title: Digital assessment and quantification of pelvic organ prolapse (DPOP-Q): a randomised cross-over diagnostic agreement trial.
abstract: BACKGROUND
  Pelvic Organ Prolapse Quantification (POP-Q) system, measured in centimetres using a ruler (e.g. POPstix®), is recommended to quantify prolapse severity. POPstix® are costly (US $1/ruler). Home-made devices are used instead, but these have not been shown to be reproducible.
  
  
  OBJECTIVE
  Digitally assessed POP-Q (DPOP-Q) is as reliable, reproducible and acceptable as POP-Q assessed using POPstix®.
  
  
  METHODS
  In this randomised crossover diagnostic agreement trial, each assessor measured the index finger of their dominant hand using a ruler. At visit one, patients were randomised to either POPstix® POP-Q assessment in a modified lithotomy position or DPOP-Q in both modified a lithotomy and a standing position. After the first clinician conducted this assessment, a second blinded clinician then carried out the remaining assessment on the same patient. For each examination, duration was recorded, along with a patient-completed discomfort score. Twenty-five women were invited for visit two, at which DPOP-Q was recorded by the same clinician who undertook DPOP-Q at the first visit. This allowed evaluation of inter- and intraobserver agreement together with examination acceptability.
  
  
  RESULTS
  One hundred and nine women were recruited [median age 55 years, parity 2, body mass index (BMI) 27.1]. Of the 25 patients invited, 23 returned for visit two. DPOP-Q had high interobserver reliability [κ = 0.94, 95 % confidence interval (CI) 0.878-0.996] and intraobserver reliability (α = 0.96) with POPstix®. DPOP-Q was significantly quicker (p = 0.02) and less uncomfortable (p < 0.01) than POPstix® POP-Q.
  
  
  CONCLUSIONS
  DPOP-Q is reliable, acceptable and cost effective.
authors.affiliation: King's College Hospital, London, SE5 9RS, UK. gans.t@nhs.net.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Thiagamoorthy
authors.affiliation: King's College Hospital, London, SE5 9RS, UK.
authors.forename: Martino
authors.initials: M
authors.lastname: Zacchè
authors.affiliation: King's College Hospital, London, SE5 9RS, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Cardozo
authors.affiliation: Croydon University Hospital, Croydon, CR7 7YE, UK.
authors.forename: Madhu
authors.initials: M
authors.lastname: Naidu
authors.affiliation: King's College Hospital, London, SE5 9RS, UK.
authors.forename: Ilias
authors.initials: I
authors.lastname: Giarenis
authors.affiliation: King's College Hospital, London, SE5 9RS, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Flint
authors.affiliation: King's College Hospital, London, SE5 9RS, UK.
authors.forename: Sushma
authors.initials: S
authors.lastname: Srikrishna
authors.affiliation: King's College Hospital, London, SE5 9RS, UK.
authors.forename: Dudley
authors.initials: D
authors.lastname: Robinson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D005260:Female; D058869:Gynecological Examination / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000175:diagnosis*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index
keywords: POP-Q; Pelvic; Prolapse assessment; Vaginal