بررسی سیستماتیک سیستم مانیتورینگ بیمار پوشیدنی – چالش ها و فرصت های فعلی برای پذیرش بالینی A Systematic Review of Wearable Patient Monitoring Systems – Current Challenges and Opportunities for Clinical Adoption

Introduction In recent years, there has been an ever-growing need for a sustainable health system which manages not only acute care (in hospital wards or emergency departments), but also the care of outpatients, especially those with chronic conditions. Worldwide spending on chronic conditions has increased to a point that immediate action is now required. A chronic condition is defined as a health condition that can be managed but often cannot be cured; common examples include heart disease, stroke, cancer, diabetes and arthritis [1]. The number of people with multiple chronic conditions is likely to continue to increase with the ageing of the population. Major contributing factors are unhealthy lifestyles, along with the impact of the economic downturn on mental and physical health [1]. Wearable patient monitoring (WPM) systems are emerging as an effective tool for the prevention, early detection and management of chronic conditions. Recent estimates for annual expenditure on healthcare in the US are between $US 210.9 billion and $US 306 billion [2]. In the UK, nearly 29% of the total population now lives with a chronic medical condition, and as much as 80% of the healthcare budget is spent on the management of chronic diseases [1, 3]. As wearable sensors, smart textiles and body-worn garments become smaller, cheaper and more consumer-accessible, it is expected that they will be used more extensively across a wide variety of contexts. The expansion of wearable systems for health data collection offers the potential for user engagement and self-management of chronic diseases [4]. The rapid increase in the global adoption of WPM systems has occurred over the last couple of decades. Some of the early foundation research includes; (1) the wearable healthcare system (WEALTHY) project, which investigated the use of fabric integrated sensors to continuously monitor the vital signs of highrisk patients, including those undergoing rehabilitation [5]; (2) an investigation of a custom-developed ubiquitous healthcare (u-health-care) system consisting of custom 802.15.4-capable nodes interfaced with electrocardiogram (ECG) and blood pressure sensors, as well as a basic cell phone device for data display and signal feature extraction [6]; (3) the Human++ project in the Netherlands which developed a body area network consisting of three sensor nodes and a base station [7]; (4) the CodeBlue project developed by researchers at Harvard University [8]; (5) research from the Media Laboratory of the Massachusetts Institute of Technology (MIT) which involved designing LiveNet [9]; (6) the development of the SmartVest, a wearable physiological monitoring system that consists of a vest and a variety of sensors integrated into the garment’s fabric to collect several biosignals [10]; (7–9) and three European IST FP6 programs (the MERMOTH, MyHeart and HeartCycle projects), which are recent examples of WPM systems [11–14]. The aim of this review is to investigate how current technological barriers and challenges limiting the global clinical adoption of bed-side patient monitoring have been reduced by the use of WPM systems. In addition, this review will highlight opportunities and recommend the best possible approach for the sustainable adoption of WPM in acute care, as well as in community care settings. This continues on from previous literature reviews conducted on WPM systems [6, 15–18].