors majored in family medicine (n = 28, 35%), internal medicine (n = 12, 15%), general physician (n = 5, 6.3%), and others (n = 35, 43.8%). Most clinics had one or two doctors (n = 76, 95%), one or two registered nurses (s) (n = 49, 61.3%), one or two nurse assistants (n = 70, 87.5%), and no other staff (n = 47, 56.3%).

Among the patients recruited from six of the 80 primary care clinics, 38.7% were men, and the mean age was 74.1 years. Figure 1 illustrates the demographic distribution of participating patients and their doctors.

(Figure 1 is here)

Of the 80 patients, 32 (40.0%) were recruited from Dobong-gu, and 19 (23.8%) were from Jongno-gu, both distinct districts of Seoul. Additionally, 23 patients (28.8%) were from the other ten districts of Seoul, and six (7.4%) were from regions outside Seoul, including Yangju, Namyangju, and Uijeongbu, which are located in Gyeonggi-do Province and Miryang, Korea. Regarding medical history, 72.5% of the patients had hypertension, 30% had diabetes, and 26.3% had arthritis. The patients who were practicing exercise regularly were 62 (78.5%). Most of these patients lived with their spouses (68.4%), and only 10% lived alone. Twenty-eight individuals (35%) had calf circumferences below the cutoff value for possible sarcopenia of AWGS 2019 (men < 34 cm, women < 33 cm). Thirty-two individuals (40.5%) had 12 s or more records, the cutoff value for possible sarcopenia in the AWGS 2019. Of these patients, 28 (35.4%) replied that they had heard of sarcopenia. Only 19 doctors (23.8%) responded that they knew the definition of sarcopenia.

Patients’ willingness and preferences for sarcopenia prevention and management

Of the patients, 63 (80.8%) responded that they would receive treatment if diagnosed with sarcopenia. To the multiple-choice question asking about effective treatment for sarcopenia, 53 (66.3%) chose exercise, 33 (41.3%) chose nutrition management, and 11 (13.8%) chose medication. Regarding whether sarcopenia would improve with personalized exercise and proper nutrition, 69 (86.3%) answered yes. More than two-thirds of patients (n = 49, 68.1%) responded that they preferred exercising first to treat sarcopenia if diagnosed with it. When asked where they would like to exercise regularly, over two-thirds indicated a sports center near their homes (n = 26, 34.2%) or outdoor spaces such as parks (n = 24, 31.6%).

For the multiple-choice question about what they are doing for nutrition management to maintain muscle mass and strength, 38 (48.1%) chose ‘eating food evenly,’ 19 (23.8%) ‘increasing legume intake,’ 17 (21.3%) eating more eggs, and 16 (20.0%) selected ‘increasing dairy eating,’ while 33 (41.3%) said they ignored nutrition. Regarding the preferred method of nutritional supplementation for managing sarcopenia, protein supplementation (n=31, 40.3%), nutritional education (n=17, 22.1%), and food ingredient delivery (n=15, 19.5%) were the most commonly chosen options.

Comparison in responses between doctors and patients

Table 3 shows the similarities and differences in responses to the matched questions between doctors and patients.

(Table 3 is here)

Figure 2 shows the responses to the matched questions about the importance of sarcopenia and the presence of sarcopenia among patients and doctors.

(Figure 2 is here)

There was no statistically significant difference in agreement regarding the importance of sarcopenia for health (67 patients [83.8%] vs. 65 doctors [83.3%]; P = 0.351). The doctors believed that 16.9% of their older outpatients had sarcopenia during the past month, while 35% of the patients believed that they had sarcopenia (P = 0.0039).

The frequency of exercise education sessions that the doctors answered to be feasible was significantly lower than what the patients desired; the percentage of patients desiring at least once per week was 62.5%, significantly higher than that of the doctors (19.2%, P < 0.001). A higher percentage of patients than doctors desired exercise education lasting more than 10 minutes at a time (78.8% of patients vs. 8.9% of doctors, P < 0.001). The desired frequency and duration of nutritional education were significantly higher for patients than for doctors. Regarding the frequency of exercise education, patients favored sessions once a month (23.8%) or once a week (32.5%), whereas doctors preferred sessions once a month (47.4%) or 2–3 times a month (33.3%). Regarding the duration of exercise education, most patients wanted sessions lasting more than 15 min (62.5%), and most doctors answered that 3–5 minutes (45.6%) or 5–10 minutes (34.2%) were feasible. Regarding the frequency of nutrition education, most patients and doctors wanted it once a month (patients, 52.5%; doctors, 59.5%); however, patients wanted it more frequently than doctors (P = 0.007). Regarding the duration of nutrition education, most patients wanted 10–15 minutes (23.8%) or more than 15 minutes (38.8%), whereas most doctors wanted 3–5 minutes (44.3%) or 5–10 minutes (34.2%). When comparing responses regarding nutritional education and exercise education, patients and doctors responded that they desired fewer sessions and shorter durations of nutrition education than exercise education (P < 0.001 for frequency and P = 0.004 for duration).

When asked about the desired best ways to help consistently practice exercise at home for sarcopenia, educational materials with pictures or text were most commonly selected by doctors (33.3%), whereas only 21.5% of the patients selected them (P < 0.05). Patients preferred receiving regular text messages to help them consistently practice exercise more than doctors did (13% of patients vs. 5.8% of doctors, P = 0.0428). There were no statistically significant differences in the other responses.

When asked about the desired best ways to help consistently implement nutritional management for sarcopenia, patients again preferred receiving regular text messages more than doctors did (13 patients vs. 3 doctors, P = 0.0154). More doctors preferred educational materials with pictures or text than patients did (11 patients vs. 23 doctors, P = 0.0061). There was no significant difference between the patients and doctors in their preferences for videos or education with a caregiver.

Doctors provided various responses to a multiple-choice question about the necessary community services for sarcopenia management outside the clinic, including public health center exercise programs and home-visit services. However, more patients than doctors were unaware of the existence of such services (48.8% of patients vs. 10.0% of doctors, P < 0.001).

In our study, only 23.8% of the community-based primary care doctors responded that they knew the definition criteria for sarcopenia. These results parallel those of another study in a community setting in the US, where the percentage of those familiar with the term sarcopenia was < 20% among family medicine doctors and internists. However, 70% of geriatricians and 41% of physical medicine and rehabilitation doctors were familiar with the term (12). Our study targeted community-based primary care doctors; most were unaware of sarcopenia. In an online survey on sarcopenia involving oncologists in Australia, 88% were aware of the accepted definition of sarcopenia (8). In a survey involving Asian doctors, the percentage of doctors who were aware of the definition of sarcopenia (76.7%) was significantly higher than that in our study (23.8%) (9). However, in the Australian study, the doctors were specialists working in public hospitals, and therefore, most were aware of sarcopenia. In the Asian survey, most survey participants (76.2%) worked in general hospitals and were recruited through AWGS members. Therefore, they may have had a higher awareness of sarcopenia than the doctors in our study. Most participating doctors in this study answered that early diagnosis of sarcopenia in older adults is important for treatment. In a survey of healthcare professionals in New Zealand, only 14% reported that sarcopenia was a disease before education; however, after education on sarcopenia, the percentage of the participants rose significantly to 93.4% immediately and 59.5% six months later (10).

In our study, the proportion of patients who thought they had sarcopenia was higher than that of doctors. The reported prevalence of sarcopenia varies according to diagnostic criteria (13, 14). The prevalence of sarcopenia according to AWGS 2019 criteria in a meta-analysis was 14 to 18% (15). The average percentage of patients suspected of having sarcopenia by doctors during the previous month was 16.9%, similar to the results of the abovementioned meta-analysis. Meanwhile, 35% of the patients in our study replied that they thought they had sarcopenia. Therefore, it does not seem that primary care doctors underestimate sarcopenia. Instead, patients may be more concerned about it than its actual prevalence. Only 19 (41.3%) of the 46 patients with a small calf circumference or extended 5-time chair rise test by the AWGS 2019 criteria perceived themselves to have sarcopenia (data not shown). Patients with a small calf or extended 5-time chair rise test were more likely to think they had sarcopenia (41.3%) than those who did not (26.5%). However, there was no correlation between having a small calf circumference or an extended 5-time chair rise test and perception of sarcopenia presence (P = 0.169).

The patients in our study desired more exercise and nutritional education than doctors. Therefore, the unmet need for sarcopenia management in outpatients may be fulfilled by hiring exercise/nutrition experts at clinics or participating in community services. Korean data from the Health Insurance Review & Assessment Service (HIRA) show that the average numbers of staff members per clinic were 1.39 doctors, 0.51 registered nurses, 2.59 nurse assistants, and 1.79 other staff members on average (16). In our study, similar to the national data, most clinics had just one or two doctors (95%), no registered nurse in 36.3%, and one or two nurse assistants in 57.5%. According to the HIRA statistics, the average number of outpatients per day per clinic in Korea was 48.3 (17). Especially for internal medicine and family medicine clinics, the average number of outpatients per day per clinic was much higher at 60.9 (17). Therefore, due to limited manpower and short consultation time per outpatient, it is challenging for the clinic staff to provide exercise or nutrition education to patients. In addition, the Korean National Health Insurance Service (NHIS) applies a fee-for-service, but there is no fee for nutrition or exercise education. A national pilot program for chronic disease management in primary healthcare is ongoing, with preliminary attempts to introduce fees for nutritional and exercise education; however, this is still in the pilot phase.

In this study, 78.5% of the patients already exercised regularly, but 41.3% did not pay attention to nutrition for muscle mass and strength and wanted less nutritional education than exercise education. Although older adults are vulnerable to malnutrition (18) an important cause of sarcopenia (19), they are not interested in nutrition. Therefore, doctors should consider the nutritional status of older outpatients.

Patients preferred regular text messages as the best way to practice exercise and nutritional management for sarcopenia regularly. Other studies have reported that patients prefer text messages to video calls (20). Regular text messages, which are more economical and easier than home visits or video calls, should be actively used in primary care clinics.

In our study, most patients were unaware of community service resources to help with sarcopenia management. However, many public institutions already operate various exercise and nutrition programs for older adults in Korea. Senior welfare centers provide free daily lunches to community-dwelling older adults and offer various exercise programs, such as gate ball, dance sports, Pilates, and strength training. Senior welfare centers provide side dishes and lunch box delivery services for low-income and disabled seniors. Community centers also provide various exercise programs, and public health centers operate customized nutritional management programs. Doctors can inform their sarcopenic outpatients about programs already operated by various institutions so that older adults can use them.

This study had some limitations. First, clinicians and patients were selected by convenience sampling, and most of the participants lived in Seoul City (doctors 91.3%, patients 92.6%), which does not represent doctors or patients nationwide. Second, most patients were selected from four clinics. To rule out clinic bias, the responses of the 76 patients who visited the four clinics and 4 doctors at each clinic were compared. The four doctors were found to believe that an average of 21.3% of the older patients they saw in the previous month were suspected of having sarcopenia, while 34.2% of the patients reported that they thought they had sarcopenia. The results from 76 patients did not differ from those from 80 patients.

This is the first study to analyze the similarities and differences in perception of sarcopenia between outpatients and doctors in community-based primary care clinics. This study provides insights into the management of sarcopenia in community-based clinics.

Community-dwelling older patients and primary care doctors in Korea do not know much about sarcopenia. More information is needed from primary care doctors and patients to manage sarcopenia. The preference for exercise and nutritional education showed significant differences between patients and doctors. In particular, patients desired more extensive exercise and nutritional education to manage sarcopenia than the doctors thought was feasible. Therefore, it would benefit the community to take the lead in developing various programs to manage sarcopenia. These results will be beneficial for developing various programs to manage sarcopenia in community-based primary care clinics.

AWGS: Asian Working Group for Sarcopenia

HIRA: Health Insurance Review & Assessment Service

Acknowledgments

We would like to thank the study participants and staff of the Korean Frailty and Aging Cohort Study for their cooperation in conducting this study.

Funding

This research was supported by grants from the Korea Health Technology R&D Project through the Korean Health Industry Development Institute (KHIDI), which was funded by the Ministry of Health and Welfare, Republic of Korea (grant numbers: HI15C3153, HI19C0481, and HC20C0157).

Ethics approval and consent to participate

This research has been performed in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of the Clinical Research Ethics Committee of Kyung Hee University Medical Center approved the study protocol (Institutional Review Board numbers: 2022-02-022 and 2022-10-027). Each participant provided informed consent before the questionnaire survey began and agreed to participate in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Availability of data and materials

The datasets generated or analyzed during the current study are not publicly available because the data sets contain confidential information. Thus, due to ethics restrictions concerning the data sets, they are available from the corresponding author upon reasonable request.

Authors’ contributions

All authors have reviewed and endorsed the manuscript. They have collectively committed to taking personal responsibility for their contributions and to address any queries concerning the accuracy or integrity of the work, including those in which an author was not directly involved. These matters will be thoroughly investigated, resolved, and the outcomes documented in the publication.

JHP: manuscript writing and data analysis, DHL: data collection and analysis, JYJ: data collection, JHK: protocol development, JUB, MKJ, SWK, and MBK: participants recruiting and survey questionnaire, MJK: protocol development, CWW: manuscript revision, editing and principal investigator.

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Table 1. Basic characteristics of the participating doctors (n=80)

Doctors
Age	58.3 ± 9.1
Women	14 (17.5%)
Residence
Dobong-gu	40 (50.0%)
Outside the districts of Dobong-gu within Seoul	33 (41.3%)
Outside of Seoul	7 (8.7%)
Clinical Career (years)
Less than 10 years	12 (15.0%)
10–20 years	18 (22.5%)
More than 20 years	50 (62.5%)
Major
Internal medicine	12 (15.0%)
Family medicine	28 (35.0%)
General doctor	5 (6.3%)
Others	35 (43.8%)
Number of doctors in the clinic
1	43 (53.8%)
2	33 (41.3%)
3–4	3 (3.8%)
5 or over	1 (1.3%)
Number of registered nurses in the clinic
0	29 (36.3%)
1–2	49 (61.3%)
3 or over	2 (2.5%)
Number of nurse assistants in the clinic
0	2 (2.5%)
1–2	46 (57.5%)
3 or over	32 (40.0%)
Number of other staff members in the clinic
0	45 (56.3%)
1–2	23 (28.8%)
3 or over	12 (15.0%)
Knowing the diagnostic criteria for sarcopenia	19 (23.8%)

Numbers are presented as number (%) or mean ±standard deviation.

Table 2. Basic characteristics of the participating patients (n=80)

Patients
Age	74.1 ± 6.1
Women	49 (61.3%)
Residence
Dobong-gu, Seoul	32 (40.0%)
Jongno-gu, Seoul	19 (23.8%)
Outside the districts of Dobong-gu and Jongno-gu within Seoul	23 (28.8%)
Outside of Seoul	6 (7.4%)
Education
Elementary school	34 (42.5%)
Middle or high school	36 (45%)
Bachelor's degree or higher	10 (12.5%)
Living with spouse	54 (68.4%)
Number of family members living together
0–1	33 (41.2%)
2 or over	47 (58.8%)
Economic status
Moderate to well-off	48 (60.7%)
Financially challenged	31 (39.3%)
Current smoker	13 (16.5%)
Problem drinker	12 (15.2%)
Comorbidity
Hypertension	58 (72.5%)
Diabetes mellitus	24 (30%)
Hyperlipidemia	8 (10%)
Myocardial infarction	2 (2.5%)
Arrhythmia	1 (1.3%)
Peripheral artery disease	1 (1.3%)
Stroke	6 (7.5%)
Cancer	4 (5%)
Depression	1 (1.3%)
Arthritis	21 (26.3%)
Others	4 (5%)
Small calf circumference (man < 34, woman < 33 cm)*	28 (35%)
5-time chair stand test (≥ 12 seconds) *	32 (40.5%)
Have heard about sarcopenia	28 (35.0%)

Numbers are presented as number (%) or mean ± standard deviation.

* Cut-off values for calf circumference and 5-time chair stand test proposed by the Asian Working Group for Sarcopenia (AWGS) 2019, which are recommended for defining possible sarcopenia.

Table 3. Responses to the matched questions among the doctors and patients

	Doctors	Patients	P-value
1. Importance of sarcopenia			0.351
Strongly disagree	0 (0.0%)	1 (1.3%)
Disagree	0 (0.0%)	2 (2.5%)
Neutral	13 (16.7%)	10 (12.5%)
Agree	39 (50.0%)	37 (46.3%)
Strongly agree	26 (33.3%)	30 (37.5%)
2. Perception of sarcopenia presence ¹⁾	(16.9%) ²⁾	28 (35.0%) ³⁾
3. Desired frequency of exercise education			<0.001^*
Once a month	37 (47.4%)	19 (23.8%)
2–3 times a month	26 (33.3%)	11 (13.8%)
Once a week	13 (16.7%)	26 (32.5%)
Twice a week	2 (2.6%)	11 (13.8%)
3 times or more a week	0 (0.0%)	13 (16.3%)
4. Desired duration of exercise education at a time			<0.001^*
Less than 3 minutes	9 (11.4%)	5 (6.3%)
3–5 minutes	36 (45.6%)	4 (5.0%)
5–10 minutes	27 (34.2%)	8 (10.0%)
10–15 minutes	6 (7.6%)	13 (16.3%)
More than 15 minutes	1 (1.3%)	50 (62.5%)
5. Desired frequency of nutrition education			0.007^*
Once a month	47 (59.5%)	42 (52.5%)
2–3 times a month	24 (30.4%)	13 (16.3%)
Once a week	7 (8.9%)	17 (21.3%)
Twice a week	1 (1.3%)	6 (7.5%)
3 times or more a week	0 (0.0%)	2 (2.5%)
6. Desired duration of nutrition education at a time			<0.001^*
Less than 3 minutes	8 (10.1%)	7 (8.8%)
3–5 minutes	35 (44.3%)	10 (12.5%)
5–10 minutes	27 (34.2%)	13 (16.3%)
10–15 minutes	7 (8.9%)	19 (23.8%)
More than 15 minutes	2 (2.5%)	31 (38.8%)
7. Desired ways to help consistently exercise at home			0.047^*
Educational materials with pictures or text	23 (33.3%)	17 (21.5%)
Videos	15 (21.7%)	18 (22.8%)
Frequent phone communication with staffs	5 (7.3%)	6 (7.6%)
Education together with a caregiver	17 (24.6%)	11 (13.9%)
Write an exercise diary	5 (7.3%)	7 (8.9%)
Regular text messages	4 (5.8%)	13 (16.5%)
Smartphone applications	0 (0.0%)	2 (2.5%)
8. Desired ways to help keep nutritional management			0.013^*
Educational materials with pictures or text	23 (33.8%)	11 (14.5%)
Videos	13 (19.1%)	19 (25.0%)
Frequent phone communication with staffs	5 (7.4%)	10 (13.2%)
Education together with a caregiver	18 (26.5%)	13 (17.1%)
Write an exercise diary	6 (8.8%)	7 (9.2%)
Regular text messages	3 (4.4%)	13 (17.1%)
Smartphone applications	0 (0.0%)	1 (1.3%)
9. Community-based services needed for managing sarcopenia ^#
Exercise program at public health center	42 (52.5%)	19 (23.8%)	<0.001^*
Home visit physical therapy	19 (23.8%)	6 (7.5%)	0.005^*
Home visit exercise education	37 (46.3%)	5 (6.3%)	<0.001^*
Home visit nutrition counselling	31 (38.8%)	6 (7.5%)	<0.001^*
Lunch box delivery	13 (16.3%)	7 (8.8%)	0.151
Unaware	8 (10.0%)	39 (48.8%)	<0.001^*

Numbers are presented as number (%).

P-values were calculated using Pearson’s chi-squared test or Fisher’s exact test, and an asterisk (*) was used to indicate P-values < 0.05.

# Multiple choices were allowed.

1) The questions on both sides were slightly different.

2) The proportion reported by the doctors for the question, "Based on the diagnosis criterion of ‘possible sarcopenia’ by AWGS 2019 presented, what percentage of older patients in your clinic have there been suspected as sarcopenia in the past month?”

3) The percentage of patients who answered "agree" or "strongly agree" to the question, "Do you think you have sarcopenia?".

No competing interests reported.

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Doctor and patient perceptions of sarcopenia in community-based primary care clinics: A questionnaire survey

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