title: Objective measurements of excess skin in post bariatric patients--inter-rater reliability.
abstract: BACKGROUND
  An ability to reliably assess excess skin after massive weight loss using well-described and transferrable methods is important. The aim of this trial was to evaluate inter-rater reliability of ptosis and circumference measurements in patients with excess skin after bariatric surgery.
  
  
  METHODS
  Twenty-five postbariatric patients were included in the study, and their excess skin was measured 18 months after surgery. A protocol was designed to measure excess skin in a standardised way. To evaluate the inter-rater reliability in the measuring protocol, all patients were measured twice, by a specialist nurse and a specialist physiotherapist.
  
  
  RESULTS
  All circumference measurements on different body parts had an ICC > 0.9, indicating high reliability. Furthermore, all breast and abdominal ptosis measurements had high reliability. In contrast, visual evaluation of abdominal ptosis had poor reliability. Measurements of ptoses on different body parts had an ICC > 0.6. There were no systematic differences between the results of the two testers, except for measurements of the buttocks and maximal knee circumference.
  
  
  CONCLUSIONS
  The measuring protocol presented in this study has high reliability and, therefore, represents a useful instrument to provide a consistent and objective assessment of excess skin in the postbariatric patient.
authors.affiliation: a Department of Surgery , Sahlgrenska University Hospital and Department of Clinical Sciences/Surgery, Sahlgrenska Academy, Gothenburg University , Göteborg , Sweden .
authors.forename: Christina
authors.initials: C
authors.lastname: Biörserud
authors.affiliation: b Department of Physiotherapy , Sahlgrenska University Hospital and Department of Gastrosurgical Research and Education, Sahlgrenska Academy, Gothenburg University , Göteborg , Sweden , and.
authors.forename: Monika
authors.initials: M
authors.lastname: Fagevik Olsén
authors.affiliation: c Department of Plastic Surgery , Sahlgrenska University Hospital and Department of Clinical Sciences/Surgery, Sahlgrenska Academy, Gothenburg University , Göteborg , Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Elander
authors.affiliation: a Department of Surgery , Sahlgrenska University Hospital and Department of Clinical Sciences/Surgery, Sahlgrenska Academy, Gothenburg University , Göteborg , Sweden .
authors.forename: Malin
authors.initials: M
authors.lastname: Wiklund
mesh_terms: D000005:Abdomen; D001132:Arm; D050110:Bariatric Surgery; D001940:Breast; D002081:Buttocks; D002680:Chin; D006801:Humans; D015588:Observer Variation; D011184:Postoperative Period; D012867:Skin / Q000033:anatomy & histology*; D013848:Thigh
keywords: Obesity; bariatric surgery; excess skin; objective measurements; reliability