Instrumented platforms for balance and proprioceptive assessment in patients with total knee replacement: A systematic review and meta-analysis.

BACKGROUND: The functional outcome of total knee replacement (TKR) is usually satisfying. However, patients may show functional limitations for years after surgery, which have been ascribed to impairments in balance and proprioception, mainly during standing tasks. A number of instrumentations and parameters have been used, rising confusion for clinical decisions on the assessment of patients. RESEARCH QUESTION: Which are the most widespread and consistent procedures to assess balance and proprioception following TKR? METHODS: A literature review was conducted in Pubmed, PEDro, and Cochrane database. From a total sample of 112 articles, 23 original studies published between 2008 and 2019 met inclusion criteria. The primary outcomes selected were variables related to balance and proprioception assessment in static and dynamic tasks performed with instrumented platforms. Data from papers using the same instrumentation, on patients with unilateral TKA and at least 12 months postoperatively were synthesized quantitatively in a random effect meta-analysis. RESULTS: Fourteen articles were appropriate for the review. A large variability was found both in the instrumentation and the parameters used. The Neurocom Balance Master System™ was the most used instrument (four articles). On a total population of 186 patients with unilateral TKR 12 months postoperatively, a low degree of heterogeneity was found adopting the random effect in the four tasks explored (Firm and Foam Surface both with Eyes Open and Eyes Closed). SIGNIFICANCE: This review found a large variability in the instrumentation used to assess balance and proprioception in patients operated on TKR. The meta-analysis demonstrated that the Neurocom Balance Master System™ for static assessment of balance showed an acceptable consistency and can be considered as a reference for further studies. However, balance and proprioception impairments following TKR have not been widely quantified by means of instrumented platforms. Further research is needed to address this issue, and improve clinical practice.

A regional assessment of cumulative impact mapping on Mediterranean coralligenous outcrops.

In the last decade, the 'Cumulative Pressure and Impact Assessment' (CPIA) approach emerged as a tool to map expected impacts on marine ecosystems. However, CPIA assumes a linear response of ecosystems to increasing level of cumulative pressure weighting sensitivity to different anthropogenic pressures through expert judgement. We applied CPIA to Mediterranean coralligenous outcrops over 1000 km of the Italian coastline. Extensive field surveys were conducted to assess the actual condition of coralligenous assemblages at varying levels of human pressure. As pressure increased, a clear shift from bioconstructors to turf-dominated assemblages was found. The linear model originally assumed for CPIA did not fit the actual relationship between expected cumulative impact versus assemblage degradation. A log-log model, instead, best fitted the data and predicted a different map of cumulative impact in the study area able to appreciate the whole range of impact scenarios. Hence, the relative importance of different drivers in explaining the observed pattern of degradation was not aligned with weights from the expert opinion. Such findings stress the need for more incisive efforts to collect empirical evidence on ecosystem-specific responses to human pressure in order to refine CPIA predictions.