PROSPERO
International prospective register of systematic reviews
Exploring available eating behaviour and nutrition
supports in virtual healthcare settings: A systematic
review of Virtual Wards care for nutritional needs.
Rose Kay, Anne-Marie Minihane, Martyn Patel, Caitlyn Notely, Rebecca Moore
Citation
Rose Kay, Anne-Marie Minihane, Martyn Patel, Caitlyn Notely, Rebecca Moore. Exploring available eating behaviour and nutrition supports in virtual healthcare settings: A systematic review of Virtual Wards care for nutritional needs.. PROSPERO 2025
CRD420251040311. Available from
https://www.crd.york.ac.uk/PROSPERO/view/CRD420251040311.
REVIEW TITLE AND BASIC DETAILS
Review title
Exploring available eating behaviour and nutrition supports in virtual healthcare settings: A systematic review of Virtual Wards care for nutritional needs.
Condition or domain being studied
Nutritional Support; Nutritional status; Malnutrition; Frailty
The purpose of the study is to identify what eating behaviour supports in a virtual ward setting, as to improve an individuals overall health status regardless of condition. However, this will hopefully then focus on the specific eating behaviour supports for malnutrition in frail older individuals if there is enough literature available to answer this secondary objective.
Rationale for the review
The purpose of the review is to identify what support exists in virtual wards for monitoring and managing an individuals eating behaviour. This will include looking for to the use of scores like the Malnutrition Universal Screening Tool (MUST), meal plans, supplements, in-person or online support groups, nutritional education, the usage of food banks, fortified foods, dietitian appointments in the multidisciplinary teams used in virtual wards and appropriate monitoring and follow-ups. This is to see what is in use and what is not, for the purpose of in the future following this systematic review to implement virtual wards that have either act to:
a)	Focus on improving an individuals nutrition as a primary focus i.e. being identified to the ward as an individual suffering from malnutrition as an older frail adult.
b)	A secondary aspect on the ward to help implement healthy eating behaviour in the short-term to improve recovery and in the long-term to support nutritional choices that will allow an individual to remain healthier for longer.
Review objectives
What eating behaviour support/interventions exist in these settings?
Are nutritional supports effective in a virtual ward setting?
Can the current existing framework for inpatient care be applied to a virtual ward setting?
What are barriers and facilitators in supporting malnutrition, and would virtual wards mitigate or worsen these barriers?
Keywords
Virtual wards; Hospital at home; Nutritional status
Country
United Kingdom
ELIGIBILITY CRITERIA
Population
Included
The population identified for this study will be adults that have required nutritional or eating behaviour supports regardless of the reasons they required this support. Individuals below the age of 18 will not be considered for this study. The population for this review is broad due to the fact we are aiming to identify all forms of nutritional and eating behaviour supports, due to the expected limited amount data expected to be recalled.
Excluded
Adolescents or children (people aged below 18 years of age) will not be considered for this review.
Intervention(s) or exposure(s)
Included
Nutritional Support; Nutrition education; Healthy eating education
The intervention will be virtual wards (Hospitals at Home, early supported discharge wards, admission avoidance wards) that have provided nutritional or eating behaviour supports within the setting. The efficacy of these interventions will be measured if there is sufficient evidence to address the research question:
i.	Is the intervention of nutritional and eating behaviour support in a virtual ward setting effective at improving an individual's nutritional status in the short-term (during the duration of the virtual ward stay) and in the long-term (improving nutritional status following discharge from the virtual ward).Eating behaviour supports identified that have taken place in a Virtual Ward setting.
Comparator(s) or control(s)
Included
PICO tags selected: Inpatient Care
If there is a potential comparison to be made between virtual ward and in-patient care for eating behaviour and nutrition support it will be used to address the outcome on effectiveness between the two settings.
Excluded
The comparison will be in-patient settings, including what has been discussed as recognised nutritional and eating behaviour support and if sufficient evidence can be obtained to answer the quantitative question from the Intervention section in-patient usage of these interventions will act as the comparison for efficacy.
Study design
Both randomized and nonrandomized study types will be included.
Included
Studies including randomised, non-randomised, mixed methods, observational and qualitative studies will be appropriate to used for this systematic review.
Excluded
Systematic, scoping and other forms of secondary research will not be included as part of this systematic review. Grey literature will also not be used unless there is not sufficient primary research obtained, and the protocol will be amended to account for this in the event this occurs.
Context
The context for this systematic review will Virtual Wards (which will also be the intervention), but will not be limited to just the NHS in the UK due to the high likelihood of limited results but it will follow the NHS classification for Virtual Wards in order to be considered for this systematic review specifically:
ii.	The usage of technological enabled care, and while this varies significantly between different virtual wards it must include some form such as remote monitoring.
iii.	A multidisciplinary team during the duration of the care, that provided hospital-level care through appropriate interventions and treatment.
iv.	Care that occurred in the individual's home, i.e. a community setting.
This means studies that focus on one aspect of the virtual ward model will not be included, for instance random controlled trials on improving remote monitoring tools will not be appropriate for inclusion. Virtual Wards must be recognised within the title or abstract.
TIMELINE OF THE REVIEW
Date of first submission to PROSPERO
16 June 2025
Review timeline
Start date: 30 April 2025. End date: 1 September 2025.
Date of registration in PROSPERO 23 July 2025
AVAILABILITY OF FULL PROTOCOL
Availability of full protocol
A full protocol has been written and uploaded to PROSPERO. The protocol may be accessed through this link
https://www.crd.york.ac.uk/PROSPEROFILES/93f8cc48ba466ea5f6add84c348b516e.pdf.
SEARCHING AND SCREENING
Search for unpublished studies
Only published studies will be sought.
Main bibliographic databases that will be searched
The main databases to be searched are CINAHL - Cumulative Index to Nursing and Allied Health Literature, Embase.com.
Other important or specialist databases that will be searched
Web of Science, Medline via Ovid.
Search language restrictions
The review will only include studies published in English.
Search date restrictions
There are no search date restrictions.
Other methods of identifying studies
No other methods will be used.
Link to search strategy
A full search strategy has been uploaded to PROSPERO. The PDF may be accessed through this link
https://www.crd.york.ac.uk/PROSPEROFILES/86a55f971c01dfd2033296afaa2aebe2.pdf.
Selection process
Studies will be screened independently by at least two people (or person/machine combination) with a process to resolve differences.
Other relevant information about searching and screening
None
DATA COLLECTION PROCESS
Data extraction from published articles and reports
Data will be extracted independently by at least two people (or person/machine combination) with a process to resolve differences.
Authors will not be contacted for further information.
Study risk of bias or quality assessment
Risk of bias will be assessed using:
To assess methodological quality, this systematic review will use the Critical Appraisal Skills Programme (CASP) as it is an appropriate quality assessment tool to use in this systematic review.
Data will be assessed independently by at least two people (or person/machine combination) with a process to resolve differences.
Additional information will not be sought from study investigators if required information is unclear or unavailable in the study publications/reports.
Reporting bias assessment
Risk of bias due to missing results will be assessed
Certainty assessment
To assess methodological quality, this systematic review will use the Critical Appraisal Skills Programme (CASP) as it is an appropriate quality assessment tool to use in this systematic review. Certainty of evidence will be assessed via Grading of Recommendations Assessment, Development and Evaluation tool.
OUTCOMES TO BE ANALYSED
Main outcomes
What nutritional and eating behaviour supports exist in a virtual ward setting?
Additional outcomes
(i)	How effective are these supports in improving an individual's short and long-term nutritional status as well as compared to an in-patient setting?
(ii)	What supports can be identified as not being in a virtual ward setting?
(iii)	What are the experiences and views of patients and stakeholders following these interventions
PLANNED DATA SYNTHESIS
Strategy for data synthesis
Data will be combined using a convergent segregated approach, with quantitative and qualitative data being seperated to answer different review questions, and then being combined for the systematic review write up.
CURRENT REVIEW STAGE
Stage of the review at this submission
Review stage	Started	Completed
Pilot work	•	•
Formal searching/study identification	•
Screening search results against inclusion criteria
Data extraction or receipt of IPD
Review stage	Started Completed
Risk of bias/quality assessment
Data synthesis
Review status
The review is currently planned or ongoing.
Publication of review results
Results of the review will be published in English.
REVIEW AFFILIATION, FUNDING AND PEER REVIEW
Review team members
Miss Rose Kay (review guarantor and contact) University of East Angelia. England.
No conflict of interest declared.
Professor Anne-Marie Minihane. University of East Angelia. England.
No conflict of interest declared.
Dr Martyn Patel. Norwich and Norfolk University Hospital. England.
No conflict of interest declared.
Professor Caitlyn Notely. University of East Angelia. England.
No conflict of interest declared.
Dr Rebecca Moore. University of East Angelia. England.
No conflict of interest declared.
Named contact
Miss Rose Kay (bjn25nnu@uea.ac.uk). University of East Angelia. England.
Review affiliation
The main organisational affiliation for this review are the University of East Angelia and the Norfolk and Norwich Hospitals Charity.
Funding source
Review has no specific/external funding but is supported by guarantor/review team (noncommercial) institutions.
Additional information about funding
Project is funded by the University of East Angelia and Norfolk and Norwich Hospital Charity.
Peer review
This systematic reviewer will include a secondary reviewer (Dr Rebecca Moore) to make sure a consensus is developed, with a third reviewer (Prof Anne-Marie Minihane) being used to correct any issues if they arise. The paper will be reviewed by the entire team before publication.
ADDITIONAL INFORMATION
Review conflict of interest Declared individual interests are recorded under team member details.. No additional interests are recorded for this review.
Medical Subject Headings
Aged; Delivery of Health Care; Feeding Behavior; Frail Elderly; Hospitals; Humans; Inpatients; Malnutrition; Nutritional Status; Nutritional Support; Patient Discharge
SIMILAR REVIEWS
Check for similar records already in PROSPERO
PROSPERO identified a number of existing PROSPERO records that were similar to this one (last check made on 30 April 2025). These are shown below along with the reasons given by that the review team for the reviews being different and/or proceeding.
•	Supporting older adults with care at home through virtual wards: A systematic review of patient, carer and healthcare professionals' perspectives [published 19 April 2024] [CRD42024535878]. The review was judged not to be similar
•	A systematic review of the use of virtual reality in the treatment of eating disorders [published 1 September 2023] [CRD42023459444]. The review was judged not to be similar
•	"Barriers and Facilitators to the use of Virtual Wards: A systematic review of the qualitative evidence" [published 12 March 2024] [CRD42024519627]. The review was acknowledged as similar but the authors opted to continue because there are differences in intervention or comparator, the review looks at additional or different outcomes. The authors also noted: "We will be looking at the barriers and facilitators in using virtual wards to improve eating behaviour and nutrition specifically, rather than all barriers and facilitators associated with virtual wards."
PROSPERO version history
•	Version 1.0, published 23 Jul 2025
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