Evaluating the accuracy and utility of wearable technology to continuously monitor patients in a hospital setting: a systematic review (Preprint)

BACKGROUND The term ‘post-hospital syndrome’ has been used to describe the condition in which elderly patients are transiently frail after hospitalization and have a high chance of readmission. Since low activity and poor sleep contribute to ‘post-hospital syndrome’, continuous inpatient monitoring of these important parameters using affordable wearables may help and reduce this syndrome. While there have been systematic reviews of wearables for physical activity monitoring in the hospital setting, there is limited data on use of wearables measuring other parameters in hospitalized patients. OBJECTIVE This systematic review aimed to evaluate the utility and accuracy of wearable devices in their ability to monitor inpatients. METHODS This review incorporated a comprehensive search of seven databases and included articles which met the following inclusion criteria: inpatients above age 18, device studied in the articles had to be wearable technology and have at least one sensor, articles had to describe an element of continuous monitoring (greater than 24 hours) and monitoring had to include more than just physical activity. There were no restrictions on publication period, but only English language studies were included. From each study we extracted basic demographic information along with characteristics of the intervention. RESULTS From 2,012 articles that were screened, 15 articles met the selection criteria. All articles included were observational in design. Nine different commercial wearables, with various body locations, were examined in this review. The devices collectively measured 7 different health parameters across all studies. Only 6 studies validated their results against a reference device or standard. Of those that did validate results, many found that certain variables were inaccurate with wide limits of agreement. Heart rate and sleep had the most evidence for being valid in the hospital. Overall, wearable devices were found to be a feasible alternative for inpatient monitoring as 13 of the 15 studies had a mean participation completion rate greater than 80%. CONCLUSIONS Overall, assessment of studies in this review suggested that wearable devices showed promise in monitoring the heart rate and sleep of patients in hospital. The results demonstrate that many devices have not been validated in the inpatient setting, and amongst those that do, some wearable measurements were not found to be valid. Further research is needed to validate the wearable health variables in hospitalized patients and eventually determine whether these devices improve health outcomes.