Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 14 appraisals
JMIR mHealth and uHealth
Perceptions of Adults Aged 50 Years and Older Regarding the Use of Wearable mHealth Technologies to Promote Physical Activity: Systematic Review and Meta-Ethnography
BACKGROUND: Despite advances in wearable mobile health (mHealth) technologies and their associated apps designed to promote physical activity, and the importance of adapting them to users, little is known about older adults' perceptions of these technologies. OBJECTIVE: This review aimed to synthesize and analyze qualitative evidence exploring the perceptions of adults aged 50 years and older regarding areas to improve, barriers to, and facilitators of wearable mHealth technologies (activity trackers and companion apps) to promote physical activity. METHODS: A qualitative systematic review and meta-ethnography was conducted. Comprehensive searches were performed across 8 databases (MEDLINE, Scopus, Web of Science, CINAHL, The Cochrane Library Plus, PsycINFO, ProQuest, and ÍnDICEs-CSIC) for articles published in English or Spanish between January 2013 and January 2024. The synthesis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) guidelines. RESULTS: Ten articles met the inclusion criteria and were synthesized using meta-ethnography. Three main themes emerged: (1) barriers to promoting physical activity caused by wearable mHealth technologies: personal barriers (physical aspects, perceptions about technology, and personal preferences), technological barriers (functionality, content, design, alarms, availability, and accessibility), and environmental barriers (season of the year); (2) personal facilitators (consideration that these apps improve health, perceptions about technology, and personal preferences), technological facilitators (functionality, content, and design), relational facilitators (technological and social support), environmental facilitators (seasonal variations), and health care professionals (support and monitoring by health care services); and (3) personal areas (perceptions about technology and personal preferences), technological areas (functionality, content, and design), and relational areas (technological support). CONCLUSIONS: Although older adults acknowledge the potential of wearable mHealth technologies to promote physical activity, their effective engagement is hindered by distinct personal, technological, and environmental barriers. Bridging the digital divide requires designers to prioritize user-centered, age-friendly interfaces that are integrated with continuous support from health care professionals. To promote genuine health equity, future research must rigorously report intersectional demographics to ensure that mHealth interventions mitigate, rather than inadvertently exacerbate, existing disparities.
30 July 2026
Read appraisal →Journal of medical Internet research
Digital Health Technologies Are Bridging the Maternal Mortality Gap
Disparities in maternal outcomes along socioeconomic, racial, ethnic, and geographic lines are well established. In this News and Perspectives article, JMIR Correspondent Anika Nayak reports on the growth and potential of digital health interventions in bridging the rural-urban maternal mortality gap.
26 July 2026
Read appraisal →JMIR cardio
Mobile Apps for Heart Rate Variability: App Store Search and Content Analysis
BACKGROUND: Heart rate variability (HRV) is a noninvasive indicator of autonomic nervous system activity that is increasingly used for health and performance monitoring. Digital and mobile technologies are increasingly providing opportunities for remote HRV monitoring outside of laboratory-based settings. OBJECTIVE: This study aimed to describe the landscape of mobile apps that measure, analyze, and provide feedback on HRV, with a focus on how HRV is measured, analyzed, interpreted, and communicated to users. A secondary aim was to assess the transparency of these apps, including the extent to which they disclose the evidence underpinning their HRV metrics and feedback. METHODS: This study was an app store search and content analysis. Searches were conducted in the Google Play Store and Apple iTunes Store. Apps were eligible for inclusion if they had functionality to record, analyze, or provide feedback on HRV and were available in English. Data were extracted from app descriptions, screenshots, websites, and, where necessary, contact with developers. Data were extracted on app metadata (developer, release and update dates, and pricing), alongside information about HRV measurement, analysis, and feedback. This included the type of sensor used; HRV measurement characteristics (sensor placement, recording duration, and body position or standardization procedures); methods to calculate and interpret HRV (ie, metrics derived and how they were interpreted for users); and additional app functionality such as reminders, the ability to log self-reported stressors, and the type of feedback or guidance provided based on HRV. We used previously published criteria for assessing the quality of information on the internet, which included authorship, scientific attribution, currency of updates, and data privacy. RESULTS: Of 746 apps identified, 206 met eligibility criteria. Of these, 132 were primary measurement apps, 59 were aggregators, and 15 were hybrid. Photoplethysmogram was the most common sensing modality (n=117, 56.8%), followed by multiple sensors (n=60, 29.1%). Full data extraction across app metadata and HRV measurement and analysis data was only achievable for 93 (45.1%) apps, representing a transparent subset with sufficient available information for content analysis. The most commonly reported HRV metrics were root mean square of successive differences (n=51) and SD of normal-to-normal intervals (n=48), while frequency-domain power (n=22) and low frequency to high frequency ratios (n=15) were less common. Most apps presented data as personalized trends or individualized ranges (76/93, 81.7%), emphasizing user-specific context rather than isolated values. Although 86% (80/93) offered contextual guidance (eg, readiness or recovery scores), many relied on proprietary algorithms that were not transparently described, limiting independent assessment of how these scores were derived and validated. CONCLUSIONS: Consumer HRV apps are widely available but vary considerably in how data are collected, processed, and contextualized. While many offer personalized trends and guidance, methodological transparency is often limited, particularly regarding the proprietary algorithms underlying the feedback scores.
20 July 2026
Read appraisal →JMIR mHealth and uHealth
mHealth Technologies for the Care of Children With Congenital Heart Disease: Scoping Review
BACKGROUND: Mobile information technology (IT) is increasingly being used in the health care sector, and it can play a critical role in both the care of children with congenital heart disease (CHD) and the quality of life of their families. OBJECTIVE: This study aimed to conduct a scoping review of the application of mobile health (mHealth) technologies in the care of children with CHD. We summarized the forms of mHealth interventions and effects on CHD to provide a reference for future research in this field. METHODS: We searched PubMed; Embase; Web of Science; the Cochrane Library; CINAHL; China National Knowledge Infrastructure; Wanfang Data; the Chinese Biomedical Database; VIP Chinese Science and Technology Journal Database; National Guideline Clearinghouse of the United States; the website of the Registered Nurses' Association of Ontario, Canada; the Guidelines International Network; the American Heart Association; and the American Association of Cardiovascular and Pulmonary Rehabilitation. The search period was from the establishment of the databases to June 12, 2025. The retrieved literature was screened and analyzed. RESULTS: A total of 519 Chinese- and English-language articles were identified, with 44 (8.5%) studies meeting the inclusion criteria. The primary forms of mHealth interventions for patients with CHD included mobile apps, wearable devices, and remote monitoring equipment. The findings indicated that mHealth technologies could improve exercise capacity, nutritional status, psychological well-being, and quality of life in children with CHD. CONCLUSIONS: The application of mHealth in the care of children with CHD is feasible and demonstrates positive effects. Future research should emphasize peer education and patient privacy protection while further exploring remote education and health management based on theoretical frameworks and intelligent ITs to enhance quality of life for both children with CHD and their parents.
19 July 2026
Read appraisal →Nano letters
Regulating the Nano-Bio Interface: Converging Electrochemical and Photonic Biosensing for Wearable Diagnostics
The development of wearable biosensors has accelerated due to the combination of nanomaterials, integrative electronics, and miniaturized transduction mechanisms, enabling continuous monitoring of physiological and environmental markers. Electrochemical and photonic modalities have been shown to exhibit complementary capabilities in wearable applications, with each offering distinct advantages in sensitivity, selectivity, miniaturization, and power efficiency. Beyond single-modality functionality, the next generation of wearable diagnostics integrates electrochemical and optical transduction within the same platforms. In this short review, we examine the physical and functional demands of such convergence in wearable systems, highlighting model electrochemical systems, such as textile-integrated wound monitoring and hormone sensors, and how optical modalities provide orthogonal observables of interfacial and biochemical conditions. We further explore new emerging device architectures that leverage electrochemical and optical interrogation to generate robust, information-rich data sets, supporting long-term, real-world deployment of wearable diagnostic technologies for personalized healthcare and continuous monitoring applications.
16 July 2026
Read appraisal →Current diabetes reports
Digital Management of Early-Onset Type 2 Diabetes: Empowerment, Challenges, and Future Outlook
PURPOSE OF REVIEW: Early-onset type 2 diabetes (EOT2D), defined as a diabetes diagnosis before 40 years of age, is rising globally and associated with an aggressive disease course and early complications. This review examines the role of digital health technologies (DHT) in addressing the unique clinical and life-course challenges of EOT2D. RECENT FINDINGS: DHT, including continuous glucose monitoring, mobile health applications, digital therapeutics, telemedicine, remote patient monitoring, wearable devices, and artificial intelligence-based analytics, have demonstrated modest improvements in glycemic control, weight management, and patient engagement in people with type 2 diabetes. However, evidence in adults with EOT2D remains limited. Compared with usual-onset T2D, people with EOT2D may derive particular benefits due to higher digital literacy, greater lifestyle variability, and longer anticipated disease duration. Although DHT shows promise for improving empowerment and care integration in EOT2D, important gaps persist, including a lack of EOT2D-specific trials, digital divide-related inequities, interoperability challenges, and reimbursement barriers. Future research should prioritize tailored interventions and hybrid care models to optimize long-term outcomes in this high-risk population.
11 July 2026
Read appraisal →JMIR mHealth and uHealth
Perceived Sensitivity of Sensor-Based Digital Health Data: Qualitative Interview Study
BACKGROUND: Digital health tools are increasingly used in mental health care to passively collect patient data and analyze health status outside of clinical settings. While technologies such as digital phenotyping, affective computing, and computational behavioral analysis offer new insights into symptom manifestation in daily life, they generate large volumes of potentially sensitive data that raise significant data privacy concerns, requiring high levels of patient awareness and consent. Empirical research is lacking on stakeholder understandings toward the sensitivity of these data and expectations for data stewardship, perspectives that are critical for developing robust informed consent and data protection policies for digital health data use. OBJECTIVE: This study aimed to explore key stakeholder perspectives on the sensitivity of computer perception (CP) data, trust in existing data protections, willingness to share CP data externally, and desire for transparency of CP data transactions outside of the clinical space. METHODS: As part of a larger, multisite study, we conducted qualitative interviews (n=40) via Zoom (Zoom Communications, Inc) with 20 adolescents (aged 12-17 years) familiar with CP tools and their caregivers (n=20). Interviews consisted of a series of open-ended questions regarding stakeholders' perspectives on privacy, data security, and the use and exchange of CP data. We developed a qualitative codebook to identify and label thematic patterns in responses to questions addressing the topics above, using thematic content analysis to identify themes inductively. Each interview was coded by merging work from at least two separate coders, and several team members contributed to qualitative analysis. RESULTS: Most adolescents and caregivers viewed CP data as highly sensitive and expressed a reluctance to share these data beyond their clinical teams. While many participants expressed trust in existing data protections to protect CP data, they often misunderstood or overestimated the extent of protections to safeguard CP data. CONCLUSIONS: Our findings underscore the critical need for clear and effective patient communication and education about the risks, benefits, and protections associated with CP data through informed consent protocols. To promote greater transparency, understanding, and trust, we recommend 5 strategies: educating patients about data protection; studying secondary data exchange and reidentification risks; strengthening transparency regulations; improving data traceability mechanisms, such as distributed ledger technologies, to enhance data traceability and auditability; and adopting dynamic consent models.
11 July 2026
Read appraisal →Journal of medical Internet research
The Association Between eHealth Literacy and Health Behaviors During and Since the COVID-19 Pandemic: Systematic Review and Meta-Analysis
BACKGROUND: Since COVID-19, health information seeking, service navigation, and routine care have become increasingly digitally mediated. It remains unclear whether the association between eHealth literacy and health behaviors is consistent across behavioral domains, populations, and analytic frameworks. OBJECTIVE: This systematic review and meta-analysis synthesized COVID-19 and post-COVID-19 evidence on the association between eHealth literacy and health behaviors and examined variation across study contexts. METHODS: We conducted a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020-compliant, PROSPERO-registered review (CRD420251009048). PubMed, Embase, Web of Science Core Collection, CINAHL Ultimate, and Scopus were searched from January 1, 2020, through March 27, 2026. Eligible observational studies assessed eHealth literacy and reported analyzable associations with health behavior outcomes collected in 2020 or later. Health behaviors were classified as health decision-making, health-promoting, or health management behaviors. Correlation coefficients, grouped odds ratios (ORs), and continuous ORs were synthesized separately using random-effects models with Knapp-Hartung adjustment. Certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. RESULTS: In total, 19 studies were included: 10 contributed correlation coefficients, 6 grouped ORs, and 3 continuous ORs. In the correlation-based synthesis, higher eHealth literacy was associated with more favorable health behaviors (pooled r=0.43, 95% CI 0.36-0.51; 95% prediction interval 0.22-0.61), with substantial heterogeneity (I2=80.50%). In the grouped OR synthesis, higher eHealth literacy was also associated with more favorable health behaviors (pooled OR 2.12, 95% CI 1.47-3.05; 95% prediction interval 1.11-4.06), with moderate heterogeneity (I2=46.33%). In the continuous OR synthesis, all 3 studies showed positive associations, but the pooled effect was not statistically significant (pooled OR 1.07, 95% CI 0.89-1.30; 95% prediction interval 0.84-1.37), with very high heterogeneity (I2=97.98%). Subgroup analyses showed a significant difference only by geriatric status in the grouped OR synthesis. Certainty was low for the grouped OR synthesis and very low for the other 2 syntheses. CONCLUSIONS: Higher eHealth literacy was generally associated with more favorable health behaviors in the correlation-based and grouped OR syntheses, whereas evidence from the continuous OR synthesis was inconclusive. Given the predominantly cross-sectional evidence base, heterogeneity, risk-of-bias concerns, and low to very low certainty, the association should be interpreted as contextual and associative rather than causal or uniform. This review is innovative in synthesizing COVID-19 and post-COVID-19 evidence, applying a functional classification of health behaviors, and analyzing distinct effect measures separately. Unlike previous reviews that summarized the association more broadly, it avoids a single mixed pooled effect and provides a cautious, context-specific interpretation. In practice, interventions should pair eHealth literacy improvement with trustworthy digital services, clinician support, and behavior-specific conditions that help translate digital information into sustained health-related action.
10 July 2026
Read appraisal →Physiological measurement
A comprehensive inference-time augmentation framework in physiological signals: application to PPG-based AF detection
Objective.Accurate classification of physiological signals in real-world deployments is challenged by sensor noise, motion artifacts, and distribution shifts between training and deployment data. Inference-time augmentation (ITA), which applies augmentations during inference rather than retraining, offers a simple, model-agnostic mechanism to improve robustness. However, ITA application to physiological signals has remained narrow in scope, relying on limited augmentation methods with fixed, unoptimized parameters. This work proposes a unified ITA framework to address that gap.Approach.The framework incorporates 13 augmentation methods spanning time-domain, amplitude-domain, frequency-domain, and artifact-injection transformations, with hyperparameters systematically optimized via Bayesian optimization. We evaluate the framework on atrial fibrillation (AF) detection from 30 s photoplethysmography (PPG) signals using two deep learning architectures, generative pre-trained transformer (GPT)-PPG (in two sizes) and ResNet, across five datasets comprising more than 400 patients and ∼9800 h of PPG recording. Two evaluation strategies are assessed: standard ITA applied to all inputs, and selective ITA applied to initially positive predictions.Main results.Standard ITA consistently improved the area under the receiver operating characteristic curve (AUROC, up to 8.5% for GPT-PPG and 0.7% for ResNet) and the area under the precision-recall curve (AUPRC, up to 10.6% for GPT-PPG and 0.8% for ResNet) across all model-dataset combinations. Selective ITA further reduced average FPR by up to 4.4% (GPT-PPG) and 1.3% (ResNet) on non-AF PPG datasets.Significance.These findings establish ITA as a practical, model-agnostic approach for improving the reliability of PPG-based AF classification in deployment settings where retraining is not feasible, with broader applicability to physiological signal analysis.
9 July 2026
Read appraisal →Proceedings of the National Academy of Sciences of the United States of America
Analytical modeling for suction cup designs for skin-interfaced wearable devices
Stable mounting is a central requirement for skin-interfaced wearable biomedical devices, because accurate and long-term measurements with clinical utility typically demand intimate contact with the skin, whereas practical use also requires gentle removal to minimize skin irritation and damage. Existing mounting strategies often struggle to satisfy these competing requirements simultaneously, especially under prolonged wear or in the presence of sweat and moisture. Suction-based mounting has recently emerged as a promising alternative because it can provide strong, reversible, and adhesive-free attachment, yet its underlying mechanics remain insufficiently understood. Here, we establish analytical models for the deformation and force of suction cups in a fully explicit form, covering both the cone suction cup and an optimized ring suction cup design. Unlike previous approaches that rely on indirect quantities such as the pressure difference and contact radius, which are not available before experiments and therefore cannot serve as controllable design variables, the present framework yields direct relations between suction performance and geometry parameters, material properties, and loading conditions, including the maximum push down displacement and the subsequent pull up displacement. The resulting formulas agree closely with accurate numerical solutions and lead to compact scaling laws that clearly identify how geometry and material parameters govern suction performance. These results provide a quantitative and physically transparent foundation for the design of suction-based mounting strategies in wearable devices.
7 July 2026
Read appraisal →Telemedicine journal and e-health : the official journal of the American Telemedicine Association
Implementation and Evaluation of Virtual Care in Canadian Health Care Systems: A Scoping Review
OBJECTIVE: This scoping review examined available evidence in implementation and evaluation of virtual care in Canada. Virtual care saw recent uptake due to the COVID-19 pandemic; however, to ensure quality of care, rigorous implementation and evaluation frameworks are needed. METHODS: Peer-reviewed and gray literature were searched to determine extent, range, and nature of evidence surrounding implementation and evaluation of virtual care based on the guidelines of the Joanna Briggs Institute. Although virtual care can encompass synchronous and asynchronous modalities, this review focused on synchronous virtual care, defined as real-time interactions between patients and providers via videoconferencing or telephone. Search included MEDLINE, EMBASE, Psych Info, and CINAHL databases and national and provincial health system, professional organization, and regulatory websites. Inclusion criteria included videoconferencing or telephone and English and French Canadian sources. Citations were screened by two researchers at title, abstract, and full-text levels. RESULTS: Two hundred and eight (208) manuscripts were included for analysis. High numbers of studies on patient satisfaction, process outcomes, and barriers were identified, with underrepresentation of health and systems outcomes and impact evaluations. There were very few studies examining hybrid care, planetary health, and use of virtual care with equity-deserving groups. DISCUSSION: This scoping review identified areas of importance for future research, including the use of virtual care in rural and remote regions, inpatient, long-term, and emergency settings, hybrid care, economic and planetary health impacts, and artificial intelligence. As well, enhancing standardization of implementation and evaluation guidelines will optimize quality of care and best practice.
3 July 2026
Read appraisal →ACS sensors
Flexible Wearable Closed-Loop Diagnostic and Therapeutic System: A New Paradigm for Skin Health Management
As the largest external barrier of the human body, the skin is essential to overall health and quality of life. Conventional skin health management faces limitations such as insufficient real-time monitoring and lack of personalization. Flexible wearable devices have recently emerged as a transformative technology, enabling non-invasive sensing and targeted therapy with high skin compatibility. This review comprehensively summarizes recent advances in flexible wearable closed-loop diagnostic and therapeutic systems for skin health management. It outlines the core technological components, including skin bioinformation collection, biosignal monitoring, signal transmission and data analysis, and targeted intervention. Key applications in physiological and pathological monitoring, wound healing, drug delivery, and physical therapy are discussed. Furthermore, the innovation trajectory of closed-loop systems is clarified, key challenges are analyzed, and targeted solutions are proposed. Future directions are prospected from cross-disciplinary views including digital twins and personalized medicine, establishing a new paradigm for real-time, personalized, and continuous skin health management.
28 June 2026
Read appraisal →The Keio journal of medicine
Comparison of Clinical Development of Digital Therapeutics among Japan, the United States, and Germany
Digital therapeutics (DTx) have demonstrated promising potential as a novel therapeutic approach, with their clinical development gaining momentum. Comparison of DTx development between Japan, a relative newcomer, and Germany and the U.S., known for favorable circumstances, is a topic of interest. DTx developed in Japan as of November 2023 were identified on the Pharmaceuticals and Medical Devices Agency (PMDA) website and in the literature. Similar DTx available in the U.S. and Germany were identified in the databases maintained by the U.S. Food and Drug Administration (USFDA) and Federal Institute for Drugs and Medical Devices (BfArM). Data on their clinical trials and regulatory status were obtained from these databases and their respective national clinical trial registries. The data obtained were compared and analyzed. By November 2023, Japan had developed DTx, encompassing 11 therapeutic areas. Seven DTx had reached or completed the confirmatory study stage, whereas five DTx were in the exploratory phase. Twenty DTx in the therapeutic areas were selected from the U.S. and Germany. A total of 27 DTx were reviewed regarding the designs of confirmatory studies and regulatory actions taken. Trial designs demonstrated more similarities than differences across the countries and therapeutic areas. Placebo trial design-associated difficulties were conspicuous. Although regulatory actions to place DTx in the market differed across countries, they effectively ensured the efficacy and safety of DTx that were suitable for marketing considering the most current science. The regulatory measures in the three countries seem to have positively impacted DTx development.
27 June 2026
Read appraisal →International ophthalmology clinics
Beyond the Clinic: Home-Based Monitoring Strategies in Glaucoma Care
Glaucoma is a chronic and progressive optic neuropathy, necessitating lifelong monitoring for affected individuals. Traditional surveillance of the disease relies on evaluation of intraocular pressure (IOP), optic nerve anatomy, and visual function at the physician's office, which only provides limited snapshots of a disease characterized by dynamic physiological variation. Developments in portable ophthalmological technologies and digital health platforms have enabled home monitoring of glaucoma. This review synthesizes current evidence on the home monitoring of glaucoma, with a focus on self-tonometry and home-based visual field testing. Handheld tonometers such as iCare HOME and iCare HOME2 allow repeated, anesthesia-free self-measurement of IOP in a real-world setting. These devices have demonstrated good agreement with Goldmann applanation tonometry, the gold standard. Home tonometry captures diurnal variations of IOP, thus providing relevant insights for diagnosis and therapeutic decision-making. Home-based visual field testing (eg, tablet-based platforms, virtual reality-based testing) enables frequent, unsupervised functional assessment with repeatability and sensitivity comparable to standard automated perimetry. Increased testing frequency may facilitate earlier detection of rapid progression, particularly in the early stages of disease. Collectively, evidence suggests the feasibility and clinical relevance of these home monitoring modalities. However, patient compliance with testing schedules and cost-effectiveness remain as challenges.
24 June 2026
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