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Remote Health Devices and the Future of Health Care

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Telemedicine offers many advantages that may have positive health outcomes for various chronic diseases,1,2 and innovative technology continues to enhance a patient’s experience with this at-a-distance clinical care. Wearable biometric and activity tracking technologies help to increase connectivity between patient and practitioner, engage patients in their therapeutic treatments, and provide clinicians a contextual understanding of each patient’s functioning. They may also hold promise for disease prevention by providing an individual increased accessibility to their personal health data.

Remote Health Monitoring

Research studies continue to suggest that remote health monitoring helps to increase the effectiveness of chronic disease home care and may reduce acute hospital use for patients. A 2021 systematic review of 91 studies that included a range of populations and disease conditions found that remote patient monitoring detected disease exacerbations, facilitated proactive disease management, and reduced hospital admissions, length of stay, and emergency department presentations, especially for patients with cardiovascular disease and COPD.3 Other systematic reviews published in 2021 suggest that telemonitoring strategies that feature automatic mobile transmission and real-time feedback help to enhance diabetes management,4 while intelligent sensing systems in smart devices and smart homes play a substantial role in the continuous remote monitoring of patients with dementia by providing contextual real-life data.5 Specific to heart health, a 2020 meta-analysis of 26 randomized controlled trials (n=11,450) found that those remote health monitoring approaches that involved medication support and mobile health (i.e., software apps for smartphones, personal digital assistants, and tablet computers) were associated with improvements in all-cause mortality and hospitalization outcomes for patients with chronic heart failure.6

Telemonitoring Devices: Management & Prevention of Chronic Disease

Continuous glucose monitors, wearable heart monitoring devices, and biosensor technology that records vital signs such as temperature, respiration, and sleep are all examples of telemonitoring technologies used to remotely observe a patient’s health and record pertinent data in the context of daily life. Additional remote monitoring devices include smart devices (phones, watches, pedometers, etc.) used to acquire, transmit, process, and store health data for either communication between a patient and practitioner or for an individual’s personal health monitoring. Studies suggest that data points from these devices may identify the onset of an acute viral illness,7 and they may also help to monitor chronic illness development and progression. For example, a 2021 systematic review suggested that the use of smartphone applications in chronic disease monitoring and management, specifically app-based weight management programs, may favorably influence lifestyle factors such as healthy eating behaviors, dietary patterns, physical activity, and stress levels, as well as decrease mean body weight and waist circumference.8

In a 2020 randomized controlled trial (n=30), investigators developed a mobile health intervention delivered via a smartphone app and activity tracker to help patients with chronic obstructive pulmonary disease (COPD) set physical activity goals and monitor their progress during pulmonary rehabilitation and for eight weeks afterward.9 Researchers studied the feasibility and acceptability of this technology-based intervention among participants. Results suggested that this remote technology helped those with COPD self-manage their physical activity goals; however, the simplicity and usability of the technology-based intervention surfaced as an important feature.9 An individual’s level of experience and familiarity with the digital technology greatly impacted intervention engagement.

In addition to providing a clinician with a patient’s real-time health information, wearable biometric devices increase an individual’s access to their personal health information and patterns. Does this increased access encourage individuals to make healthier lifestyle choices for potential prevention of chronic disease? Conclusions from current research studies are mixed but encouraging overall.

A 2021 systematic review found that the use of wearable activity trackers improved conscious exercise behavior, including daily steps and weekly moderate-to-vigorous physical activity, but did not effectively change habitual behavior, such as light physical activity and sedentary behavior.10 And while a 2021 meta-analysis of 28 studies (n=7,454 healthy adults) suggested that health approaches using apps or trackers showed a small-to-moderate positive effect on physical activity measures,11 a 2020 systematic review of 58 randomized controlled trials (n=10,071) highlighted the concern that the effectiveness of interventions that use biometric monitoring devices, while promising, was dependent on the individual’s uptake and adherence.12

Conclusion

Remote health monitoring technologies are potential tools for discovery that provide a dynamic perspective of health patterns and a deeper understanding of a patient’s condition. Wearable devices and trackers may provide an opportunity for increasing patient empowerment and engagement in treatments. Data points from devices can be used to show patients measured changes in their health journey, increasing transparency and trust in the patient-practitioner therapeutic partnership. In addition, with the consumer popularity of smart devices, some patients may have a comfortable working knowledge of their health data from wearable technology. However, some patients may have encountered frustrations when using the devices or may not have easy access. These considerations may be helpful when tailoring the most appropriate therapeutic intervention for a patient’s treatment or prevention strategy.

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References

  1. Zhang W, Cheng B, Zhu W, Huang X, Shen C. Effect of telemedicine on quality of care in patients with coexisting hypertension and diabetes: a systematic review and meta-analysis. Telemed J E Health. 2021;27(6):603-614. doi:10.1089/tmj.2020.0122.
  2. Davis SP, Ross MSH, Adatorwovor R, Wei H. Telehealth and mobile health interventions in adults with inflammatory bowel disease: a mixed-methods systematic review. Res Nurs Health. 2021;44(1):155-172. doi:10.1002/nur.22091.
  3. Taylor ML, Thomas EE, Snoswell CL, Smith AC, Caffery LJ. Does remote patient monitoring reduce acute care use? A systematic review. BMJ Open. 2021;11(3):E40232. doi:10.1136/bmjopen-2020-040232.
  4. Michaud TL, Ern J, Scoggins D, Su D. Assessing the impact of telemonitoring-facilitated lifestyle modifications on diabetes outcomes: a systematic review and meta-analysis. Telemed J E Health. 2021;27(2):124-136. doi:10.1089/tmj.2019.0319.
  5. Gillani N, Arslan T. Intelligent sensing technologies for the diagnosis, monitoring and therapy of Alzheimer’s disease: a systematic review. Sensors (Basel). 2021;21(12):4249. doi:10.3390/s21124249.
  6. Ding H, Chen SH, Edwards I, et al. Effects of different telemonitoring strategies on chronic heart failure care: systematic review and subgroup meta-analysis. J Med Internet Res. 2020;22(11):E20032. doi:10.2196/20032.
  7. Radin JM, Wineinger NE, Topol EJ, Steinhubl SR. Harnessing wearable device data to improve state-level real-time surveillance of influenza-like illness in the USA: a population-based study. Lancet Digit Health. 2020;2(2):E85-E93. doi:10.1016/S2589-7500(19)30222-5.
  8. Moses JC, Adibi S, Shariful Islam SM, Wickramasinghe N, Nguyen L. Application of smartphone technologies in disease monitoring: a systematic review. Healthcare (Basel). 2021;9(7):889. doi:10.3390/healthcare9070889.
  9. Bentley CL, Powell L, Potter S, et al. The use of a smartphone app and an activity tracker to promote physical activity in the management of chronic obstructive pulmonary disease: randomized controlled feasibility study. JMIR Mhealth Uhealth. 2020;8(6):E16203. doi:10.2196/16203.
  10.  Li C, Chen X, Bi X. Wearable activity trackers for promoting physical activity: a systematic meta-analytic review. Int J Med Inform. 2021;152:104487. doi:10.1016/j.ijmedinf.2021.104487.
  11.  Laranjo L, Ding D, Heleno B, et al. Do smartphone applications and activity trackers increase physical activity in adults? Systematic review, meta-analysis and metaregression. Br J Sports Med. 2021;55(8):422-432. doi:10.1136/bjsports-2020-102892.
  12.  Perlmutter A, Benchoufi M, Ravaud P, Tran V-T. Identification of patient perceptions that can affect the uptake of interventions using biometric monitoring devices: systematic review of randomized controlled trials. J Med Internet Res. 2020;22(9):E18986. doi:10.2196/18986.

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