GENERAL ORTHOPAEDICS
Development of simulated arthroscopic skills
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(2):86 Acta Orthop. 2011 Feb;82(1):90-5. Epub 2011 Feb 121 orthopaedic surgeons participated in this study. 14 inexperienced surgeons were randomized to undergo virtual reality (VR) training for shoulder arthroscopy or no training, while 7 experienced surgeons acted as controls. The primary outcomes were 5-parameters based on the VR unit. Results indicated the inexperienced intervention group showed improvement in arthroscopic skills (based on the VR) unit from the first testing period to the second testing period. The experienced surgeons demonstrated comparable outcomes between both testing periods, while the inexperienced control group demonstrated large variations in the outcomes. Further studies are required to determine the transferability of skills developed from the VR unit into the operating theatre.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
2/4
Randomization
3/4
Outcome Measurements
0/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
Previous studies have reported a correlation in performance with virtual reality (VR) training and arthroscopic skills. VR training units may improve an individual's ability to perform invasive surgical techniques. However, no studies have looked at inexperienced orthopaedic surgeon's development in arthroscopic skills with a VR training unit compared to experienced orthopaedic surgeons.
主な研究課題は何ですか？
What are the outcomes in arthroscopic skills development when inexperienced orthopaedic surgeons undergo virtual reality (VR) training (for shoulder arthroscopy) compared to experienced surgeons who regularly perform arthroscopic surgery, or compared to inexperienced surgeons who do not receive any VR training?
重要な知見は？
- The inexperienced intervention group saw a reduction in mean arthroscopy time from 720 (SD 239) seconds to 223 (SD 114) seconds (p=0.03 compared to the inexperienced control group).
- The inexperienced intervention group had a reduction in camera distance traveled from 367 (SD 151) cm to 84 (SD 44) cm (p=0.02 compared to the inexperienced control group).
- The intervention group had a significantly reduced depth of collision. Number of collisions and distance traveled by probe were also improved (although non-statistically significant).
- The intervention group showed an improvement in reduced collisions (highest number of collisions from the first test out of all groups, to the lowest number of collisions by the second test), but the improvement was not significant (p=0.07). The number of collisions increased in both control groups from the first to second testing.
最も覚えておくべきことは？
The intervention group showed great improvements on the 5 tested parameters from the first to second testing period. The experienced control group had comparable results, and the inexperienced control group had large intra- and interpersonal variation. Virtual reality (VR) training units for arthroscopic surgery may help inexperienced surgeons develop basic navigation skills required in arthroscopic surgery procedures.
それが私の患者ケアにどのように影響するか？
Further studies should be performed to determine the transferability of skills from the virtual reality (VR) training unit to the operating theater.
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