Study Design. Radiologic evaluation of lumbar range of motion (ROM) with dynamic radiograph.Objectives. To calculate 95% confidence intervals (CIs) for the measurement error accompanying different methods, different observers, and different levels of training when measuring sagittal plane segmental ROM in lumbar spine. In addition, to compare the 95% CI with frequently common statistical methods of reliability analysis.Summary of Background Data. Dynamic radiographs are commonly used for ROM calculation of the lumbar spine. Yet, the reliability of different measurement methods still remains unclear.Methods. In 24 patients, levels L4 -L5 and L5-S1 were measured with the Cobb and superimposition methods on flexion-extension radiographs. There were 2 experienced and 1 inexperienced observer that performed the measurements. The 95% CIs were compared with the corresponding Pearson correlation coefficient and P value (t test).Results. The 95% CI of the superimposition method was Ϯ4.0°for the experienced and Ϯ4.7°for the inexperienced observer. The corresponding values for the Cobb method was Ϯ4.2°for the experienced and Ϯ6.8°for the inexperienced observer. The 95% CI for the measurement error became even worse when different methods or observers were compared, whereas a method constancy revealed superior reliability than observer constancy in experienced observers.Conclusions. For lumbar ROM measurement with dynamic radiograph, the superimposition method seems to be more reliable than the Cobb method. Study protocols dealing with ROM measurement have to calculate the 95% CI of the measurement method used because clinically valid conclusions can only be drawn with respect to these intervals.
Background Artificial reality technologies are currently being explored as potential options to improve surgical education. Previous studies have primarily examined the efficacy of artificial reality in laparoscopic procedures, but to our knowledge, none have been performed in orthopaedically relevant procedures such as intramedullary tibial nailing, which calls for more versatile large-scale movements. Questions/purposes Does a virtual reality simulator with or without a standard technique guide result in (1) a higher proportion of participants who completed the insertion of an intramedullary tibial nail in a synthetic bones model and (2) greater procedural accuracy than does training with a technique guide alone? Methods Twenty-five first- and second-year medical students without prior exposure to intramedullary tibial nail insertion were recruited. Participants were randomly assigned to the technique guide control group (n = 8), the virtual reality group (n = 8), or the virtual reality and technique guide group (n = 9). The technique guide was adapted from a commercially available technique guide, which participants in the assigned groups could use to prepare as much as desired. The virtual reality simulation was based on the same procedure, and we used a commercially available virtual reality simulator that we purchased for this task. Participants in the virtual reality experimental groups completed the simulation on three separate sessions, at a set interval of 3 to 4 days apart. After 10 to 14 days of preparation, all participants attempted to insert an intramedullary nail into an intact, compact bone-model tibia that lacked surrounding soft tissue. Participants were given written hints if requested, but no other assistance was given. A procedure was considered complete if the nail and screw were properly placed. Procedural accuracy was defined as the number of incorrect steps normalized out of the 16 possible performed. After the procedure, one orthopaedic surgeon assessed a blinded video of the participant performing it so the assessor could not recognize the individual or that individual’s gender. Additionally, the assessor was unaware of which group each participant had been randomized to during the evaluation. Results A higher proportion of participants in the virtual reality group (6 of 8) and the virtual reality and technique guide group (7 of 9) completed the intramedullary nail than did participants in the technique guide group (2 of 8; p = 0.01). There was no difference in completion between the virtual reality groups (p = 0.89). Participants in the virtual reality and virtual reality and technique guide had fewer normalized incorrect steps than did participants in the technique guide group (3.2 ± 0.1 of 16 and 3.1 ± 0.1 of 16 versus 5.7 ± 0.2 of 16, respectively; p = 0.02 for comparisons of virtual reality groups to technique guide, p = 0.63 between the virtual reality group). Conclusions Virtual reality increased both procedural accuracy and the completion proportion compared with a technique guide in medical students. Based on our findings, virtual reality may help residents learn the procedural workflow and movements required to perform surgical procedures. Future studies should examine how and when exactly the technology can be applied to residencies and its impact on residents. Level of Evidence Level I, therapeutic study.
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