Background: Home health monitoring shows promise in improving health outcomes; however, navigating the literature remains challenging given the breadth of evidence. There is a need to summarize the effectiveness of monitoring across health domains and identify gaps in the literature. In addition, ethical and user-centered frameworks are important to maximize the acceptability of health monitoring technologies. Objective: This review aimed to summarize the clinical evidence on home-based health monitoring through a scoping review and outline ethical and user concerns and discuss the challenges of the current user-oriented conceptual frameworks. Methods: A total of 2 literature reviews were conducted. We conducted a scoping review of systematic reviews in Scopus, MEDLINE, Embase, and CINAHL in July 2021. We included reviews examining the effectiveness of home-based health monitoring in older adults. The exclusion criteria included reviews with no clinical outcomes and lack of monitoring interventions (mobile health, telephone, video interventions, virtual reality, and robots). We conducted a quality assessment using the Assessment of Multiple Systematic Reviews (AMSTAR-2). We organized the outcomes by disease and summarized the type of outcomes as positive, inconclusive, or negative. Second, we conducted a literature review including both systematic reviews and original articles to identify ethical concerns and user-centered frameworks for smart home technology. The search was halted after saturation of the basic themes presented. Results: The scoping review found 822 systematic reviews, of which 94 (11%) were included and of those, 23 (24%) were of medium or high quality. Of these 23 studies, monitoring for heart failure or chronic obstructive pulmonary disease reduced exacerbations (4/7, 57%) and hospitalizations (5/6, 83%); improved hemoglobin A1c (1/2, 50%); improved safety for older adults at home and detected changing cognitive status (2/3, 66%) reviews; and improved physical activity, motor control in stroke, and pain in arthritis in (3/3, 100%) rehabilitation studies. The second literature review on ethics and user-centered frameworks found 19 papers focused on ethical concerns, with privacy (12/19, 63%), autonomy (12/19, 63%), and control (10/19, 53%) being the most common. An additional 7 user-centered frameworks were studied. Conclusions: Home health monitoring can improve health outcomes in heart failure, chronic obstructive pulmonary disease, and diabetes and increase physical activity, although review quality and consistency were limited. Long-term generalized monitoring has the least amount of evidence and requires further study. The concept of trade-offs between technology usefulness and acceptability is critical to consider, as older adults have a hierarchy of concerns. Implementing user-oriented frameworks can allow long-term and larger studies to be conducted to improve the evidence base for monitoring and increase the receptiveness of clinicians, policy makers, and end users.

Adolescent Idiopathic Scoliosis (AIS) is a 3-dimensional spinal deformity that affects 1-3% of youth. Severe cases require surgical intervention involving the insertion of pedicle screws near the spinal cord, making accurate placement imperative. Currently, surgeons use either CT-navigation methods to guide placement of screws or free-hand methods. The free-hand method has higher breach rates; however, CT-navigation exposes children to sensitive ionizing radiation. A novel custom three-dimensional ultrasound (3DUS) system has been developed to provide the accuracy benefits similar to traditional CT-navigation systems without exposing patients to ionizing radiation. This study evaluates the accuracy of the custom 3DUS guidance system for localizing 3D reconstructions of vertebral phantoms and tracking handheld surgical tools in the surgical space. Tool tracking was evaluated with commercial motion tracking cameras using a 3D-printed pointer device and a high-precision probe device. Experiments were performed on 3D-printed vertebral phantoms to investigate the positional and orientational accuracy using a high precision reference grid. The 3D-printed pointer device was shown to be inferior to the high-precision probe, finding positional accuracy of 1.1 ± 1.1 mm versus 0.7 ± 0.4 mm. The rotational accuracy was 0.0 ± 1.7°, which met the surgical objective. The 3DUS localization, which was also evaluated using the vertebral phantoms and reference grid, showed positional accuracy of 0.8 ± 0.6 mm making it a promising image-guidance tool for scoliosis surgery.

Background: With the growing proportion of Canadians aged >65 years, smart home and health monitoring technologies may help older adults manage chronic disease and support aging in place. Localization technologies have been used to support the management of frailty and dementia by detecting activities in the home. Objective: This systematic review aims to summarize the clinical evidence for in-home localization technologies, review the acceptability of monitoring, and summarize the range of technologies being used for in-home localization. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology was followed. MEDLINE, Embase, CINAHL, and Scopus were searched with 2 reviewers performing screening, extractions, and quality assessments. Results: A total of 1935 articles were found, with 36 technology-focused articles and 10 articles that reported on patient outcomes being included. From moderate- to high-quality studies, 2 studies reported mixed results on identifying mild cognitive dementia or frailty, while 4 studies reported mixed results on the acceptability of localization technology. Technologies included ambient sensors; Bluetooth- or Wi-Fi–received signal strength; localizer tags using radio frequency identification, ultra-wideband, Zigbee, or GPS; and inertial measurement units with localizer tags. Conclusions: The clinical utility of localization remains mixed, with in-home sensors not being able to differentiate between older adults with healthy cognition and older adults with mild cognitive impairment. However, frailty was detectable using in-home sensors. Acceptability is moderately positive, particularly with ambient sensors. Localization technologies can achieve room detection accuracies up to 92% and linear accuracies of up to 5-20 cm that may be promising for future clinical applications. Trial Registration: PROSPERO CRD42022339845; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339845