JMIR Publications

ABSTRACT

Background:

Chronic disease contributes to high rates of disability and death. Patient engagement in chronic disease self-management is an essential component of chronic disease models of healthcare. Wearables provide patient-centred health data in real-time that can help inform self-management decision-making. Despite the perceived benefits of wearables to improve chronic disease self-management, their influence on healthcare outcomes remains poorly understood.

Objective:

To examine the influence of wearables on healthcare outcomes in people with chronic disease through systematic review of the literature

Methods:

A narrative systematic review was conducted by searching six databases for randomised and observational studies published between January 1st 2016 – July 1st 2021 that included the use of a wearable intervention in a chronic disease group to assess impact on a predefined outcome measure. These outcomes were defined as any influence on the patient or clinician experience, cost-effectiveness, or healthcare outcome as a result of the wearable intervention. Data from included studies were extracted from six key extraction themes, from which a narrative qualitative synthesis was performed. All outcomes were mapped against each component of the Quadruple Aim of Healthcare. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were followed.

Results:

A total of 31 articles were included. Studies reported a total of 2,512 participants with a mean age range of 10.1 to 74.4 years, in which the influence of 15 types of wearables on 19 chronic diseases were presented. The most studied chronic diseases were Type 2 diabetes (n = 4), Parkinson’s disease (n = 3) and chronic lower back pain (n = 3). Results were mixed when assessing the impact on a predefined primary outcome, with 16 studies finding a positive influence on the studied outcome and 15 demonstrating nil effect. There was a positive effect of 3D virtual reality systems on chronic pain in two studies evaluating two distinct chronic pain syndromes. Mixed results were observed in influencing exercise capacity, weight and biomarkers of disease such as HbA1c in diabetes. In total, 164 outcomes were studied. The majority (n = 147; 89.6%) addressed the “healthcare outcomes” component, which included pain (n = 11; 7.5%), quality of life (n = 7; 4.8%) and physical function (n = 5; 3.4%). Thirteen (7.9%) outcome measures represented the “patient experience” component, with two (1.2%) addressing the “clinician experience” and “cost” respectively.

Conclusions:

Given their popularity and capabilities, wearables may play an integral role in chronic disease management. However, further research is required to generate a strong evidence base behind their safe, effective implementation. Clinical Trial: The protocol for this review was registered in the International Prospective Register for Systematic Reviews (PROSPERO) on April 22nd 2021 - CRD42021244562.