Queensland Digital Health Research Network, Global Change Institute, The University of Queensland, Brisbane, Australia.
Metro North Hospitals and Health Service, Brisbane, Australia.
J Med Internet Res. 2022 Jul 1;24(7):e36690. doi: 10.2196/36690.
Chronic diseases contribute to high rates of disability and mortality. Patient engagement in chronic disease self-management is an essential component of chronic disease models of health care. Wearables provide patient-centered health data in real time, which can help inform self-management decision-making. Despite the perceived benefits of wearables in improving chronic disease self-management, their influence on health care outcomes remains poorly understood.
This review aimed to examine the influence of wearables on health care outcomes in individuals with chronic diseases through a systematic review of the literature.
A narrative systematic review was conducted by searching 6 databases for randomized and observational studies published between January 1, 2016, and July 1, 2021, that included the use of a wearable intervention in a chronic disease group to assess its impact on a predefined outcome measure. These outcomes were defined as any influence on the patient or clinician experience, cost-effectiveness, or health care outcomes as a result of the wearable intervention. Data from the included studies were extracted based on 6 key themes, which formed the basis for a narrative qualitative synthesis. All outcomes were mapped against each component of the Quadruple Aim of health care. The guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement were followed in this study.
A total of 30 articles were included; studies reported 2446 participants (mean age: range 10.1-74.4 years), and the influence of 14 types of wearables on 18 chronic diseases was presented. The most studied chronic diseases were type 2 diabetes (4/30, 13%), Parkinson disease (3/30, 10%), and chronic lower back pain (3/30, 10%). The results were mixed when assessing the impact on a predefined primary outcome, with 50% (15/30) of studies finding a positive influence on the studied outcome and 50% (15/30) demonstrating a nil effect. There was a positive effect of 3D virtual reality systems on chronic pain in 7% (2/30) of studies that evaluated 2 distinct chronic pain syndromes. Mixed results were observed in influencing exercise capacity; weight; and biomarkers of disease, such as hemoglobin A, in diabetes. In total, 155 outcomes were studied. Most (139/155, 89.7%) addressed the health care outcomes component. This included pain (11/155, 7.5%), quality of life (7/155, 4.8%), and physical function (5/155, 3.4%). Approximately 7.7% (12/155) of outcome measures represented the patient experience component, with 1.3% (2/155) addressing the clinician experience and cost.
Given their popularity and capability, wearables may play an integral role in chronic disease management. However, further research is required to generate a strong evidence base for safe and effective implementation.
PROSPERO International Prospective Register of Systematic Reviews CRD42021244562; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=244562.
慢性病导致高残疾率和死亡率。患者参与慢性病自我管理是慢性病医疗模式的重要组成部分。可穿戴设备实时提供以患者为中心的健康数据，有助于指导自我管理决策。尽管可穿戴设备在改善慢性病自我管理方面具有明显的优势，但它们对医疗保健结果的影响仍知之甚少。
本综述旨在通过系统综述文献，考察可穿戴设备对慢性病患者医疗保健结果的影响。
对 6 个数据库进行了叙述性系统综述，以搜索 2016 年 1 月 1 日至 2021 年 7 月 1 日期间发表的随机和观察性研究，这些研究使用可穿戴设备干预来评估其对预定义结果测量的影响。这些结果被定义为可穿戴设备干预对患者或临床医生体验、成本效益或医疗保健结果的任何影响。根据 6 个关键主题提取纳入研究的数据，这些主题构成了叙述性定性综合的基础。所有结果都与医疗保健四重目标的每个组成部分相对应。本研究遵循系统评价和荟萃分析的首选报告项目（PRISMA）声明的指南。
共纳入 30 篇文章；研究报告了 2446 名参与者（平均年龄：范围 10.1-74.4 岁），并介绍了 14 种可穿戴设备对 18 种慢性病的影响。研究最多的慢性病是 2 型糖尿病（4/30，13%）、帕金森病（3/30，10%）和慢性腰痛（3/30，10%）。评估预定义主要结果的影响时，结果喜忧参半，50%（15/30）的研究发现对研究结果有积极影响，50%（15/30）显示无效果。有 3 项研究评估了 2 种不同的慢性疼痛综合征，发现 3D 虚拟现实系统对慢性疼痛有积极影响（7%[2/30]）。在影响运动能力、体重和疾病生物标志物（如血红蛋白 A）方面，观察到混合结果。共有 155 个结果进行了研究。大多数（139/155，89.7%）涉及医疗保健结果部分。这包括疼痛（11/155，7.5%）、生活质量（7/155，4.8%）和身体功能（5/155，3.4%）。约 7.7%（12/155）的测量结果代表患者体验部分，其中 1.3%（2/155）涉及临床医生体验和成本。
鉴于可穿戴设备的普及性和功能，它们可能在慢性病管理中发挥重要作用。然而，需要进一步的研究来为安全有效的实施提供坚实的证据基础。
PROSPERO 国际前瞻性系统评价注册中心 CRD42021244562；https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=244562。
