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Validation of the Activities Assessment Scale in Women Undergoing Pelvic Reconstructive Surgery

Barber, Matthew D. MD, MHS*; Kenton, Kim MD, MS; Janz, Nancy K. PhD; Hsu, Yvonne MD§; Dyer, Keisha Y. MD, MPH; Greer, W. Jerod MD; White, Amanda MD#; Meikle, Susie MD, MSPH**; Ye, Wen PhD

Female Pelvic Medicine & Reconstructive Surgery: July/August 2012 - Volume 18 - Issue 4 - p 205–210
doi: 10.1097/SPV.0b013e31825e6422
Original Articles

Objective The Activities Assessment Scale (AAS) is a 13-item postoperative functional activity scale validated in men who underwent hernia surgery. We evaluated the psychometric characteristics of the AAS in women who underwent vaginal surgery for pelvic organ prolapse (POP) and stress urinary incontinence (SUI).

Methods Participants included 163 women with POP and SUI enrolled in a randomized trial comparing sacrospinous ligament fixation to uterosacral vault suspension with and without perioperative pelvic floor muscle training. Participants completed the AAS and SF-36 at baseline and 2 weeks and 6 months postoperatively. Internal reliability of the AAS was evaluated using Cronbach α. Construct validity and responsiveness were examined in cross-sectional and longitudinal data using Pearson correlation coefficient and analysis of variance. The AAS is scored from zero to 100 (higher scores = better function).

Results Mean (SD) baseline AAS score was 87 (17.3) (range, 25–100). Functional activity declined from baseline to 2 weeks postoperatively (mean change, −4.5; 95% confidence interval, −7.6 to −1.42) but improved above baseline at 6 months (mean change, +10.9; 95% confidence interval, 7.8–14.0). Internal reliability of the AAS was excellent (Cronbach α = 0.93). Construct validity was demonstrated by a correlation of 0.59 to 0.60 between the AAS and SF-36 physical functioning scale (P < 0.0001) and lower correlations between the AAS and other SF-36 scales. Patients who improved in physical functioning based on the SF-36 between 2 weeks and 6 months postoperatively showed an effect size of 0.86 for change in the AAS over the same period.

Conclusions The AAS is a valid, reliable, and responsive measure for evaluation of physical function in women after pelvic reconstructive surgery.

The Activity Assessment Scale (AAS) is a valid, reliable and responsive measure of physical function in women after pelvic reconstructive surgery.

From the *Obstetrics, Gynecology, and Women’s Health Institute, Cleveland Clinic, Cleveland, OH; †Departments of Obstetrics and Gynecology, and Urology, Loyola University, Chicago, IL; ‡Data Coordinating Center, University of Michigan, Ann Arbor, MI; §Department of Obstetrics and Gynecology, University of Utah Medical Center, Salt Lake City, UT; ∥Department of Reproductive Medicine, University of California-San Diego, San Diego, CA; ¶Department of Obstetrics and Gynecology, University of Alabama-Birmingham, Birmingham, AL; #Department of Obstetrics and Gynecology, University of Texas-Southwestern Medical Center, Dallas, TX; and **Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.

Reprints: Matthew D. Barber, MD, MHS, Cleveland Clinic, 9500 Euclid Ave, Desk A81, Cleveland, OH 44195. E-mail:

The authors declare that they have nothing to disclose.

This work was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the NIH Office of Research on Women’s Health (U01 HD41249, U10 HD41250, U10 HD41261, U10 HD41267, U10 HD54136, U10 HD54214, U10 HD54215, and U10 HD54241).

This trial is registered at under Registration # NCT00597935.

Reprints will not be available.

© 2012 by Wolters Kluwer Health | Lippincott Williams & Wilkins