Evaluating the Validity and Utility of Wearable Technology for Continuously Monitoring Patients in a Hospital Setting: Systematic Review

Abstract

Background The term posthospital syndrome has been used to describe the condition in which older patients are transiently frail after hospitalization and have a high chance of readmission. Since low activity and poor sleep during hospital stay may contribute to posthospital syndrome, the continuous monitoring of such parameters by using affordable wearables may help to reduce the prevalence of this syndrome. Although there have been systematic reviews of wearables for physical activity monitoring in hospital settings, there are limited data on the use of wearables for measuring other health variables in hospitalized patients. Objective This systematic review aimed to evaluate the validity and utility of wearable devices for monitoring hospitalized patients. Methods This review involved a comprehensive search of 7 databases and included articles that met the following criteria: inpatients must be aged >18 years, the wearable devices studied in the articles must be used to continuously monitor patients, and wearables should monitor biomarkers other than solely physical activity (ie, heart rate, respiratory rate, blood pressure, etc). Only English-language studies were included. From each study, we extracted basic demographic information along with the characteristics of the intervention. We assessed the risk of bias for studies that validated their wearable readings by using a modification of the Consensus-Based Standards for the Selection of Health Status Measurement Instruments. Results Of the 2012 articles that were screened, 14 studies met the selection criteria. All included articles were observational in design. In total, 9 different commercial wearables for various body locations were examined in this review. The devices collectively measured 7 different health parameters across all studies (heart rate, sleep duration, respiratory rate, oxygen saturation, skin temperature, blood pressure, and fall risk). Only 6 studies validated their results against a reference device or standard. There was a considerable risk of bias in these studies due to the low number of patients in most of the studies (4/6, 67%). Many studies that validated their results found that certain variables were inaccurate and had wide limits of agreement. Heart rate and sleep were the parameters with the most evidence for being valid for in-hospital monitoring. Overall, the mean patient completion rate across all 14 studies was >90%. Conclusions The included studies suggested that wearable devices show promise for monitoring the heart rate and sleep of patients in hospitals. Many devices were not validated in inpatient settings, and the readings from most of the devices that were validated in such settings had wide limits of agreement when compared to gold standards. Even some medical-grade devices were found to perform poorly in inpatient settings. Further research is needed to determine the accuracy of hospitalized patients’ digital biomarker readings and eventually determine whether these wearable devices improve health outcomes.

Accuracy and Systematic Biases of Heart Rate Measurements by Consumer-Grade Fitness Trackers in Postoperative Patients: Prospective Clinical Trial

“…Studies on the use of fitness trackers in a perioperative setting or among patients with multiple pre-existing diseases are rare [ 12 ] and, according to systematic reviews, also hampered by a high risk of bias [ 13 ] and suffer from low quality [ 14 ]. In particular, it has been shown that motion artifacts influence the mean absolute error (MAE) of the measurements by up to 30% [ 15 ].…”

Daily Physical Activity and Sleep Measured by Wearable Activity Trackers during the Coronavirus Disease 2019 Pandemic: A Lesson for Preventing Physical Inactivity during Future Pandemics

“…Wearable devices that can comfortably be worn on the body and perform several tasks in conjunction with handheld devices, such as smartphones, play a pivotal role in healthcare [6]. Recent systematic reviews have shown that wearable devices are useful for monitoring heart rate and sleep in hospital settings [7], increasing physical activity in children and adolescents [8], improving health-related outcomes in patients with cancer [9], and reducing body weight in individuals with obesity [10]. In addition, during the COVID-19 pandemic, sleep pattern and duration were accurately and effectively monitored by wearable devices [11][12][13][14][15].…”

Assessing Pain Research: A Narrative Review of Emerging Pain Methods, Their Technosocial Implications, and Opportunities for Multidisciplinary Approaches

“…When implementing sensor-based measurements, choosing which devices to use or program is not trivial, as there are hundreds on the market. Moreover, many direct-to-consumer devices claim to accomplish similar things or perform similarly to SOTA devices without openly shared data or validation studies ( 271 – 273 ). Additionally, many devices come with their own out-of-the-box or off-the-shelf output metrics that are automatically computed for the user or consumer; care should be taken as to whether or not to take these metrics at face value (since many calculations are “black box” or proprietary and thus cannot be easily examined for noise, privacy, reliability, or accuracy) 16 ( 274 , 275 ).…”