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Background: The Virtual Rehabilitation Environment (VRE) provides patients oflong term neurological conditions with a platform to review their previousphysiotherapy sessions, as well as see their goals and any treatments orexercises that their clinician has set for them to practice before their nextsession.  Objective: The initial application implemented 21 of the 27 core featuresusing the Microsoft ASP.NET MVC stack. However, the two core, non-functionalrequirements were negated from the project due to lack of experience and stricttime constraints. This project aimed to investigate whether the applicationwould be more suited to a non-relational solution.  Method: The application was re-written using the MEAN stack (MongoDB,ExpressJS, AngularJS, NodeJS), an open source, fully JavaScript stack and thenperformance tests were carried out to compare the two applications. Ascalability review was also conducted to assess the benefits and drawbacks ofeach technology in this aspect.  Results: The investigation proved that the non-relational solution was muchmore efficient and performed faster. However, the choice of database was only asmall part of the increase in efficiency and it was an all-round better designthat gave the new application its performance upper hand.  Conclusion: A proposal for a new application design is given that follows themicroservice architecture used by companies such as Amazon and Netflix. Theapplication is to be split up into four parts; database, client application,server application and content delivery network. These four, independentlyscalable and manageable services offer the greatest flexibility for futuredevelopment at the low costs necessary for a start-up.

A comparison of the performance and scalability of relational and  document-based web-systems for large scale applications in a rehabilitation  context