Wearable Devices: Usable or useless information?

This article is part of the 2018 NMJ Oncology Special Issue. Download the full edition.

reference

PEAKE JM, Kerr G, Sullivan JP. A critical review of consumer wearables, mobile applications and devices to provide biofeedback, monitoring stress and sleep in physically active population groups. front physiol . 2018; 9: 743.

objective

to summarize the characteristics of portable health technologies and to evaluate their suitability for consumer use by evaluating whether the data was validated, reliable and for consumers what the manufacturers claim.

draft

Checking the portable health technology devices available in stores. The researchers identified devices for admission to the review by using the Internet and databases with scientific literature (e.g. PubMed) using key terms such as "technology", "hydration", "welding analysis", "heart frequency", "biofeedback", "breathing", "muscle oxenization", "sleep", "cognitive function" and "Skin of the brain".

study parameters evaluated

The researchers examined the websites of commercial technologies on links to research results and, if necessary, related to published research literature. Then they divided technologies into the following categories:

• devices for monitoring hydration status and metabolism
• devices, clothing and mobile applications for monitoring physical and psychological stress
• portable devices that offer physical biofeedback (e.g. muscle stimulation, haptic feedback)
• devices that offer cognitive feedback and training
• devices and applications for sleep monitoring and funding
• devices and applications for evaluating brain conceals

primary result measurements

The investigators assessed the available information based on 4 measurements:

1. What is the technology?
2. was the technology validated independently based on recognized standards?
3. Is the technology reliable and is a calibration required?
4. Is the technology commercially available or still in development?

important knowledge

The researchers identified and evaluated 89 devices; Some were available in stores and others were not. They found that the vast majority (82/89) had never been officially validated. Only 10 % were used in research environments.

Almost all devices (87/89) had no published reliability tests. The calibration of the devices fell in 1 of 3 categories: 1) not reported; 2) registered as "self -calibrating"; and 3) Manufacturers stated that no calibration was required.

In terms of sleep-tracking devices, of the 15 checked wearables, only 3 validation information (Up, Fitbit Charge2, Oura) had been subjected to a reliability test. The 1 device that had reliability data (Fitbit Flex) has not reported validation tests.

practice implications

This study was the first to evaluate various types of portable devices to determine whether the data generated by portable devices are valid and reliable.

The sortable devices industry grows by 15 % annually and will probably be worth $ 51.50 billion worldwide by 2020. Understanding the technology, especially with regard to the demands of a certain device, is essential for well -thought -out conversations with patients who are likely to use data from your device as "medical information" during visits to the clinic.

The vast majority of the devices assessed by the researchers failed in every respect. The manufacturers have not validated the data generated by the devices, most of them did not calibrate the data to ensure the consistency of the data readings over time, and they have also not carried out or disclosed reliability tests on how reference limit values ​​were created. Unless otherwise confirmed, doctors should not assume that the data generated by portable devices are correct.

For example, the 2 devices were compared with validation data (UP and FITBIT Flex) with the gold standard for sleep studies, a polysomnography. Each device correlated with the total sleep time and time in bed, but they did not correlate with deep sleep, light sleep or sleep efficiency.

Despite the current restrictions on accuracy, there is a potential advantage of the portable technology in the fact that it can create a way to sharpen the awareness of the patient for certain health problems. For example, a sleeping tracker could offer a starting point for a helpful conversation about sleep and its improvement. With this conversation, the doctor can better assess the sleep quality and quantity. This can lead to talks about how sleep can be improved, or contribute to determining whether a more formal sleep study is justified.

The silver stripe on the horizon, however, is that these devices can offer opportunities to promote healthier living behavior and at the same time to verify potential health problems through stricter and validated test methods.

A systematic review and meta -analysis from 2018, published in American journal for health promotion , evaluated the effectiveness of portable devices to improve physical activity in patients with diagnosed cardiometabolic illness. Activity [MVPA] The activities such as jogging, lane swimming, tennis or racquetball, cycling, aerobics and dancing can include.

35 studies with 4,528 volunteers met the inclusion criteria. The pooled data showed a significant increase in physical activity and the MVPA for volunteers, which used portable devices. ^{4 This study supports the idea that portable devices can promote physical activity by making their activity more aware of the patient.}

Similarly, portable devices that monitor other health parameters such as stress and emotions, heart rate and blood oxygen content can offer an opportunity to focus further clinical reviews on the concerns of the patients and to help them either validate or refute the data of the respective device.

While the current study showed that manufacturers are not launching validated products on the market, researchers carry out post-market studies to test the accuracy and reproducibility of certain devices. A study by Nelson and all in 2019 evaluated the heart frequency accuracy of Apple Watch 3 and Fitbit Charge 2 and compared the data they generated with an outpatient EKG (VRIJE University Ambulatory Monitoring System). ^{5 The authors came to the conclusion: " Activity an acceptable heart rate accuracy (<± 10 %), with the exception of the Apple Watch 3 during the daily activities. ” 5}

The reservation of Nelsons and Allen's review is that devices may only perform well under certain conditions. However, it may not be possible to know these restrictions from the manufacturer's literature solely. This brings doctors into a difficult situation. Without revealing the restrictions on your devices, it is not possible to know which specific terms of use are more or less precisely.

The silver stripe on the horizon, however, is that these devices can offer opportunities to promote healthier living behavior and at the same time to verify potential health problems through stricter and validated test methods.