Beyond the lab: a review on neurophysiological mental states assessment in real-world settings.
Clinical Snapshot
PICO Framework
| P — Population | Human subjects (individuals and teams) in real-world or ecologically valid settings, including occupational, operational, and everyday environments |
| I — Intervention | Wearable, non-invasive neurophysiological sensors and biosensors used for real-time monitoring of mental states (EEG, ECG, fNIRS, GSR, EOG, and multimodal combinations) |
| C — Comparator | Traditional laboratory-grade neurophysiological devices and/or subjective self-report assessments of mental states |
| O — Outcomes | Objective, real-time assessment of mental workload, stress, attention, mental fatigue, drowsiness, and teamwork; methodological robustness, data quality, and signal processing suitability for real-world deployment |
Bottom Line
This narrative review from Sapienza University of Rome synthesises ten years of research across 123 studies on wearable neurophysiological monitoring of six mental states — workload, stress, attention, fatigue, drowsiness, and teamwork — in real-world settings. The review's principal contribution is its methodological focus: it moves beyond device cataloguing to examine data quality, signal processing robustness, and the translational gap between laboratory-grade and wearable-grade neurophysiological systems. For senior clinicians and occupational health practitioners, the key message is that wearable biosensor technology has matured sufficiently to produce ecologically valid data, but standardised validation frameworks, formal risk-of-bias assessment, and quantitative benchmarking against clinical reference standards remain absent from the field. The review does not provide pooled effect sizes or certainty-of-evidence ratings, limiting its immediate practice-changing utility. It is best read as a state-of-the-science map for researchers and health technology assessors rather than a clinical practice guide. In the Australian context, TGA regulatory pathways and Safe Work Australia obligations will need to be navigated before these tools enter routine occupational or clinical use. Clinicians with interests in occupational neuroscience, fatigue management, or human factors should monitor this rapidly evolving field.
Key Findings
P Value: Not reported at review level
Effect Size: Not applicable — no pooled quantitative effect size reported; narrative synthesis only
Primary Outcome: Qualitative synthesis of methodological advancements in real-time, wearable neurophysiological monitoring of mental workload, stress, attention, mental fatigue, drowsiness, and teamwork in real-world settings across 123 studies published over approximately ten years
Nnt Or Sensitivity: Not reported; individual study-level classification accuracy metrics (e.g., sensitivity, specificity, AUC for mental state detection algorithms) are likely discussed within the full text but are not synthesised in the abstract
Confidence Interval: Not reported — narrative review design precludes confidence interval calculation
Clinical Application
Wearable neurophysiological monitoring is technically feasible in research settings, but real-world clinical deployment faces barriers including signal artefact management in ambulatory conditions, inter-individual variability in neurophysiological signals, absence of validated clinical reference standards, regulatory approval requirements for medical-grade claims, data privacy and security obligations, and the need for clinician training in neurophysiological data interpretation. Cost and infrastructure requirements vary substantially by modality (EEG versus ECG/HRV versus fNIRS). In Australia, wearable neurophysiological monitoring for mental state assessment is not currently embedded in RACGP clinical guidelines or standard occupational health practice. The TGA regulates software-based medical devices under the Software as a Medical Device (SaMD) framework; any wearable system making clinical diagnostic claims regarding mental states would require TGA registration. Safe Work Australia's work-related psychological health standards and the model Work Health and Safety Act create a regulatory environment where objective mental state monitoring tools could theoretically support employer duty-of-care obligations, particularly in high-risk industries (mining, aviation, healthcare). PBS listing is not applicable to neurophysiological monitoring devices. Australian research groups, including those affiliated with the ARC Centre of Excellence for Integrative Brain Function, are active in related neurotechnology research. The National Mental Health Commission's focus on workplace mental health may create future policy pathways for validated wearable monitoring tools. Occupational health professionals, human factors practitioners, operational personnel in high-stakes environments (aviation, defence, healthcare, transport), and researchers developing real-time mental state monitoring systems. Potential secondary applicability to clinical populations with fatigue, stress, or attentional disorders where continuous objective monitoring may supplement clinical assessment.
Abstract
Recent advancements in wearable, non-invasive neurophysiological sensors have increased interest in applying Human factors (HF) research beyond controlled laboratory settings. HF research aims to objectively quantify individuals' (alone or working in team) mental and emotional states to ensure safety, maintain good performances and prevent risks. These devices enable real time, unobtrusive monitoring of individuals in real-world environments, overcoming the limitations of traditional subjective assessments. Unlike self-reports, neurophysiological signals provide objective, real-time data, allowing for a more accurate and continuous understanding of mental states. This review examines the latest advancements over the past ten years in real-time monitoring of the most studied and operationally relevant mental states, including mental workload (MW), stress, attention, fatigue, drowsiness, and teamwork, by analyzing studies that contribute to research advancing toward real-world application direction. While wearable biosensors were used as one criterion for selecting studies, this review extends beyond device usage to explore crucial methodological aspects relevant to real-world applications, such as data quality, customized processing steps, and the robustness of results compared to traditional laboratory-grade devices. Thus, this review analyzes 123 articles exploring current advancements in real-time monitoring of MW, stress, attention, mental fatigue, drowsiness, and teamwork using wearable devices. The findings provide a comprehensive overview of methodology advancement toward real-time, objective individuals monitoring in real world settings.
References
- 1.Capotorto, R., Ronca, V., Di Flumeri, G., Borghini, G., Babiloni, F., & Aricò, P. (2026). Beyond the lab: a review on neurophysiological mental states assessment in real-world settings. Progress in Biomedical Engineering. https://doi.org/10.1088/2516-1091/ae7863
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