Sensor-Based Monitoring of Knee Osteoarthritis Symptoms in Free-Living Settings: Scoping Review

Clinical Snapshot

Key Findings

• P Value: Not reported at the review level

• Effect Size: Not applicable — scoping review with narrative synthesis only. IMUs (n=6 studies, 37.5% of included studies) demonstrated the strongest representation, with reported robust correlations between gait asymmetry/range of motion metrics and functional limitations

• Primary Outcome: Mapping of sensor modalities to knee OA symptom domains in free-living settings; 16 studies met inclusion criteria

• Nnt Or Sensitivity: Not applicable. Key finding: poor self-reported sleep quality predicted pain exacerbations despite stable objective actigraphy metrics — highlighting a clinically important subjective-objective discordance. Physiological sensors (ECG, bioimpedance) are critically underrepresented. Most systems function as passive data loggers without active feedback integration.

• Confidence Interval: Not reported — no statistical pooling performed

Clinical Application

Wearable IMU-based monitoring is the most technically mature modality identified and is feasible for community deployment. However, the absence of active feedback loops in current systems, the subjective-objective data discrepancy in sleep monitoring, and the lack of integration with clinical workflows represent significant implementation barriers. A hybrid paradigm combining wearables with structured PROMs is proposed but not yet validated in clinical practice. Knee OA affects approximately 9% of Australians and represents a major burden on the Medicare and PBS systems, particularly through analgesic prescribing and surgical referral pathways. The RACGP Clinical Guideline for the Diagnosis and Management of Knee and Hip Osteoarthritis (2018, updated guidance) emphasises exercise, weight management, and self-management — domains where continuous sensor monitoring could theoretically support adherence and symptom tracking. The TGA has approved several wearable devices for general wellness monitoring, but none are currently listed as therapeutic goods specifically for OA symptom monitoring. PBS does not currently subsidise wearable sensor devices for OA management. The findings of this review are relevant to Australian digital health initiatives (e.g., My Health Record integration, telehealth expansion post-COVID) but require prospective Australian-specific validation before clinical implementation guidance can be issued. Adults with diagnosed knee osteoarthritis (any severity) who are ambulatory and capable of wearing sensor devices in community settings. The review does not specify OA grade, age range, or comorbidity profile of included populations, which limits precision of applicability.

Abstract

BACKGROUND: Knee osteoarthritis is a heterogeneous condition characterized by chronic pain, stiffness, and fatigue that fluctuate rapidly over time. Traditional clinical assessments provide only static diagnoses of disease severity, failing to capture the dynamic, day-to-day symptom variability that impacts patient quality of life. While wearable technologies offer the potential for continuous, high-frequency monitoring, previous reviews have examined general technological interventions for knee osteoarthritis management, yet they lack a specific synthesis of technologies for symptom monitoring. OBJECTIVE: This study aims to synthesize current research on sensor technologies used for the continuous monitoring of knee osteoarthritis symptoms in free-living or simulated daily environments. Specifically, the review seeks to (1) map sensor modalities to specific symptom domains (biomechanical, physiological, and behavioral); (2) evaluate the alignment between objective sensor metrics and patient-reported outcome measures; and (3) identify gaps in current monitoring paradigms. METHODS: A systematic literature search was conducted across PubMed, Embase, Web of Science, and IEEE Xplore. The review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Eligibility criteria included studies involving participants with knee osteoarthritis using wearable or portable sensors capable of continuous monitoring (eg, inertial measurement units and electrocardiography) and assessing clinical symptoms (eg, pain, fatigue, and stiffness). Studies relying solely on stationary laboratory equipment (eg, force plates) without a portable component were excluded to ensure relevance to real-world applicability. Data regarding sensor types, sampling frequencies, monitored symptoms, and the statistical association between objective features and subjective symptom severity (key findings) were extracted. RESULTS: A total of 16 studies met the inclusion criteria. The summary constructed from the results revealed a distinct technological saturation: the majority of studies (n=6) used inertial measurement units to quantify biomechanical deficits (eg, gait asymmetry and range of motion), which showed robust correlations with functional limitations. In contrast, there was a notable scarcity of research using physiological sensors (eg, electrocardiography and bioimpedance) to monitor systemic symptoms. Crucially, findings highlighted a significant discrepancy between subjective and objective data, particularly in sleep monitoring, where poor self-reported sleep quality predicted pain exacerbations despite stable objective actigraphy metrics. Furthermore, most systems operated as passive data loggers, with a lack of integration into active feedback loops. CONCLUSIONS: Unlike previous reviews focused solely on biomechanics, this study innovatively maps the use of sensors across a multidimensional symptom spectrum, revealing a critical gap in the monitoring of fatigue and physiological stress. The findings suggest that current sensor applications are limited by a lack of integration with subjective patient experiences. Real-world implementation requires a hybrid monitoring paradigm that combines the ecological validity of wearable sensors with the clinical relevance of patient-reported outcomes. This approach paves the way for digital phenotyping and active feedback systems, offering a personalized strategy for managing the complex symptom burden of knee osteoarthritis.

References

1. 1.Cui, B., van Beijnum, B.-J., Tabak, M., & Wang, Y. (2026). Sensor-Based monitoring of knee osteoarthritis symptoms in free-living settings: Scoping review. Journal of Medical Internet Research. https://doi.org/10.2196/84262