In Situ Physiologic and Behavioral Monitoring With Digital Sensors for Cerebrovascular Disease: A Scoping Review

Abstract

Cerebrovascular disease (CeVD) is a leading cause of death and disability worldwide. Early detection of behavioral and physiologic changes associated with CeVD may be critical to improving patient outcomes. The growing prevalence of remote monitoring tools, from wearable devices to smartphone applications, which facilitate in situ observation of patients, holds promise for more timely recognition and possible prevention of stroke. The goal of this review was to examine and establish categories of innovation with digital sensors that monitor physiologic and behavioral variables in situ to augment the current CeVD screening and diagnostic processes. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist, a search strategy spanning multiple databases from January 2012 to September 30, 2022, was implemented, aggregating 729 articles, of which 51 (7.0%) met the inclusion criteria. The articles were divided into 2 categories on the basis of their focus: physiologic and behavioral. Physiologic articles were sorted into 1 of the following 6 subcategories according to the signal(s) monitored: motor function, heart rhythm, heart rate, kinematic analysis, physical activity, and blood pressure. Behavioral articles were sorted into the following 3 subcategories: mood, cognitive function, and fatigue. Most studies used a wearable accelerometer, photoplethysmography-enabled smartwatch, or smartphone-based sensors. This scoping review identified disparate methods and conclusions associated with the use of digital sensors for in situ physiologic and behavioral monitoring of patients with CeVD. Although most articles evaluated pilot validation and feasibility trials, the lack of randomized controlled trials was identified as a critical gap specific to this evolving research area.