From Paper to Digital Applications of the Pain Drawing: Systematic Review of Methodological Milestones

Background In a pain drawing (PD), the patient shades or marks painful areas on an illustration of the human body. This simple yet powerful tool captures essential aspects of the subjective pain experience, such as localization, intensity, and distribution of pain, and enables the extraction of meaningful information, such as pain area, widespreadness, and segmental pattern. Starting as a simple pen-on-paper tool, PDs are now sophisticated digital health applications paving the way for many new and exciting basic translational and clinical applications. Objective Grasping the full potential of digital PDs and laying the groundwork for future medical PD apps requires an understanding of the methodological developments that have shaped our current understanding of uses and design. This review presents methodological milestones in the development of both pen-on-paper and digital PDs, thereby offering insight into future possibilities created by the transition from paper to digital. Methods We conducted a systematic literature search covering PD acquisition, conception of PDs, PD analysis, and PD visualization. Results The literature search yielded 435 potentially relevant papers, from which 53 methodological milestones were identified. These milestones include, for example, the grid method to quantify pain area, the pain-frequency maps, and the use of artificial neural networks to facilitate diagnosis. Conclusions Digital technologies have had a significant influence on the evolution of PDs, whereas their versatility is leading to ever new applications in the field of medical apps and beyond. In this process, however, there is a clear need for better standardization and a re-evaluation of methodological and technical limitations that no longer apply today.

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Computerized quantification of pain drawings

Scandinavian Journal of Pain ◽

10.1515/sjpain-2019-0082 ◽

2019 ◽

Vol 20 (1) ◽

pp. 175-189

Author(s):

Søren O’Neill ◽

Tue Secher Jensen ◽

Peter Kent

Keyword(s):

Visual Inspection ◽

Principal Component ◽

Visual Assessment ◽

Spinal Pain ◽

Correct Choice ◽

Significant Degree ◽

Clinical Registry ◽

Pain Drawing ◽

Pain Drawings ◽

Pain Area

AbstractBackground and aimsUsing a computer algorithm to quantify pain drawings could be useful, especially when large numbers of drawings need to be assessed. Whilst informal visual assessment of pain drawings can give clinicians a quick impression of the extent of pain and its location, formal quantification of pain drawings by computer for research purposes is not necessarily trivial. The current study compared seven different approaches to quantification in a large sample of clinical spinal pain drawings.MethodsA large number (n = 55,720) of pain drawings were extracted from the SpineData database, a clinical registry of spinal pain patients in the Region of Southern Denmark. Drawings were analyzed both as pixel (raster) and vector based images, with different approaches based on the raw pain drawing, simple encircling polygons, convex-hull encircling polygons and discrete anatomical regions. Data were analyzed using principal component analysis, correlation and linear regression, as well as informal visual inspection of outlier pain drawings.ResultsEighty-one percent of the variance could be explained by the first principal component, which we interpreted as the true score variance, i.e. the variance attributable to differences in pain area between individuals. The second principal component explained 10% of the variance and was loaded differentially by polygon-based methods and non-polygon-based methods. Correlations between the different approaches ranged from 0.66 to 1.00. Some approaches correlated so strongly as to be interchangeable, others tended to bias area estimates significantly. Visual inspection of outlier pain drawing indicated that when the different approaches to quantification yielded different results, characteristic patterns could be identified in the style and patterns of those pain drawings.ConclusionsThe different approaches reflected the same underlying construct (pain area), but could not be relied upon to produce the same area estimates and were affected by the interaction between drawing style and quantification approach. To some extend, the “correct” choice of quantification method is specific to and dictated by the style of each pain drawing. A differentiated approach is required in which the results of quantification and the drawing style are considered in combination. We provide suggestions for such differentiated approaches taking into account the nature of the drawing data (raster vs. vector) and the method of analysis (partly vs completely automated).ImplicationsThe chosen method of quantifying pain drawings in combination with the drawing style of the individual patient, can impact the resulting area estimate to a significant degree. These issues should be considered before undertaking computerized area estimation of pain drawings.

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Sex Differences in Pain Indices, Exercise, and Use of Analgesics

Psychological Reports ◽

10.2466/pr0.2000.86.1.129 ◽

2000 ◽

Vol 86 (1) ◽

pp. 129-133 ◽

Cited By ~ 13

Author(s):

Amos Zeichner ◽

Michael Loftin ◽

Georgia Panopoulos ◽

Sabina Widner ◽

Joseph Allen

Keyword(s):

Physical Activity ◽

Sex Differences ◽

Acute Pain ◽

Cold Pressor ◽

Cold Pressor Task ◽

Frequent Use ◽

Subjective Pain ◽

Pain Frequency ◽

Pain Symptoms ◽

Daily Pain

To understand better reported sex differences in sensitivity to pain, this study examined daily pain frequency and intensity, use of analgesics, physical activity, and both subjective and physiological response to acute pain in 18 men and 24 women, healthy people who provided information about their daily pain symptoms and physical activity before completing a cold pressor task. Compared to men, women reported more frequent and intense pain symptoms, as well as more frequent use of analgesics and lower physical activity. Women evinced higher physiological arousal during the cold pressor task but similar subjective pain. The findings highlight the different ways men and women cope with pain and the effect on their responses to acute pain.

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Mobile Health Usage, Preferences, Barriers, and eHealth Literacy in Rheumatology: Patient Survey Study (Preprint)

10.2196/preprints.19661 ◽

2020 ◽

Cited By ~ 1

Author(s):

Johannes Knitza ◽

David Simon ◽

Antonia Lambrecht ◽

Christina Raab ◽

Koray Tascilar ◽

...

Keyword(s):

Chronic Diseases ◽

Rheumatic Diseases ◽

Mobile Health ◽

Mobile Apps ◽

Data Entry ◽

Mobile App ◽

Survey Study ◽

Full Potential ◽

Ehealth Literacy ◽

Medical Apps

BACKGROUND Mobile health (mHealth) defines the support and practice of health care using mobile devices and promises to improve the current treatment situation of patients with chronic diseases. Little is known about mHealth usage and digital preferences of patients with chronic rheumatic diseases. OBJECTIVE The aim of the study was to explore mHealth usage, preferences, barriers, and eHealth literacy reported by German patients with rheumatic diseases. METHODS Between December 2018 and January 2019, patients (recruited consecutively) with rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis were asked to complete a paper-based survey. The survey included questions on sociodemographics, health characteristics, mHealth usage, eHealth literacy using eHealth Literacy Scale (eHEALS), and communication and information preferences. RESULTS Of the patients (N=193) who completed the survey, 176 patients (91.2%) regularly used a smartphone, and 89 patients (46.1%) regularly used social media. Patients (132/193, 68.4%) believed that using medical apps could be beneficial for their own health. Out of 193 patients, only 8 (4.1%) were currently using medical apps, and only 22 patients (11.4%) stated that they knew useful rheumatology websites/mobile apps. Nearly all patients (188/193, 97.4%) would agree to share their mobile app data for research purposes. Out of 193 patients, 129 (66.8%) would regularly enter data using an app, and 146 patients (75.6%) would welcome official mobile app recommendations from the national rheumatology society. The preferred duration for data entry was not more than 15 minutes (110/193, 57.0%), and the preferred frequency was weekly (59/193, 30.6%). Medication information was the most desired app feature (150/193, 77.7%). Internet was the most frequently utilized source of information (144/193, 74.6%). The mean eHealth literacy was low (26.3/40) and was positively correlated with younger age, app use, belief in benefit of using medical apps, and current internet use to obtain health information. CONCLUSIONS Patients with rheumatic diseases are very eager to use mHealth technologies to better understand their chronic diseases. This open-mindedness is counterbalanced by low mHealth usage and competency. Personalized mHealth solutions and clear implementation recommendations are needed to realize the full potential of mHealth in rheumatology.

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Use of digital tools by PHC professionals as instrument for health decision-making

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.068 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

R B David ◽

V A Oliveira ◽

L G Mota ◽

D F Botelho ◽

M Barral-Netto

Keyword(s):

Health Care ◽

Decision Making ◽

Digital Health ◽

Digital Tools ◽

Full Potential ◽

Health Work ◽

Health Issues ◽

Work Process ◽

Critical View ◽

Daily Work

Abstract Background Investments have been made in precision public health strategies, as a way to better assess needs and evaluate the health services. Experiences point out that the computerization of health systems reduces costs and improves the quality of information. Primary Health Care (PHC) workers are key elements of this transformation, which can be enhanced with the use of digital health strategies. This paper aims to know the perception of the use of digital tools provided by the Ministry of Health by PHC workers in municipalities in the state of Ceará/Brazil. Methods Focus groups and field monitoring were carried out with different professional profiles. The inclusion criterion was the use of digital tools in their daily work. Questionnaires were built to conduct semi-structured interviews. The analyzes were made using content analysis method. Results Among the 21 participants (32-49 years old, mostly female),3 reported not having digital knowledge prior to the use of digital tools in their daily work. Mostly associated the use of digital tools with greater agility and ease in the work routine and greater accuracy of information. The challenges were mainly related to the use of the equipment(tablet),such as fear of breakage, theft and problems in the synchronization of the information system. There was a consensus that the data collected are useful, however they are underutilized for the work process in PHC. Conclusions The use of digital tools in the health work process is able to foster the critical view of professionals for analysis and decision making, pointing out strategies to face health issues in the territories. Pointed out as a facilitator in daily work, the use of digital tools does not exclude the use of paper sheets. Despite the greater supply of data, these are not used to their full potential, mainly due to insufficient time, given the numerous tasks for professionals. Key messages Carefully planned, developed and deployed digital interventions are powerful tools to improve health care system performance. The use of digital tools in the health work process is able to foster the critical view for analysis and decision making, pointing out strategies to face health issues in the territories.

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Public-private partnerships and collaboration in digital health: a scoping review and case study analysis of applications during the COVID-19 pandemic (Preprint)

10.2196/preprints.36046 ◽

2021 ◽

Author(s):

Nishali Kirit Patel ◽

Elinor Wahal ◽

Adriana Mancilla Galindo ◽

Alejandra Rodarte ◽

Tim Jesudason ◽

...

Keyword(s):

Public Health ◽

Case Studies ◽

Literature Search ◽

Digital Health ◽

Grey Literature ◽

Public Private Partnerships ◽

Search Results ◽

Stage Process

BACKGROUND The emergence of digital technologies over the past decade has presented a novel opportunity to address healthcare challenges associated with COVID-19 and accelerate progress towards achieving the health-related goals under the 2030 Sustainable Development Agenda. Public-private partnerships (PPPs) have played a vital role in scaling up digital health solutions and disseminating curated scientific information in the face of the infodemic. However, several challenges remain around the effectiveness of PPP-related digital solutions and antagonistic viewpoints of engaging the private sector. We sought to evaluate the role of public-private partnerships in the digital public health space during COVID-19 and identify key lessons learned and challenges in the uptake of digital health solutions globally. OBJECTIVE Electronic and grey literature search results from PubMed, Google, and Google Scholar were screened by one reviewer through a two-stage process. We included all relevant systematic reviews, interventional, observational, and descriptive studies published in English published from January 2020 to June 2021. Two case study analyses on digital health chatbots, informed by expert opinion, were also performed to assess for the role of public-private partnerships in advancing digital public health solutions. METHODS Electronic and grey literature search results from PubMed, Google, and Google Scholar were screened by one reviewer through a two-stage process. We included all relevant systematic reviews, interventional, observational, and descriptive studies published in English published from January 2020 to June 2021. Two case study analyses on digital health chatbots, informed by expert opinion, were also performed to assess for the role of public-private partnerships in advancing digital public health solutions. RESULTS Forty-five articles met the inclusion criteria for qualitative analysis, the majority of which were secondary research. Results of the publications can be broadly categorized into three groups: (1) models and definitions of public-private partnerships used in the healthcare space; (2) purposes of and motivations of public-private partnerships in global public health; and (3) and facilitators, barriers, and challenges to date. CONCLUSIONS The literature review as well as the case studies analysis reveal that PPPs can represent a valid option for tackling global healthcare issues with a digital health approach. Further research is needed to complement the initial findings of the present paper, as well as to assess a wider pool of case studies and the different features that they might present.

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A Long Way to Go: Patient Perspectives on Digital Health for Parkinson’s Disease

Journal of Parkinson s Disease ◽

10.3233/jpd-202408 ◽

2021 ◽

pp. 1-6

Author(s):

Sara Riggare ◽

Jon Stamford ◽

Maria Hägglund

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Digital Health ◽

Digital Technologies ◽

Full Potential ◽

Health And Wellness ◽

Individual Level ◽

Active Involvement ◽

The Right ◽

Personalised Feedback

Digital health promises to improve healthcare, health, and wellness through the use of digital technologies. The purpose of this commentary is to review and discuss the field of digital health for Parkinson’s disease (PD) focusing on the needs, expectations, and wishes of people with PD (PwP). Our analysis show that PwP want to use digital technologies to actively manage the full complexity of living with PD on an individual level, including the unpredictability and variability of the condition. Current digital health projects focusing on PD, however, does not live up to the expectations of PwP. We conclude that for digital health to reach its full potential, the right of PwP to access their own data needs to be recognised, PwP should routinely receive personalised feedback based on their data, and active involvement of PwP as an equal partner in digital health development needs to be the norm.

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Present Status and Future Prospects of Cold Spraying

Materials Science Forum ◽

10.4028/www.scientific.net/msf.534-536.433 ◽

2007 ◽

Vol 534-536 ◽

pp. 433-436 ◽

Cited By ~ 6

Author(s):

Frank Gaertner ◽

Tobias Schmidt ◽

Heinrich Kreye

Keyword(s):

New Technology ◽

Thermal Spraying ◽

Cold Spraying ◽

Spray Forming ◽

Full Potential ◽

Spray Parameters ◽

Present Contribution ◽

High Kinetic Energy ◽

Coating Formation ◽

New Applications

Cold spraying is a fairly new coating technique, which within the last decade attracted serious attention of research groups and spray companies. As compared to thermal spraying, the low process temperatures in cold spraying result in unique coating properties, which promise new applications. Since particles impact with high kinetic energy in the solid state, new concepts to describe coating formation are requested to enable the full potential of this new technology. The present contribution gives a brief review of current models concerning bonding, supplying a description of the most influential spray parameters and consequences for new developments. With respect to spray forming by cold cold spraying, microstructures and thick, further machineable structures are presented.

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Addressing the Selectivity of Enzyme Biosensors: Solutions and Perspectives

Sensors ◽

10.3390/s21093038 ◽

2021 ◽

Vol 21 (9) ◽

pp. 3038

Author(s):

Bogdan Bucur ◽

Cristina Purcarea ◽

Silvana Andreescu ◽

Alina Vasilescu

Keyword(s):

Sensor Arrays ◽

Data Interpretation ◽

Full Potential ◽

Enzymatic Reactions ◽

Practical Application ◽

The Status ◽

The Subject ◽

Enzymatic Biosensors ◽

New Applications ◽

Traditional Approaches

Enzymatic biosensors enjoy commercial success and are the subject of continued research efforts to widen their range of practical application. For these biosensors to reach their full potential, their selectivity challenges need to be addressed by comprehensive, solid approaches. This review discusses the status of enzymatic biosensors in achieving accurate and selective measurements via direct biocatalytic and inhibition-based detection, with a focus on electrochemical enzyme biosensors. Examples of practical solutions for tackling the activity and selectivity problems and preventing interferences from co-existing electroactive compounds in the samples are provided such as the use of permselective membranes, sentinel sensors and coupled multi-enzyme systems. The effect of activators, inhibitors or enzymatic substrates are also addressed by coupled enzymatic reactions and multi-sensor arrays combined with data interpretation via chemometrics. In addition to these more traditional approaches, the review discusses some ingenious recent approaches, detailing also on possible solutions involving the use of nanomaterials to ensuring the biosensors’ selectivity. Overall, the examples presented illustrate the various tools available when developing enzyme biosensors for new applications and stress the necessity to more comprehensively investigate their selectivity and validate the biosensors versus standard analytical methods.

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Effectiveness of Splanchnic Nerve Neurolysis for Targeting Location of Cancer Pain: Using the Pain Drawing as an Outcome Variable

January 2018 - Pain Physician ◽

10.36076/ppj/2016.19.397 ◽

2016 ◽

Vol 6;19 (6;7) ◽

pp. 397-403

Author(s):

Diane Novy

Keyword(s):

Cancer Pain ◽

Pain Intensity ◽

Grid Method ◽

Splanchnic Nerve ◽

Effect Sizes ◽

Outcome Variable ◽

Size Difference ◽

Pain Drawing ◽

Intensity Rating ◽

Effect Size Difference

The effectiveness of splanchnic nerve neurolysis (SNN) for cancer-related abdominal pain has been investigated using numeric pain intensity rating as an outcome variable. The outcome variable in this study used the grid method for obtaining a targeted pain drawing score on 60 patients with pain from pancreatic or gastro-intestinal primary cancers or metastatic disease to the abdominal region. Results demonstrate excellent inter-rater agreement (intra-class correlation [ICC] coefficient at pre-SNN = 0.97 and ICC at within one month post-SNN = 0.98) for the grid method of scoring the pain drawing and demonstrate psychometric generalizability among patients with cancerrelated pain. Using the Wilcoxon signed rank test and associated effect sizes, results show significant improvement in dispersion of pain following SNN. Effect sizes for the difference in pre-SNN to 2 post-SNN time points were higher for the pain drawing than for pain intensity rating. Specifically, the effect size difference from pre- to within one month post-SNN was r = 0.42 for pain drawing versus r = 0.23 for pain intensity rating. Based on a smaller subset of patients who were seen within 1 – 6 months following SNN, the effect size difference from pre-SNN was r = 0.46 for pain drawing versus r = 0.00 for pain intensity rating. Collectively, these data support the use of the pain drawing as a reliable outcome measure among patients with cancer pain for procedures such as SNN that target specific location and dispersion of pain. Key words: Cancer pain, pain drawing, splanchnic block

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Health System Stakeholders’ Perspective on the Role of Mobile Health and Its Adoption in the Swiss Health System: Qualitative Study (Preprint)

10.2196/preprints.17315 ◽

2019 ◽

Author(s):

Myriam Lingg ◽

Verena Lütschg

Keyword(s):

Health Care ◽

Health System ◽

Mobile Health ◽

Care Delivery ◽

Digital Health ◽

Full Potential ◽

Semistructured Interview ◽

Swiss Health ◽

Recommendations For Action

BACKGROUND Digital health solutions have great potential to change the way health care is delivered, including better clinical outcomes and improved processes and access to health services. However, the adoption of mobile health (mHealth) solutions for patient monitoring has been rather slow in Switzerland. The reasons are complex, and a better understanding is needed to leverage the full potential of mHealth. OBJECTIVE This study aimed to deepen the understanding of the potential relevance and influence of mHealth for the health system and health care provision, and factors influencing its adoption. The findings will be used to provide an outlook on feasible recommendations for action. METHODS We conducted a qualitative survey using a maximum variation sample of a heterogeneous group of stakeholders (N=50) in the Swiss health care system with a profound knowledge of digital health and medical devices. A semistructured interview guide including open- and closed-ended questions was used to address questions around mHealth relevance and its influence on the health system, the relevance of selected determinants for mHealth adoption, and important influencing factors. A content analysis method was applied. RESULTS Overall, respondents thought that mHealth would have a beneficial impact on the Swiss health system but that its adoption would evolve slowly. We derived 23 key opportunities regarding patient and patient pathway, treatment of disease, and diseases and health conditions. High consistency in answers among respondents was observed for treatment of disease. Stakeholders’ attitudes toward mHealth adoption along the relevance of 23 preselected determinants were relatively consistent. However, we obtained diverging attitudes regarding the influence of trends, enablers, and restraints in Switzerland and translated them into 26 key themes influencing mHealth adoption. Relevant trends comprise changing needs and expectations of patients, a rising need for efficient health care delivery, growing interest in improved outpatient care, and emerging technologies and progressing digitization. Important enablers include growing demand for new financing schemes and incentive concepts, rising demand for comprehensive information on and stronger body of evidence for mHealth use cases, and increasing need for easy to use alternate care approaches. Challenging restraints are rigidness of thinking and siloed actions of health system actors, complexity of changing the existing regulations and structures, little understanding of mHealth use and the role of clinicians, and risk of further polarization of the population. CONCLUSIONS This study provides a comprehensive look at mHealth in the Swiss health system. It becomes apparent that strong governance is inevitable to foster a sustainable data strategy and to reconcile the different interests of stakeholders. The use of mHealth will add value but will not necessarily reduce the burden on the system caused by emerging societal needs and changing disease prevalence.

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