Int Urogynecol J (2017) 28:1441 DOI 10.1007/s00192-017-3421-5 LETTER TO THE EDITOR Authors’ reply to the comment by Hanis et al. on BPredictors of unsuccessful pessary fitting in women with prolapse: a cross-sectional study in general practice,^ by Panman et al. 1 1 Janny H. Dekker & Huibert Burger Received: 12 June 2017 /Accepted: 29 June 2017 /Published online: 26 July 2017 The International Urogynecological Association 2017 Dear Editor, indeed were very careful in interpreting the associations we Thank you very much for giving us the opportunity to respond found in our cross-sectional study. We agree that to the comment of Hani et al. on some methodological aspects bootstrapping or other methods of internal validation are valu- of our study on the success of fitting a pessary in women in able techniques to correct a model for so-called overoptimism. This is particularly important when it is intended that the primary care. The first comment by Hanis et al. is on the cross-sectional model is applicable directly to patients in clinical practice. In design of our study, which would make it difficult to draw our study, however, the aim was more modest, i.e., to generate conclusions on the predictors of fitting success, as this would hypotheses about what the independent predictive factors are, require a longitudinal study. We do not agree with this com- as stated in the Discussion section. Given our sample size, ment: In a cross-sectional study, it is possible to study diag- construction of a final model was beyond our scope. We con- nostic predictors, with the diagnosis in our study being unsuc- cluded that ’further research is needed to confirm the associ- cessful pessary fitting . We agree that no causal inferences ations we found, and prediction models must be validated in should be made in prediction studies (diagnostic and prognos- other primary care populations,^ which is external validation. tic). That is why we stated in our conclusions: BOur results We thank the authors for emphasizing once again which meth- indicated that lower age, higher BMI, and underactive or in- odological considerations should play a role in developing active pelvic floor muscle function were associated with a prediction models. higher risk of unsuccessful pessary fitting.^ In their second comment, Hanis et al. argue that consider- ing the variables age, BMI, and pelvic floor muscle function Reference as independent predictors is an optimistic interpretation. It will be clear from our response on the first comment that we 1. Moons KG, Altman DG, Reitsma JB, Ioannidis JP, Macaskill P, Steyerberg EW, et al. Transparent reporting of a multivariable pre- diction model for individual prognosis or diagnosis (TRIPOD): ex- planation and elaboration. Ann Intern Med. 2015;162(1):W1–W73. This reply refers to the comment available at doi:10.1007/s00192-017- 3359-7. * Janny H. Dekker firstname.lastname@example.org Department of General Practice, University Medical Center Groningen, University of Groningen, P.O. Box 196, 9700 AD Groningen, The Netherlands
International Urogynecology Journal – Springer Journals
Published: Jul 26, 2017
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