Is the Visual Analogue Scale inferior to the Pelvic Organ Prolapse Distress Inventory for assessing symptom bother of pelvic organ prolapse?

Aims: Disease-specific validated questionnaires are used to quantify symptom severity, but they are time consuming to complete and evaluate. A Visual Analogue Scale (VAS) assessment of bother is simpler and faster. The aim of this study is to compare VAS with individual and composite pelvic floor disability index-short form 20 items in predicting significant pelvic organ prolapse (POP).

Methods: A retrospective analysis of data was obtained at a tertiary urogynaecological clinic between February 2017 and August 2018. All women filled out the PFDI-20 and underwent a standardised physician-directed interview, POP-Q and translabial ultrasound. Women with symptoms of POP were asked to indicate the degree of bother using a VAS. Receiver operating characteristic curves were used to evaluate the performance of individual Pelvic Organ Prolapse Distress Inventory (POPDI)-6 items, the six-item composite POPDI-6 score, and VAS in predicting significant POP on clinical and ultrasound examination.

Results: The complete data sets of 231 women were analysed. Median VAS for POP was 2.9 (range 0-10). Median POPDI-6 individual and composite scores for items one to six were 2, 2, 2, 1, 2, 0 (all range 0-4) and 9 (range 0-22), respectively. The majority had significant prolapse on clinical examination (n = 195, 84%) and on ultrasound (n = 192, 83%). The composite POPDI-6 prolapse score provided areas under the curve of 0.68 and 0.64 for the prediction of clinical and sonographic POP, compared to 0.74 and 0.69, respectively, for VAS. The difference was not significant (P = 0.3 and 0.8, respectively).

Conclusions: The VAS score was not inferior to the POPDI-6 in predicting significant POP. It has the potential to simplify the assessment of symptom severity.