Consumer Health WearablesAHMAD HAMAD

What are they ?

* Digital technology has been used for decades ( thermometers, glucose monitor, etc.)

* Patients will gain personal analytics to help in diagnosis and monitoring.

Usefulness:

Help patients with defined illness or comorbidity (3):1- Monitoring severity of depression by tracking physical activity, sleep, etc.2- Monitoring sleep quality3- Early diagnostics ( PD)4- At home management of chronic conditions5- Obesity / sedentary lifestyle ( using pedometers has been associated with increase in physical activity and decrease BMI). Activity trackers may offer new social experience, boost self esteem and

enhance feeling of autonomy (2).

Limitations & Challenges:

People with already healthy lifestyle are more likely to buy wearable. “solution in search of a problem.” In one survey, 30% have an income > 100,000 and about half < 35 ( making it less available for people who need it most).

Only few RCTs were done to test the validity and reliability of the data gathered by these devices. Errors margins between different devices tracking physical activity was up to 25%.

Recent surveys showed that 32% of users stop wearing these devices after six months, and 50% after one year.

Systematic review of 22 studies included assessments of five Fitbit and two Jawbone trackers, focusing on validity and reliability of steps, distance, physical activity, energy expenditure, and sleep. No single specific tracker had a complete assessment across the five measures (1) ( UNC).

Limitations & Challenges:

Benefit was seen in the setting of clinical trials setting and there is no evidence that behavioral changes are consistent beyond the duration of the trials. Sustained behavioral changes are what matter most especially for chronic disease.

Excessive self monitoring can have negative consequences: uncomfortable, unpleasant.

The relationship between patients and wearables is complex , further research is needed and personality factors or other extrinsic factors may play a role in how useful it is.

Security/Privacy: Patients do NOT own their data often. It’s owned by the manufacturer. Easy to hack.

Moving forward

Regulatory framework, similar in a way to regulating “prescribed” health apps. Standardize monitoring data and methods to validate trackers. More RTC; validation. Decoding individual big data by connecting medical devices together and

personalize their interpretation , providing feedback to the patient. The connection may be physical with having one device ( e.g smar phone) (4).

Education: the margin of error can be high when patients attempt to attribute symptoms to a specific stream of unreliable data.

Privacy: set rules to safeguard personal information collected by medical devices ( 5)

Rogers's technology diffusion trajectory.captionSource: Rogers (1983).

References:

(1) Evenson KR, Goto MM, Furberg RD. Systematic review of the validity and reliability of consumer-wearable activity trackers. The International Journal of Behavioral Nutrition and Physical Activity. 2015;12:159. doi:10.1186/s12966-015-0314-1.(2) Karapanos E, Gouveia R, Hassenzahl M, Forlizzi J. Wellbeing in the Making: Peoples’ Experiences with Wearable Activity Trackers. Psychology of Well-Being. 2016;6:4. doi:10.1186/s13612-016-0042-6.(3) Piwek L, Ellis DA, Andrews S, Joinson A (2016) The Rise of Consumer Health Wearables: Promises and Barriers. PLoS Med 13(2): e1001953. doi:10.1371/journal.pmed.1001953(4) Patel MS, Asch DA, Volpp KG. Wearable Devices as Facilitators, Not Drivers, of Health Behavior Change. JAMA. 2015;313(5):459-460. doi:10.1001/jama.2014.14781(5) Kostkova P, Brewer H, de Lusignan S, et al. Who Owns the Data? Open Data for Healthcare. Frontiers in Public Health. 2016;4:7. doi:10.3389/fpubh.2016.00007.