title: Inter-observer reliability of digital vaginal examination using a four-grade scale in different patient positions.
abstract: This study aims to compare digital vaginal examination with the patient in supine and standing position and to correlate the degree of pelvic organ prolapse (POP) with a prolapse quality of life (P-QOL) questionnaire. Two hundred and seven women with POP symptoms were digitally examined in supine and standing positions using a four-grade scale (none, minimal, moderate, and severe). P-QOL was used to assess the severity of prolapse symptoms. Cohen's kappa coefficient was used to calculate the inter-observer agreement and Spearman rank correlation test to assess the correlation between examination findings and P-QOL scores. Only vaginal examination findings in standing position had a good inter-observer reliability (kappa value 0.76-0.91). The severity of P-QOL scores only correlated with the examination findings in the standing position (P < 0.001). Digital examination of POP is unreliable if woman is supine but is reliable and correlates with symptoms and QOL impairment when the examination is performed with the patient standing.
authors.affiliation: Department of Urogynaecology, St. Mary's Hospital, Imperial College, London, UK. digesualex@hotmail.com
authors.forename: G Alessandro
authors.initials: GA
authors.lastname: Digesu
authors.forename: Vik
authors.initials: V
authors.lastname: Khullar
authors.forename: Linda
authors.initials: L
authors.lastname: Cardozo
authors.forename: Dudley
authors.initials: D
authors.lastname: Robinson
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods*; D011187:Posture / Q000502:physiology*; D011788:Quality of Life; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D014621:Vagina