Clinical evaluation of anterior vaginal wall support defects: interexaminer and intraexaminer reliability.
OBJECTIVE
The purpose of this study was to determine the interobserver and intraobserver reliability of the clinical examination of anterior vaginal wall support defects.


METHODS
Sixty-three patients with at least stage II anterior vaginal wall prolapse were prospectively evaluated with a standardized examination to detect anterior vaginal wall support defects. Interobserver reliability was assessed with a duplicate examination performed by a blinded second examiner. Intraobserver reliability was assessed with a second examination performed at least 3 weeks later by 1 of the original 2 examiners. Examination reliability for the 4 types of defects (central, right lateral, left lateral, and superior) was evaluated with the kappa statistic.


RESULTS
The inter- and intraexaminer reliability of the clinical examination for central, superior, and right and left paravaginal defects was poor; all kappas were less than 0.50. Overall interexaminer agreement was 42% with a kappa of 0.16 (95% CI, 0-0.32). Overall intraexaminer agreement was 46% with a kappa of 0.16 (95% CI, 0-0.45). Reliability was noted to improve with increasing stage of prolapse.


CONCLUSIONS
The clinical examination of anterior vaginal wall support defects displays poor interexaminer and intraexaminer agreement.
Whiteside
James L
JL
Department of Gynecology and Obstetrics, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. whitesj1@ccf.org
Barber
Matthew D
MD
Paraiso
Marie F
MF
Hugney
Cathy M
CM
Walters
Mark D
MD
D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D014596:Uterine Prolapse / Q000175:diagnosis*