Initial validation of AUGS-PERFORM: Construct validity and test-retest reliability

Objectives: To test the construct validity and test-retest reliability of the American Urogynecologic Society’s Prolapse p<b>ERFORmance Measure (AUGS-PERFORM), a novel 11-item patient-reported outcome measure designed to assess several symptom domains that are relevant for treatment of pelvic organ prolapse (POP).

Methods: We recruited English-speaking participants over 18 years of age at a single academic institution for this validation study. Participants seeking care with either pessary or surgery for symptomatic POP were eligible. After providing informed consent, baseline demographic characteristics and medical information were collected. To assess for construct validity, participants completed AUGS-PERFORM and the PFDI-20. To assess test-retest reliability, approximately 2 weeks later and prior to initiation of POP therapy, participants completed AUGS-PERFORM a second time. All questionnaires were completed electronically. We hypothesized that AUGS-PERFORM items #1 and 2, which measure prolapse frequency and bother, respectively, would have a high correlation with PFDI-20 item #3 which also measures this POP domain.



We estimated that a sample size of 110 participants would provide 80% power to detect an 85% agreement between these items. To test construct validity, we calculated percent agreement and Kappa statistics. To assess test-retest reliability, we calculated intraclass correlation coefficients (ICC) between baseline and 2-week AUGS-PERFORM summary scores from the same participant.

Results: We enrolled 148 participants. Participants self-identified as 80% White, 10% as Black, 10% “Other” race/ethnicity, and 56% were sexually active. Table 1 shows the language and wording of the items and response options, as well as how participants responded to each item. After accounting for missing data on questionnaires and loss to follow-up, responses were compared between 139 participants for assessment of construct validity and 128 participants for test-retest reliability. Table 2 shows the results of our primary analyses for construct validity and test-retest reliability.

Conclusions: AUGS-PERFORM is a concise, 11-item, POP-specific, patient-reported outcomes questionnaire that demonstrates high percent agreement and strong test-retest reliability in both sexually active and inactive patients with symptomatic POP who wish to pursue treatment. The next phase of validation will entail ongoing assessment of construct validity in a broader population and assessing for responsiveness to change after treatment. AUGS-PERFORM is a promising patient-reported outcome measure for assessment of surgical and non-surgical care of POP.