Interobserver variation in the assessment of pelvic organ prolapse.

Kobak, W. H.; Rosenberger, K.; Walters, M. D.

doi:10.1007/bf01894199

Cited by 103Pelvic floor disorders treatmentsUrinary Bladder and Prostate ResearchReliability and Agreement in Measurement

Interobserver variation in the assessment of pelvic organ prolapse.

Kobak, W. H., Rosenberger, K., Walters, M. D.·1996·International Urogynecology Journal and Pelvic Floor Dysfunction

DOI 10.1007/bf01894199

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Abstract

The aim of this study was to determine the interobserver agreement of two grading systems for pelvic organ prolapse: the vaginal profile and the International Continence Society (ICS) draft proposal. Forty-nine consecutive women referred for evaluation of urinary incontinence and/or pelvic organ prolapse were studied. Patients were first examined by a physician and a nurse clinician using the vaginal profile, followed by an examination according to the technique described in the ICS draft proposal for standardization of terminology (1994). kappa statistic and Pearson's correlation coefficient were used to determine interobserver variability for the ICS system by overall stage, by stage-specific comparison, and by specific anatomic location. The vaginal profile was evaluated by obtaining a kappa for overall degree of prolapse, stage-specific comparison and by anatomic area. The kappa for the ICS stage was 0.79 (P < 0.001), and the kappa for the vaginal profile by area of greatest prolapse was 0.68 (P < 0.001), indicating substantial interobserver agreement for both systems. The ICS system was noted to have substantial interobserver agreement by a stage-specific comparison. All anatomic locations of the ICS staging system were found to correlate significantly, and a high degree of interobserver precision was found. The vaginal profile also showed significant interobserver agreement by overall degree of prolapse, by specific degree of prolapse, and by anatomic area. It was concluded that both the proposed ICS staging system and the traditional vaginal profile show significant interobserver agreement both by overall stage, stage-specific analysis and specific location. The registered nurse examination correlated well with the physician examination, indicating that the most important factor in obtaining reproducible results may be definition and close attention to examination technique.

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The smallest discernable difference in POPQ measurements is 1.0 cm for the apex (point C) and 0.5 cm for other measurements.
“A noninferiority threshold of a 1-cm difference was chosen because the investigative team felt this to be a clinically relevant change, and prior research has shown that the smallest discernable difference in POPQ measurements is 1.0 cm for the apex (point C) and 0.5 cm for other measurements.24”
From Standard Restrictions vs Expedited Activity After Pelvic Organ Prolapse Surgery (2023) · cites this paper as [24]
Point estimates of SLmax favored the expedited group, and we would still have demonstrated noninferiority had we chosen a margin of 0.5 cm, the smallest discernable difference in POPQ measurement.
“Of note, point estimates of SLmax favored the expedited group, and we would still have demonstrated noninferiority had we chosen a margin of 0.5 cm, the smallest discernable difference in POPQ measurement.24”
From Standard Restrictions vs Expedited Activity After Pelvic Organ Prolapse Surgery (2023) · cites this paper as [24]

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Authors: Kobak, W. H., Rosenberger, K., & Walters, M. D.
Affiliations: University of Southern California (US)
Cleveland Clinic (US)
ORCID: Kobak, W. H.
Walters, M. D.
Venue: International Urogynecology Journal and Pelvic Floor Dysfunction
Publisher: Springer Science and Business Media LLC
Published: 1996-05
Volume: 7
Issue: 3
Pages: 121-124
ISSN: 0937-3462 (ISSN-L)
1433-3023
DOI: 10.1007/bf01894199
OpenAlex: W1984988372
Cited by: 103
References: 12
Citations by year: 2026: 1 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 3 · 2019: 3 · 2017: 7 · 2016: 1 · 2015: 2 · 2014: 11 · 2012: 4
FWCI: 1.16
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (tdm)
Locations: International Urogynecology Journal (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Reliability and Agreement in Measurement
Keywords: pelvic organ prolapse, interobserver agreement, prolapse staging, urinary incontinence
MeSH terms: Female, Humans, Methods, Uterine Prolapse, Observer Variation

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Interobserver variation in the assessment of pelvic organ prolapse.

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