Training effect of a virtual reality haptics-enabled dynamic hip screw simulator

Figures & data

Figure 1. CONSORT diagram.

Figure 2. Box and whisker plot showing improvement in metrics in time (s) (A), fluoroscopy (s) (B), number of radiographs (C), number of retries (D), tip-apex distance (mm) (E), and cut-out (%) (F). Dots indicate max outliers. Boxes show the median value (red) and interquartile range (IQR) and whiskers show Q₁–1.5×IQR and Q₃+1.5×IQR.

Figure 3. Box and whisker plot to show improving global score from first (pooled) to last attempts for both cohorts. Dots indicate min outliers. For definitions, see Figure 2.

Table 1. Comparison of metrics for training and control groups before and after training. Values are mean (SD)

	Training group				Control				Intergroup comparison
	Attempt 1	Attempt 10	Change (%)	p-value^a	Attempt 1	Attempt 2	Change (%)	p-value^a	Overall change (%)	p-value^b
Time (s)	621 (327)	156 (59)	–75	< 0.001	641 (204)	493 (228)	–23	0.005	–68	< 0.001
Fluoroscopy (s)	71 (86)	36 (23)	–49	0.1	120 (92)	147 (138)	22	0.3	–75	< 0.001
No. of radiographs	78 (102)	19 (11)	–75	< 0.001	57 (30)	57 (31)	0	0.9	–66	< 0.001
No. of retries	2.2 (1.8)	0.7 (1.0)	–68	< 0.001	4.0 (4.7)	3.8 (3.9)	–5	0.6	–82	< 0.001
TAD (mm)	26 (8.7)	12 (5.6)	–53	< 0.001	26 (13)	21 (11)	–21	0.09	–41	< 0.001
Cut-out (%)	7.5 (11)	0.9 (2.6)	–88	< 0.001	12 (21)	6.1 (15)	–50	0.3	–85	< 0.001
Score	15 (11)	35 (7.4)	132	< 0.001	8.4 (18)	21 (14)	152	0.001	63	< 0.001

^a Significance determined by the Wilcoxon signed ranks test.

^b Significance determined by the Mann Whitney-U test.

Figure 4. Learning curve for objective metrics per attempt.

Table 2. Correlation coefficients and coefficients of determination for all objective metrics

Metric	Correlation coefficient (r)	Correlation of determination (r^2)
Time	0.82	0.67
Fluoroscopy	0.86	0.74
No. of radiographs	0.92	0.84
No. of retries	0.73	0.53
TAD	0.85	0.72
Cut-out rate	0.75	0.56
Global score	0.86	0.74