A Portable Wireless Solution for Back Pain Telemonitoring: A 3D-Based, Virtual Reality Approach - Computational Intelligence in Healthcare: Advanced Methodologies - page 425

strengths and weaknesses. However, compared to paper-based techniques, they were
found to be extremely useful in capturing time-stamped data [20], specifically neces-
sary for recording pain variations over time. In addition, numerous advantages have
been described in literature, such as their portability, ease of data sharing, instant
access [20], as well as direct transfer of information, and their ability of a dynamic
graphical display to visualize data [41].
Based on the above, it could be suggested that computer-based tools could easily be
used for recording patient medical information. Indeed, several studies in literature
indicate that electronic tools could be very practical in recording back pain informa-
tion. As cited in [18], [14] digitally linked pain drawings as part of the assessment
process with very positive results.
Thus, in overall, previous sections have highlighted that back pain information is
mainly gathered through the use of interactive interviews by highly skilled medical
personnel, supported by various paper-based questionnaires and tools. Yet, the 2-D
representation of pain drawings constitute a limited dimension representation of the
medical information, potentially resulting in a time-consuming process with possible
irrelevant medical data collected that can lead to a report that obscures important
information. Therefore, it seems natural to implement digitized, computer-based 3-D
pain drawings, since such an approach provides an attractive opportunity for enhanc-
ing interaction between the practitioner and the patient in amore perceivable way to
the natural environment.
2.3 Objective Phase
In addition to subjective testing, in order to accomplish a complete evaluation of a
patient suffering from back pain, objective testing should also be used where physical
examinations are performed to confirm or refine the preliminary diagnosis derived
from the previous phase. This testing phase usually proceeds in an iterative way and
may require additional subjective tests, especially when the preliminary diagnosis was
not supported by the examination results [27].
Although the physical examination is not as important as the subjective phase proc-
ess, as cited by [29], many authors in the literature demonstrated that impairments of
trunk strength, flexibility, and endurance have been observed in many patients suffer-
ing from back pain, which result in neurological and physiological spine changes. To
this end, several physical examination tests that address the aforementioned aspects
should be considered, however, because presenting a thorough description of these
tests is outside the scope of this work, in the following discussion only an overview of
the available physical examination tests will be given.
Having said that, according to [39] and [42] , a thorough musculoskeletal and neu-
rologic examination should be the starting point of the physical examination. Specifi-
cally, it should initiate with the observation of the patient's physiologic functionalities
in order to determine any abnormalities in several physiological and neurological
aspects including “ algometry, gait, muscles strength, muscle tension, posture, or
ROM , specifically in the trunk, thighs, and legs”. For those aspects to be measured,
several tests could be used, and which are cited in [4] and [29], as follows: