Author: Pia Kreutzer
One of the still ongoing paradigm shifts in current medicine is the one towards ever-more empowered patients and a more patient-centric provision of health care. At the same time, chronic diseases play a continuously more important role and population health management steadily gains significance in order to relieve overstrained health care systems. Customers and patients are therefore seeking to exert more power over their own health and have responded to social pull marketing strategies, especially in the case of wearable fitness devices like smartwatches and wristbands. But wearables also include regulated medical devices, such as insulin pumps, blood pressure monitoring devices, chemical, and inertial measurement sensors and many more. Wearables are a heterogeneous group of devices that can be differentiated by the types of stimuli they respond to (e.g. physiological vital signs, organic substances, or body movements) as well as where they are worn (e.g. like wristbands, watches, or jewelry, they can be woven into garments and worn as clothing, they can be electronic stamps (tattoos) on the body, etc.) (Yetisen et al. 2018; Appelboom et al. 2014). But what can wearables be used for? And why are they important?
What can they be used for?
The fields of application of wearables are numerous. While many are familiar with commercial wearable applications that enable the tracking of fitness progress, there are also solutions for diagnostic and treatment purposes. The possibility to evaluate disease progression (e.g. for Parkinson’s disease diagnosis and as well as evolution), patients’ responses to pharmaceutical therapies, or recovery after surgical intervention are among the fields of application. The continuous logging of real-time data can prove especially useful for both chronic (where the course during daily activities might be especially interesting) as well as acute conditions. The severity of depression may be assessed, for example, through factors such as physical activity, duration of sleep, or conversation timelines. By including electronic self-reporting, feedback, and similar tools, medical conditions such as post-traumatic stress disorder, anxiety, panic disorder, obesity, and asthma can be better monitored to name only a few possible applications (Yetisen et al. 2018; Chan et al. 2012). An example of how a wearable might prove life-saving in case of an acute event is a system that is able to send an ambulance if it detects a stroke. In such cases, every minute might count to determine the patient’s outcome (Chan et al. 2012).
What are their benefits…?
Wearables can provide crucial benefits in multiple stages of a patient’s journey. The accurate prediction of disease onset and course in individual patients presents one of the obstacles towards more personalized medicine. Data generated from wearables may be a step in the right direction, not only at a population health level but also at the individual patient’s level. Oftentimes diseases only receive medical attention once symptoms have been developed, but in the case of some wearables, information can be obtained in pre-diagnosis and pre-symptomatic stages of a disease which in turn may lead to preventive and therapeutic interventions with significant positive clinical impact (Tyler et al. 2020). For example, if ‘pre-diabetes’ is detected and treated, the progression to diabetes with its end-organ complications may be prevented altogether. The same holds true for precancerous conditions, and similarly, improved patient outcomes are expected for other events such as drug toxicities, infections, blood clots, etc (Tyler et al. 2020).
One of the vital advantages of wearables lies in the provision of real-time data, which, like has been stated before, is beneficial for both chronic, as well as acute conditions. The evolution of a disease can be monitored more clearly and ‘tipping points’ where patients’ physiological factors transition from the ‘background noise’ of a pre-disease state to the disease-state can be observed. Interventions performed in these transition states may result in better health outcomes (Tyler et al. 2020).
Furthermore, wearables devices are practical since they typically require little attention from the subject and/ or the physician. They can be used in inpatient or remote settings, thereby allowing for non-invasive and continuous monitoring, where subjects can often still enjoy the comfort of their own homes (Tyler et al. 2020). This in turn is appreciated by many patients such as elderly people or patients in rehabilitation, where these remote settings are associated with a greater degree of independence and quality of life. In general, it also aids in making healthcare more accessible which is still a barrier in some areas. Quite connected to these points, wearables might also play a substantial role in lowering healthcare costs, e.g. by reducing the length of stay in hospitals or preventing admissions in hospitals, nursing homes, or other institutions (Chan et al. 2012).
Many wearable technologies, not only unregulated (i.e. commercial) ones, apply the concept of gamification by creating virtual challenges as well as rewards to improve for example physical activity or other lifestyle factors. However, these benefits do not stop at the pre-clinical stage: If wearables’ data and their application is integrated into the clinical stage of a patient’s journey, a more complete picture of a patient’s condition can be obtained and hence, potentially better treatment options can be made available. This is one more step towards patients’ active participation in their own healthcare. Well-informed patients are more likely to actively contribute and make healthy behavioral changes which bring about improved quality of life and patient outcomes (Appelboom et al. 2014). Another benefit is that oftentimes, through the application of wearables, subjective questionnaires can be replaced, and quantitative clinical data can be obtained (Yetisen et al. 2018; Tyler et al. 2020).
…and potential drawbacks and barriers?
Potential barriers to the more widespread implementation of wearables are concerns regarding data privacy and security due to the sensitive nature of medical information of patients. These are also among the factors that will be required in order to achieve acceptance among people, as well as the system’s affordability, easy and intuitive use as well as compatibility and interoperability among the diverse platforms. While technology that renders people independent (at least for a longer period of time) tends to be received with positive attitudes, other factors will also influence acceptance rates (Chan et al. 2012). Some of these are connected to the system’s hard- and software, where the weight and size of the wearable, its comfortability (e.g. through flexible components) its power consumption, potential skin reactions to it, sources of error (movement or environmental circumstances like temperature, humidity, light, etc.) will have to be considered as well as the system’s frequency of calibration and maintenance and their effect on safety and performance (Chan et al. 2012; Majumder et al. 2017). Naturally, costs, connectivity, ethics, legal constraints, freedom, autonomy, reliability, perception of usefulness, and service issues are also among the obstacles that need to be overcome (Kluge 2011; Chan et al. 2012; Rheingans et al. 2016).
What the Future Holds
The wearables market will undoubtedly experience steady growth in the upcoming decades, and likewise, the amount of scientific evidence regarding their real impact will grow. Nevertheless, the increased usage of wearable devices will not only aid in prevention, diagnosis, and diagnostics, as well as therapy of diseases, but will also enable the availability of continuous data to monitor conditions and their progression, responses to pharmaceutical therapies, and assess clinical trial efficacy. (Yetisen et al. 2018)
This upward trend will be further augmented by technical advances, such as 5G communication, low-power microelectromechanical as well as biochemical systems, and the improvement in garments in which electronics are integrated. Moreover, it will likely also have a lasting impact on the way insurers, health care providers, and other companies in the industry work (Phaneuf 2020). In order for wearables and more telehealth solutions to become truly integrated into our healthcare systems potentially updated regulations and the compliance of such products is of paramount importance, as well as technology that ensures data privacy and security, robust data compression algorithms, reliable communication links, and energy efficiency (Majumder et al. 2017).
Conclusions
Real-time multiparameter measurement will be one of the drivers of dynamic forecasting with improvements in early detection and rapid intervention. Wearables will represent one step in the path to get there. The time is ripe for these developments as technological advances and interdisciplinary approaches (physicians, clinical researchers, biologists, data scientists, engineers, etc.) facilitate their implementation. By understanding better the dynamic nature of disease onset and evolution, personalized real-time medicine as well as more accurate prognoses are yet one step closer. The application of wearables allows for patients to lead their independent and active lives while ensuring mostly non-invasive, non-intrusive, and continuous monitoring typically from the comfort of the patient’s home and often associated with lower health care costs. However, in order to truly take advantage of them, wearables need to be incorporated in the routine care of patients and the healthcare industry, thereby providing more patient-centric provision of health care, increasing patient autonomy and changing their behavior, making healthcare more accessible and revolutionizing health care management and spending (Tyler et al. 2020; Appelboom et al. 2014; Majumder et al. 2017).
References
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