Comparing Fixation Pressure and Operator Proficiency in the Use of Pelvic Binders: A Study of the SAM Pelvic Sling II and AP MAX Truncal Orthosis

Comparing Fixation Pressure and Operator Proficiency in the Use of Pelvic Binders: A Study of the SAM Pelvic Sling II and AP MAX Truncal Orthosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Comparing Fixation Pressure and Operator Proficiency in the Use of Pelvic Binders: A Study of the SAM Pelvic Sling II and AP MAX Truncal Orthosis Li-Chien Chien, Hua-De Lin, Yi-Ting Tsai This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7576430/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Pelvic fractures are associated with high morbidity and mortality and often require immediate stabilization. Pelvic binders help control hemorrhage; however, variations in design and operator proficiency may affect performance. This study compares the SAM Pelvic Sling II and AP MAX Truncal Orthosis in terms of pressure application and consistency. Methods Thirty emergency nurses participated in two trials using both binders on a human truncal dummy model. The applied pressure was measured with a water column system. Paired t-tests assessed pressure differences, ANOVA analyzed operator variability, and linear regression examined the influence of clinical experience. Results Both binders exhibited a significant increase in pressure during the second trial (SAM, p = 0.007; MAX, p < 0.001), indicating a learning effect. However, SAM exhibited greater variability in early trials, whereas MAX demonstrated a more stable pressure application. Operator experience had no significant effect on consistency (p = 0.802). Discussion Both binders provided effective stabilization; however, MAX demonstrated greater consistency, making it a better option for less-experienced users. Its wider coverage may also enhance uniform pressure distribution, and its cost-effectiveness suggests potential use in resource-limited settings. Health sciences/Health care Health sciences/Medical research Pelvic fractures pelvic binder trauma stabilization. Figures Figure 1 Introduction Pelvic fractures are among the most severe skeletal injuries, accounting for approximately 3–8% of all fractures 1 , 2 . These injuries primarily affect two distinct age groups. In younger individuals, particularly men aged 20–40 years, they are often caused by traffic collisions or high-impact trauma 3 . Such fractures frequently coincide with multiple injuries to the head, thorax, abdomen, and extremities, with mortality rates ranging from 4% to 32% 4 . The second group primarily consists of older women, whose fractures typically result from low-energy mechanisms such as falls 3 , 5 . Massive hemorrhage remains the leading cause of mortality 5 , 6 . Previous research indicates that 59% of individuals with unstable pelvic fractures experience active pelvic bleeding 7 , which subsequently compromises hemodynamic stability 6 . In cases of pelvic trauma, 85% of bleeding originates from the venous system, primarily the presacral plexus and prevesical veins, potentially leading to severe hemorrhage as the pelvic cavity can accommodate the entire circulating blood volume. Arterial bleeding accounts for approximately 15–20% of cases, mainly arising from branches of the internal iliac artery. Additionally, hemorrhage can result from a ruptured fracture site 8 , which serves as a non-vascular source of bleeding. According to the Advanced Trauma Life Support (ATLS) guidelines 9 , a Pelvic Circumferential Compression Device (PCCD) should be applied during pre-hospital management in cases of mechanically unstable pelvis, hemodynamic instability, or suspected intrapelvic hemorrhage to control bleeding. Besides bedsheets, commercial pelvic binders are commonly used in pre-hospital settings to stabilize the pelvis 3 , 10 , 11 . Applying a pelvic binder provides circumferential compression, enhancing the mechanical stability of the pelvic ring, reducing fracture fragment displacement, decreasing the pelvic cavity volume, and increasing intrapelvic pressure, all of which help limit fracture-related bleeding. Furthermore, pelvic binding can mitigate cancellous bone bleeding and reduce the risk of sharp fracture fragments causing additional damage to blood vessels and soft tissues 3 . Studies indicate that pelvic binders can effectively reduce the need for blood transfusions 10 . Correct application is critical to achieving the intended therapeutic effects. Specifically, identifying the midpoint between the proximal and distal ends of both greater trochanters, considered the optimal binder placement, ensures adequate compression of the pelvic region 2 , 12 . Biomechanical investigations have demonstrated that an ideal compression force of 180 N should be applied at the levels of the greater trochanter and symphysis 12 . Pelvic Circumferential Compression Devices (PCCDs) for pelvic fractures function by stabilizing the pelvis by tightening a strap with a closure mechanism. Currently, the three most frequently used PCCDs—Pelvic Binder®, T-POD®, and SAM Sling®—are widely applied in both pre-hospital and clinical settings 13 . However, previous studies have identified suboptimal accuracy in the pre-hospital placement of pelvic binders. Upon arrival in the emergency department, binders are often found to be malpositioned, thereby compromising their effectiveness 3 . Ensuring reliable stabilization and uniform pressure distribution is therefore crucial. Multiple pelvic binders are available in Taiwan. This study compares two: the SAM Pelvic Sling II (SAM Medical®, Tualatin, USA) and the AP Max Truncal Orthosis (Asia Pacific Pharmaceutical Co, Taiwan). Both feature tightly woven textiles but differ in shape, fastening mechanism, and coverage width. The SAM Sling is commonly used at the study site and is designed for placement over the greater trochanters; however, accurately identifying these landmarks in pre-hospital settings can be challenging. In contrast, AP Max, with its broader coverage, often fully encompasses the pelvis and extends above the trochanters, potentially achieving more uniform pressure distribution and facilitating better fracture management. Therefore, this study compares the pressure values generated by both binders, applied by different operators on the pelvic region of a human truncal dummy model, to analyze any performance discrepancies. Additionally, this study evaluates how each binder influences the pressure indices at various abdominal locations. The primary objective is to identify potential differences in their effectiveness in pelvic stabilization and hemorrhage control. Method Study Design An experimental study was conducted using a human truncal dummy model to simulate pelvic fracture fixation scenarios. The procedures were performed by emergency nurses with a minimum of one year of experience in managing pelvic fractures. To maintain consistency and minimize variability in data collection, a single research recorder was responsible for documenting all measurements. The study was approved by the Institutional Review Board of National Cheng Kung University Hospital (IRB No. A-ER-114-347) . Experimental Procedures In the first trial, the SAM Pelvic Sling II was positioned on the dummy model over the pelvic region, aligning with the greater trochanters. A water-filled IV bag in the lower abdomen simulated internal pressure, and changes in water column height were recorded as the sling was tightened. In the second trial, the same operator applied the AP Max Truncal Orthosis under identical conditions, and the water column height was measured in the same manner. Each operator repeated both tests, and all data were logged using the same recorder. Data Analysis Water column heights were subjected to descriptive statistics, including mean, standard deviation, median, and interquartile range. Paired t-tests were used to assess differences between the two binders. A one-way ANOVA was conducted to evaluate operator effects. Statistical significance was set at p < 0.05, and analyses were performed using JASP 0.18.3.0 14 . Result This study examined changes in pressure application across trials for two pelvic binders, SAM and MAX, using a paired-sample t-test. The findings indicated a significant increase in the applied pressure during the second trial, suggesting a learning effect in which operators became more proficient. Pressure Measurement and Variability Analysis The pressure measurements across trials showed an overall increase in applied pressure for both pelvic binders [Table 1 ]. The SAM binder increased from 55.2 to 57.9, while the MAX binder rose from 56.2 to 60.4, suggesting a learning effect in which operators became more proficient, leading to improved consistency in pressure application. Greater familiarity with the equipment may have also contributed to a more controlled and stable application of force. However, along with the increase in mean pressure, the standard deviation (SD) also rose in the second trial, indicating greater variability. The SAM binder’s SD increased from 9.6 to 11.2, while the MAX binder’s SD increased from 10.1 to 11.2. This suggests that although operators became more effective in applying pressure, inconsistencies in force distribution persisted across trials. Boxplots [Figure 1] illustrate the pressure distribution across trials, revealing differences in consistency and variability. SAM binder in the first trial had the highest number of extreme values, indicating greater operator inconsistency and a steeper learning curve during initial use. Both binders demonstrated an increase in median pressure in the second trial, reinforcing the learning effect observed in the paired t-test. However, the MAX binder exhibited less variability, suggesting greater ease of consistent application across operators. Overall, both binders showed improved consistency with repeated use. However, the SAM binder exhibited greater initial variability, requiring more experience for consistent application. In contrast, the MAX binder demonstrated more stable performance, making it a potentially more user-friendly option for less-experienced operators. To further investigate these observations, a paired-sample t-test was conducted to compare pressure measurements obtained at different time points for the same participants. The aim was to assess whether pressure variations between the SAM and MAX binders under different testing conditions were statistically significant. The results indicated a statistically significant increase in the applied pressure from the first to the second trial for both binders. The SAM showed a significant change ( t = -2.88, p = 0.007), while the MAX binder exhibited an even more pronounced increase (t= -4.726, p < 0.001). These findings further reinforce the learning effect, suggesting that operators became more proficient in applying pressure over time [Table 2 ]. However, when comparing the SAM and MAX binders within the same testing rounds, no statistically significant differences were observed (first trial: t = -0.66, p = 0.51; second trial: t = -1.249, p = 0.222) [Table 2 ]. This suggests that while both binders facilitated increased pressure application over time, neither demonstrated clear superiority over the other. This study utilized Linear regression analysis to examine the effect of operator experience (years in nursing) on pressure variability when using pelvic binders (SAM and MAX) across the first and second trials. The results indicated a very weak correlation between experience and pressure variation. The coefficient of determination (R² = 0.061) suggests that experience explains only 6.1% of the variance. After adjusting for model complexity, the adjusted R² was negative (-0.089) [Table 3 ], further indicating that experience does not significantly influence pressure application. Additionally, the ANOVA results showed an F -value of 0.407 and a p -value of 0.802 [Table 4 ], confirming that the regression model lacked statistical significance and implying that the observed variations in pressure were likely due to random fluctuations rather than the influence of experience. Further analysis of the regression coefficients revealed that none of the four testing conditions (SAM First Trial, SAM Second Trial, MAX First, and MAX-second trial) reached statistical significance ( p > 0.05). The most influential condition was the MAX binder in the second trial ( β = 0.476), but this effect was not statistically significant ( p = 0.332) [Table 5 ], suggesting that experience had limited impact on pressure application consistency across different testing conditions. Discussion The findings of this study indicate that both the SAM and AP MAX pelvic binders provide effective stabilization, with no significant difference in fixation pressure. However, operator proficiency appeared to influence fixation effectiveness, as repeated trials resulted in increased pressure application, suggesting a learning effect. During the initial testing, both binders exhibited similar pressure levels, demonstrating their ability to stabilize the pelvis effectively. As operator experience improved, pressure application became more consistent, highlighting the importance of technical proficiency in optimizing pelvic binder performance. Despite their comparable fixation performance, the AP MAX is a cost-effective alternative to the SAM, offering similar pressure stability at a lower cost. Additionally, its wider coverage allows complete pelvic encasement and extension above the greater trochanter, contributing to more uniform pressure distribution. This characteristic may enhance the initial stabilization, making it a viable option for resource-limited medical facilities or high-demand emergency situations 15 , 16 , such as battlefield medicine and disaster response. Although this study provided insights into the application of pelvic binders, certain limitations should be acknowledged. The primary focus was on fixation pressure without assessing application time, which is critical in emergency settings. Since faster application can improve hemorrhage control and patient outcomes, future research should compare the efficiency of different binders in high-pressure trauma scenarios. Additionally, the relatively small sample size of 30 clinical nurses may limit generalizability as operator variability could influence the results. Future studies should include a more diverse group of health care providers to enhance applicability. Furthermore, this study utilized a human truncal dummy model, which, although useful for standardization, does not fully replicate variations in patient anatomy, tissue response, or injury severity. Clinical trials involving patients are necessary to validate these findings and ensure the effectiveness of pelvic binders across different body types and trauma conditions. Another limitation is the use of water column height for pressure measurement, which may be affected by external factors, such as fluid density changes and environmental temperature variations. To improve data accuracy and reliability, future research should adopt more precise pressure measurement devices, such as digital sensors or biomechanical monitoring systems. Conclusion This study demonstrated that both binders (SAM and AP MAX) provide similar pressure levels, effectively stabilize the pelvis. As operator experience improved, pressure application became more consistent, highlighting the importance of technical proficiency in optimizing pelvic binder performance. Despite their comparable fixation performance, the AP MAX binder presents a cost-effective alternative to the SAM, offering broader pelvic coverage at a lower cost. This characteristic may enhance convenience for caregivers and benefit injured patients during initial management, particularly in battlefield or disaster scenarios. Declarations Conflict of Interest The authors have no conflict of interest to declare. Ethics Approval and Consent to Participate All methods were carried out in accordance with relevant guidelines and regulations, and informed consent was obtained from all participants who provided their background information, including work experience. Funding No funding was received for this project. Author Contribution LCC: Conceptualization, Project adminittration, Supervision, ReviewHDL: Methodology, Writing,Statistical Analysis, and Editing.YTT: Investigation, Resources.All authors reviewed the manuscript. Data Availability The datasets generated and/or analysed during the current study are not publicly available due to ongoing related research projects, but are available from the corresponding author on reasonable request. References Pohlemann, T. et al. Mar. [Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group]. Unfallchirurg . ;99(3):160-7. Beckenverletzungen: Epidemiologie, Therapie und Langzeitverlauf. Ubersicht über die multizentrische Studie der Arbeitsgruppe Becken. (1996). Culemann, U., Scola, A., Tosounidis, G., Pohlemann, T. & Gebhard, F. [Concept for treatment of pelvic ring injuries in elderly patients. A challenge]. Unfallchirurg . Apr ;113(4):258 – 71. Versorgungskonzept der Beckenringverletzung des alten Patienten. Eine Herausforderung. (2010). 10.1007/s00113-010-1762-3 Privalov, M. et al. Comparison of T-POD and SAM Pelvic Sling II and the influence of attachment level in the initial management of unstable pelvic type C injuries - a cadaveric study. Int J. Emerg. Med Mar. 4 (1), 34. 10.1186/s12245-024-00610-8 (2024). Pierrie, S. N. et al. Pilot randomized trial of pre-hospital advanced therapies for the control of hemorrhage (PATCH) using pelvic binders. Am J. Emerg. Med Apr . 42 , 43–48. 10.1016/j.ajem.2020.12.082 (2021). Hsieh, S. L. et al. Trends and treatments of pelvic and acetabular fractures in Taiwan: facing an aging society. Arch Osteoporos May . 10 (1), 66. 10.1007/s11657-023-01255-5 (2023). Cryer, H. M., Miller, F. B., Evers, B. M., Rouben, L. R. & Seligson, D. L. Pelvic fracture classification: correlation with hemorrhage. J Trauma Jul . 28 (7), 973–980 (1988). Eastridge, B. J., Starr, A., Minei, J. P., O’Keefe, G. E. & Scalea, T. M. The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. J Trauma Sep. 53 (3), 446–450. 10.1097/00005373-200209000-00009 (2002). discussion 450-1. Benders, K. E. M. & Leenen, L. P. H. Management of Hemodynamically Unstable Pelvic Ring Fractures. Front. Surg. 7 , 601321. 10.3389/fsurg.2020.601321 (2020). Spanjersberg, W. R. et al. Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: a systematic review of literature. Injury Oct. 40 (10), 1031–1035. 10.1016/j.injury.2009.06.164 (2009). Khaliq, F. P. R. EMS Pelvic Binders. StatPearls Publishing. Accessed 0203, (2025). https://www.ncbi.nlm.nih.gov/books/NBK598968/ Schweigkofler, U. et al. Is there any benefit in the pre-hospital application of pelvic binders in patients with suspected pelvic injuries? Eur J. Trauma. Emerg. Surg Apr . 47 (2), 493–498. 10.1007/s00068-019-01239-6 (2021). Reiter, A. et al. Does a pre-hospital applied pelvic binder improve patient survival? Injury Apr . 55 (4), 111392. 10.1016/j.injury.2024.111392 (2024). Knops, S. P. et al. Measurements of the exerted pressure by pelvic circumferential compression devices. Open Orthop. J Feb . 17 , 4:101–106. 10.2174/1874325001004020101 (2010). Team, J. JASP. (2024). Gordon, W. T. et al. Pelvic Fracture Care. Mil. Med. 183 (suppl_2), 115–117. 10.1093/milmed/usy111 (2018). Loftus, A., Pynn, H. & Parker, P. Improvised first aid techniques for terrorist attacks. Emerg. Med. J. 35 (8), 516–521. 10.1136/emermed-2018-207480 (2018). Tables Table 1 Descriptive Statistics of Fixation Pressure Measurements for SAM and MAX Pelvic Binders SAM (First) SAM (Second) MAX (First) MAX (Second) Valid 30 30 30 30 Missing 0 0 0 0 Mean 55.200 57.933 56.200 60.367 Std. Deviation 9.615 11.246 10.060 11.248 Minimum 40.000 41.000 35.000 32.000 Maximum 78.000 81.000 75.000 80.000 Note. second Table 2 Paired Samples T-Test Results for Fixation Pressure Comparisons Between Trials and Binders Measure 1 Measure 2 t df p SAM (First) - SAM (Second) -2.880 29 0.007 MAX (First) - MAX (Second) -4.726 29 < .001 SAM (First) - MAX (First) -0.660 29 0.515 SAM (Second) - MAX (Second) -1.249 29 0.222 Note. Student’s t-test. Table 3 Operator Experience and Fixation Pressure Model R R² Adjusted R² RMSE H₀ 0.000 0.000 0.000 5.951 H₁ 0.247 0.061 -0.089 6.210 Table 4 ANOVA Results for Linear Regression Analysis of Operator Experience and Fixation Pressure Model Sum of Squares df Mean Square F p H₁ Regression 62.842 4 15.710 0.407 0.802 Residual 964.125 25 38.565 Total 1026.967 29 Table 5 Coefficients of Linear Regression Model for Operator Experience and Fixation Pressure Model Unstandardized Standard Error Standardized t p H₀ (Intercept) 9.367 1.086 8.621 < .001 H₁ (Intercept) 6.043 7.347 0.822 0.419 SAM (First) -0.012 0.313 -0.019 -0.038 0.970 SAM (Second) -0.068 0.241 -0.129 -0.282 0.780 MAX (First) -0.129 0.296 -0.219 -0.437 0.666 MAX (Second) 0.252 0.255 0.476 0.989 0.332 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 22 Dec, 2025 Reviews received at journal 19 Dec, 2025 Reviewers agreed at journal 08 Dec, 2025 Reviews received at journal 24 Nov, 2025 Reviewers agreed at journal 14 Nov, 2025 Reviewers invited by journal 29 Oct, 2025 Editor invited by journal 18 Sep, 2025 Editor assigned by journal 18 Sep, 2025 Submission checks completed at journal 13 Sep, 2025 First submitted to journal 09 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7576430","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":541885669,"identity":"be70ff67-9a3d-419a-a2af-d084bb650ceb","order_by":0,"name":"Li-Chien 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12:21:16","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":77609,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7576430/v1/271169cce2e51d5a5b5ed2cd.html"},{"id":95544708,"identity":"e67df182-49fd-433d-83f0-f2e05a57fb39","added_by":"auto","created_at":"2025-11-10 12:21:15","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":46557,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBoxplot Comparison of Fixation Pressure for SAM and MAX Pelvic Binders Across Two Trials\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7576430/v1/073d5df79f196076091cc41c.jpg"},{"id":95660000,"identity":"7e670623-7f60-44cd-9441-ae5bd3fc03fc","added_by":"auto","created_at":"2025-11-11 16:30:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":731011,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7576430/v1/d0b53d76-dc38-49be-bbc0-7a9aec783cd9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparing Fixation Pressure and Operator Proficiency in the Use of Pelvic Binders: A Study of the SAM Pelvic Sling II and AP MAX Truncal Orthosis","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePelvic fractures are among the most severe skeletal injuries, accounting for approximately 3\u0026ndash;8% of all fractures\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. These injuries primarily affect two distinct age groups. In younger individuals, particularly men aged 20\u0026ndash;40 years, they are often caused by traffic collisions or high-impact trauma\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Such fractures frequently coincide with multiple injuries to the head, thorax, abdomen, and extremities, with mortality rates ranging from 4% to 32%\u003csup\u003e4\u003c/sup\u003e. The second group primarily consists of older women, whose fractures typically result from low-energy mechanisms such as falls\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Massive hemorrhage remains the leading cause of mortality\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003ePrevious research indicates that 59% of individuals with unstable pelvic fractures experience active pelvic bleeding\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e, which subsequently compromises hemodynamic stability\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. In cases of pelvic trauma, 85% of bleeding originates from the venous system, primarily the presacral plexus and prevesical veins, potentially leading to severe hemorrhage as the pelvic cavity can accommodate the entire circulating blood volume. Arterial bleeding accounts for approximately 15\u0026ndash;20% of cases, mainly arising from branches of the internal iliac artery. Additionally, hemorrhage can result from a ruptured fracture site\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, which serves as a non-vascular source of bleeding.\u003c/p\u003e\u003cp\u003eAccording to the Advanced Trauma Life Support (ATLS) guidelines\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, a Pelvic Circumferential Compression Device (PCCD) should be applied during pre-hospital management in cases of mechanically unstable pelvis, hemodynamic instability, or suspected intrapelvic hemorrhage to control bleeding. Besides bedsheets, commercial pelvic binders are commonly used in pre-hospital settings to stabilize the pelvis\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eApplying a pelvic binder provides circumferential compression, enhancing the mechanical stability of the pelvic ring, reducing fracture fragment displacement, decreasing the pelvic cavity volume, and increasing intrapelvic pressure, all of which help limit fracture-related bleeding. Furthermore, pelvic binding can mitigate cancellous bone bleeding and reduce the risk of sharp fracture fragments causing additional damage to blood vessels and soft tissues\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Studies indicate that pelvic binders can effectively reduce the need for blood transfusions\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Correct application is critical to achieving the intended therapeutic effects. Specifically, identifying the midpoint between the proximal and distal ends of both greater trochanters, considered the optimal binder placement, ensures adequate compression of the pelvic region\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Biomechanical investigations have demonstrated that an ideal compression force of 180 N should be applied at the levels of the greater trochanter and symphysis \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Pelvic Circumferential Compression Devices (PCCDs) for pelvic fractures function by stabilizing the pelvis by tightening a strap with a closure mechanism. Currently, the three most frequently used PCCDs\u0026mdash;Pelvic Binder\u0026reg;, T-POD\u0026reg;, and SAM Sling\u0026reg;\u0026mdash;are widely applied in both pre-hospital and clinical settings\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. However, previous studies have identified suboptimal accuracy in the pre-hospital placement of pelvic binders. Upon arrival in the emergency department, binders are often found to be malpositioned, thereby compromising their effectiveness\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Ensuring reliable stabilization and uniform pressure distribution is therefore crucial.\u003c/p\u003e\u003cp\u003eMultiple pelvic binders are available in Taiwan. This study compares two: the SAM Pelvic Sling II (SAM Medical\u0026reg;, Tualatin, USA) and the AP Max Truncal Orthosis (Asia Pacific Pharmaceutical Co, Taiwan). Both feature tightly woven textiles but differ in shape, fastening mechanism, and coverage width. The SAM Sling is commonly used at the study site and is designed for placement over the greater trochanters; however, accurately identifying these landmarks in pre-hospital settings can be challenging.\u003c/p\u003e\u003cp\u003eIn contrast, AP Max, with its broader coverage, often fully encompasses the pelvis and extends above the trochanters, potentially achieving more uniform pressure distribution and facilitating better fracture management. Therefore, this study compares the pressure values generated by both binders, applied by different operators on the pelvic region of a human truncal dummy model, to analyze any performance discrepancies.\u003c/p\u003e\u003cp\u003eAdditionally, this study evaluates how each binder influences the pressure indices at various abdominal locations. The primary objective is to identify potential differences in their effectiveness in pelvic stabilization and hemorrhage control.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eAn experimental study was conducted using a human truncal dummy model to simulate pelvic fracture fixation scenarios. The procedures were performed by emergency nurses with a minimum of one year of experience in managing pelvic fractures. To maintain consistency and minimize variability in data collection, a single research recorder was responsible for documenting all measurements. The study was approved by the Institutional Review Board of National Cheng Kung University Hospital \u003cb\u003e(IRB No. A-ER-114-347)\u003c/b\u003e.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eExperimental Procedures\u003c/h3\u003e\n\u003cp\u003eIn the first trial, the SAM Pelvic Sling II was positioned on the dummy model over the pelvic region, aligning with the greater trochanters. A water-filled IV bag in the lower abdomen simulated internal pressure, and changes in water column height were recorded as the sling was tightened. In the second trial, the same operator applied the AP Max Truncal Orthosis under identical conditions, and the water column height was measured in the same manner. Each operator repeated both tests, and all data were logged using the same recorder.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eWater column heights were subjected to descriptive statistics, including mean, standard deviation, median, and interquartile range. Paired t-tests were used to assess differences between the two binders. A one-way ANOVA was conducted to evaluate operator effects. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, and analyses were performed using JASP 0.18.3.0\u003csup\u003e14\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e"},{"header":"Result","content":"\u003cp\u003eThis study examined changes in pressure application across trials for two pelvic binders, SAM and MAX, using a paired-sample t-test. The findings indicated a significant increase in the applied pressure during the second trial, suggesting a learning effect in which operators became more proficient.\u003c/p\u003e\n\u003ch3\u003ePressure Measurement and Variability Analysis\u003c/h3\u003e\n\u003cp\u003eThe pressure measurements across trials showed an overall increase in applied pressure for both pelvic binders [Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e]. The SAM binder increased from 55.2 to 57.9, while the MAX binder rose from 56.2 to 60.4, suggesting a learning effect in which operators became more proficient, leading to improved consistency in pressure application. Greater familiarity with the equipment may have also contributed to a more controlled and stable application of force.\u003c/p\u003e\u003cp\u003eHowever, along with the increase in mean pressure, the standard deviation (SD) also rose in the second trial, indicating greater variability. The SAM binder\u0026rsquo;s SD increased from 9.6 to 11.2, while the MAX binder\u0026rsquo;s SD increased from 10.1 to 11.2. This suggests that although operators became more effective in applying pressure, inconsistencies in force distribution persisted across trials.\u003c/p\u003e\u003cp\u003eBoxplots [Figure 1] illustrate the pressure distribution across trials, revealing differences in consistency and variability. SAM binder in the first trial had the highest number of extreme values, indicating greater operator inconsistency and a steeper learning curve during initial use.\u003c/p\u003e\u003cp\u003eBoth binders demonstrated an increase in median pressure in the second trial, reinforcing the learning effect observed in the paired t-test. However, the MAX binder exhibited less variability, suggesting greater ease of consistent application across operators.\u003c/p\u003e\u003cp\u003eOverall, both binders showed improved consistency with repeated use. However, the SAM binder exhibited greater initial variability, requiring more experience for consistent application. In contrast, the MAX binder demonstrated more stable performance, making it a potentially more user-friendly option for less-experienced operators.\u003c/p\u003e\u003cp\u003eTo further investigate these observations, a paired-sample t-test was conducted to compare pressure measurements obtained at different time points for the same participants. The aim was to assess whether pressure variations between the SAM and MAX binders under different testing conditions were statistically significant.\u003c/p\u003e\u003cp\u003eThe results indicated a statistically significant increase in the applied pressure from the first to the second trial for both binders. The SAM showed a significant change (\u003cem\u003et\u003c/em\u003e = -2.88, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007), while the MAX binder exhibited an even more pronounced increase (t= -4.726, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These findings further reinforce the learning effect, suggesting that operators became more proficient in applying pressure over time [Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, when comparing the SAM and MAX binders within the same testing rounds, no statistically significant differences were observed (first trial: \u003cem\u003et\u003c/em\u003e = -0.66, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.51; second trial: \u003cem\u003et\u003c/em\u003e = -1.249, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.222) [Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e]. This suggests that while both binders facilitated increased pressure application over time, neither demonstrated clear superiority over the other.\u003c/p\u003e\u003cp\u003eThis study utilized Linear regression analysis to examine the effect of operator experience (years in nursing) on pressure variability when using pelvic binders (SAM and MAX) across the first and second trials. The results indicated a very weak correlation between experience and pressure variation. The coefficient of determination (R\u0026sup2; = 0.061) suggests that experience explains only 6.1% of the variance. After adjusting for model complexity, the adjusted R\u0026sup2; was negative (-0.089) [Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e], further indicating that experience does not significantly influence pressure application.\u003c/p\u003e\u003cp\u003eAdditionally, the ANOVA results showed an \u003cem\u003eF\u003c/em\u003e-value of 0.407 and a \u003cem\u003ep\u003c/em\u003e-value of 0.802 [Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e], confirming that the regression model lacked statistical significance and implying that the observed variations in pressure were likely due to random fluctuations rather than the influence of experience.\u003c/p\u003e\u003cp\u003eFurther analysis of the regression coefficients revealed that none of the four testing conditions (SAM First Trial, SAM Second Trial, MAX First, and MAX-second trial) reached statistical significance (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The most influential condition was the MAX binder in the second trial (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.476), but this effect was not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.332) [Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e], suggesting that experience had limited impact on pressure application consistency across different testing conditions.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study indicate that both the SAM and AP MAX pelvic binders provide effective stabilization, with no significant difference in fixation pressure. However, operator proficiency appeared to influence fixation effectiveness, as repeated trials resulted in increased pressure application, suggesting a learning effect.\u003c/p\u003e\u003cp\u003eDuring the initial testing, both binders exhibited similar pressure levels, demonstrating their ability to stabilize the pelvis effectively. As operator experience improved, pressure application became more consistent, highlighting the importance of technical proficiency in optimizing pelvic binder performance.\u003c/p\u003e\u003cp\u003eDespite their comparable fixation performance, the AP MAX is a cost-effective alternative to the SAM, offering similar pressure stability at a lower cost. Additionally, its wider coverage allows complete pelvic encasement and extension above the greater trochanter, contributing to more uniform pressure distribution. This characteristic may enhance the initial stabilization, making it a viable option for resource-limited medical facilities or high-demand emergency situations\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e, such as battlefield medicine and disaster response.\u003c/p\u003e\u003cp\u003eAlthough this study provided insights into the application of pelvic binders, certain limitations should be acknowledged. The primary focus was on fixation pressure without assessing application time, which is critical in emergency settings. Since faster application can improve hemorrhage control and patient outcomes, future research should compare the efficiency of different binders in high-pressure trauma scenarios.\u003c/p\u003e\u003cp\u003eAdditionally, the relatively small sample size of 30 clinical nurses may limit generalizability as operator variability could influence the results. Future studies should include a more diverse group of health care providers to enhance applicability. Furthermore, this study utilized a human truncal dummy model, which, although useful for standardization, does not fully replicate variations in patient anatomy, tissue response, or injury severity. Clinical trials involving patients are necessary to validate these findings and ensure the effectiveness of pelvic binders across different body types and trauma conditions.\u003c/p\u003e\u003cp\u003eAnother limitation is the use of water column height for pressure measurement, which may be affected by external factors, such as fluid density changes and environmental temperature variations. To improve data accuracy and reliability, future research should adopt more precise pressure measurement devices, such as digital sensors or biomechanical monitoring systems.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrated that both binders (SAM and AP MAX) provide similar pressure levels, effectively stabilize the pelvis. As operator experience improved, pressure application became more consistent, highlighting the importance of technical proficiency in optimizing pelvic binder performance.\u003c/p\u003e\u003cp\u003eDespite their comparable fixation performance, the AP MAX binder presents a cost-effective alternative to the SAM, offering broader pelvic coverage at a lower cost. This characteristic may enhance convenience for caregivers and benefit injured patients during initial management, particularly in battlefield or disaster scenarios.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConflict of Interest\u003c/h2\u003e\u003cp\u003eThe authors have no conflict of interest to declare.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003cp\u003e All methods were carried out in accordance with relevant guidelines and regulations, and informed consent was obtained from all participants who provided their background information, including work experience.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNo funding was received for this project.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLCC: Conceptualization, Project adminittration, Supervision, ReviewHDL: Methodology, Writing,Statistical Analysis, and Editing.YTT: Investigation, Resources.All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to ongoing related research projects, but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePohlemann, T. et al. 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Trends and treatments of pelvic and acetabular fractures in Taiwan: facing an aging society. \u003cem\u003eArch Osteoporos May\u003c/em\u003e. \u003cb\u003e10\u003c/b\u003e (1), 66. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11657-023-01255-5\u003c/span\u003e\u003cspan address=\"10.1007/s11657-023-01255-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCryer, H. M., Miller, F. B., Evers, B. M., Rouben, L. R. \u0026amp; Seligson, D. L. Pelvic fracture classification: correlation with hemorrhage. \u003cem\u003eJ Trauma Jul\u003c/em\u003e. \u003cb\u003e28\u003c/b\u003e (7), 973\u0026ndash;980 (1988).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEastridge, B. J., Starr, A., Minei, J. P., O\u0026rsquo;Keefe, G. E. \u0026amp; Scalea, T. M. The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. \u003cem\u003eJ Trauma Sep.\u003c/em\u003e \u003cb\u003e53\u003c/b\u003e (3), 446\u0026ndash;450. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/00005373-200209000-00009\u003c/span\u003e\u003cspan address=\"10.1097/00005373-200209000-00009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2002). discussion 450-1.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBenders, K. E. M. \u0026amp; Leenen, L. P. H. Management of Hemodynamically Unstable Pelvic Ring Fractures. \u003cem\u003eFront. Surg.\u003c/em\u003e \u003cb\u003e7\u003c/b\u003e, 601321. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fsurg.2020.601321\u003c/span\u003e\u003cspan address=\"10.3389/fsurg.2020.601321\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSpanjersberg, W. R. et al. Effectiveness and complications of pelvic circumferential compression devices in patients with unstable pelvic fractures: a systematic review of literature. \u003cem\u003eInjury Oct.\u003c/em\u003e \u003cb\u003e40\u003c/b\u003e (10), 1031\u0026ndash;1035. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.injury.2009.06.164\u003c/span\u003e\u003cspan address=\"10.1016/j.injury.2009.06.164\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2009).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhaliq, F. P. R. EMS Pelvic Binders. StatPearls Publishing. Accessed 0203, (2025). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK598968/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/books/NBK598968/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchweigkofler, U. et al. Is there any benefit in the pre-hospital application of pelvic binders in patients with suspected pelvic injuries? \u003cem\u003eEur J. Trauma. Emerg. Surg Apr\u003c/em\u003e. \u003cb\u003e47\u003c/b\u003e (2), 493\u0026ndash;498. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00068-019-01239-6\u003c/span\u003e\u003cspan address=\"10.1007/s00068-019-01239-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eReiter, A. et al. Does a pre-hospital applied pelvic binder improve patient survival? \u003cem\u003eInjury Apr\u003c/em\u003e. \u003cb\u003e55\u003c/b\u003e (4), 111392. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.injury.2024.111392\u003c/span\u003e\u003cspan address=\"10.1016/j.injury.2024.111392\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKnops, S. P. et al. Measurements of the exerted pressure by pelvic circumferential compression devices. \u003cem\u003eOpen Orthop. J Feb\u003c/em\u003e. \u003cb\u003e17\u003c/b\u003e, 4:101\u0026ndash;106. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2174/1874325001004020101\u003c/span\u003e\u003cspan address=\"10.2174/1874325001004020101\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2010).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTeam, J. JASP. (2024).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGordon, W. T. et al. Pelvic Fracture Care. \u003cem\u003eMil. Med.\u003c/em\u003e \u003cb\u003e183\u003c/b\u003e (suppl_2), 115\u0026ndash;117. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/milmed/usy111\u003c/span\u003e\u003cspan address=\"10.1093/milmed/usy111\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2018).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLoftus, A., Pynn, H. \u0026amp; Parker, P. Improvised first aid techniques for terrorist attacks. \u003cem\u003eEmerg. Med. J.\u003c/em\u003e \u003cb\u003e35\u003c/b\u003e (8), 516\u0026ndash;521. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/emermed-2018-207480\u003c/span\u003e\u003cspan address=\"10.1136/emermed-2018-207480\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2018).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive Statistics of Fixation Pressure Measurements for SAM and MAX Pelvic Binders\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eSAM\u003c/p\u003e\u003cp\u003e(First)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eSAM (Second)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eMAX\u003c/p\u003e\u003cp\u003e(First)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003eMAX (Second)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eValid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55.200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e57.933\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e56.200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e60.367\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStd. Deviation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.615\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11.246\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10.060\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e11.248\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMinimum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e41.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e35.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e32.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaximum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e81.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e75.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e80.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNote.\u003c/em\u003e second\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePaired Samples T-Test Results for Fixation Pressure Comparisons Between Trials and Binders\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"12\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMeasure 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eMeasure 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003edf\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSAM (First)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSAM (Second)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-2.880\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMAX (First)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMAX (Second)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-4.726\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u0026lt;\u0026nbsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSAM (First)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMAX (First)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.660\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.515\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSAM (Second)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMAX (Second)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-1.249\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.222\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNote.\u003c/em\u003e \u0026nbsp;Student\u0026rsquo;s t-test.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eOperator Experience and Fixation Pressure\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eModel\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eR\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eAdjusted R\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003eRMSE\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH₀\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e5.951\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH₁\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.247\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.061\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.089\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e6.210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eANOVA Results for Linear Regression Analysis of Operator Experience and Fixation Pressure\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"14\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eModel\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eSum of Squares\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003edf\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003eMean Square\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c14\" namest=\"c13\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eH₁\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRegression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e62.842\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e15.710\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.407\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.802\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eResidual\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e964.125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e38.565\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1026.967\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCoefficients of Linear Regression Model for Operator Experience and Fixation Pressure\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"14\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eModel\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eUnstandardized\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eStandard Error\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" 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colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.347\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.822\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.419\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSAM (First)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" 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colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSAM (Second)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.068\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.241\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-0.282\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.780\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMAX (First)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.296\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-0.437\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.666\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMAX (Second)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.252\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.255\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.476\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.989\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.332\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pelvic fractures, pelvic binder, trauma stabilization.","lastPublishedDoi":"10.21203/rs.3.rs-7576430/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7576430/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePelvic fractures are associated with high morbidity and mortality and often require immediate stabilization. Pelvic binders help control hemorrhage; however, variations in design and operator proficiency may affect performance. This study compares the SAM Pelvic Sling II and AP MAX Truncal Orthosis in terms of pressure application and consistency.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThirty emergency nurses participated in two trials using both binders on a human truncal dummy model. The applied pressure was measured with a water column system. Paired t-tests assessed pressure differences, ANOVA analyzed operator variability, and linear regression examined the influence of clinical experience.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eBoth binders exhibited a significant increase in pressure during the second trial (SAM, p\u0026thinsp;=\u0026thinsp;0.007; MAX, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating a learning effect. However, SAM exhibited greater variability in early trials, whereas MAX demonstrated a more stable pressure application. Operator experience had no significant effect on consistency (p\u0026thinsp;=\u0026thinsp;0.802).\u003c/p\u003e\u003ch2\u003eDiscussion\u003c/h2\u003e\u003cp\u003eBoth binders provided effective stabilization; however, MAX demonstrated greater consistency, making it a better option for less-experienced users. Its wider coverage may also enhance uniform pressure distribution, and its cost-effectiveness suggests potential use in resource-limited settings.\u003c/p\u003e","manuscriptTitle":"Comparing Fixation Pressure and Operator Proficiency in the Use of Pelvic Binders: A Study of the SAM Pelvic Sling II and AP MAX Truncal Orthosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-10 12:21:11","doi":"10.21203/rs.3.rs-7576430/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-22T13:50:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-19T21:00:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"220945974735721901072427132683898639992","date":"2025-12-08T18:11:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-24T10:52:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"270337848858292883170663023050095929926","date":"2025-11-14T15:15:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-29T09:04:41+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-18T19:37:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-18T19:17:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-13T08:47:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-09-09T18:17:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0ca2d669-6519-491e-86d0-e72b7ba601d5","owner":[],"postedDate":"November 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":57652376,"name":"Health sciences/Health care"},{"id":57652377,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-02-06T14:08:50+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-10 12:21:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7576430","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7576430","identity":"rs-7576430","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}