Preferences and user experience of wearable devices in cardiac rehabilitation: a systematic review and mixed-methods synthesis protocol.

Abstract

Background: Cardiac rehabilitation (CR) is an essential intervention for improving prognosis in patients with cardiovascular diseases. Despite its proven benefits, participation remains suboptimal due to time, geographic, and resource constraints. Wearable devices have emerged as promising tools to support home- and community-based CR by enabling continuous monitoring and personalized feedback. However, evidence on their effectiveness, user preferences, and experiences is inconsistent, and existing research often overlooks patients' subjective perceptions. Understanding these experiences is crucial for optimizing device design and promoting sustained use.

Methods: This systematic review and mixed-methods synthesis has been prospectively registered in PROSPERO (registration number: CRD420251170358) and will be reported in accordance with the PRISMA-P and PRISMA 2020 reporting guidelines. Eligible studies will include quantitative, qualitative, and mixed-methods research focusing on the use of non-invasive wearable devices among CR patients, healthcare providers, or caregivers. Databases including PubMed, Embase, CINAHL, Cochrane Library, CNKI, Wanfang, VIP, and SinoMed will be searched from inception to October 2025, complemented by gray literature and trial registries. Two reviewers will independently conduct study selection, data extraction, and risk of bias assessment using Cochrane RoB 2.0, ROBINS-I, and JBI tools. Quantitative data will be summarized descriptively and, where appropriate, meta-analyzed using random-effects models. Qualitative findings will be synthesized through thematic analysis guided by the Technology Acceptance Model and integrated with quantitative results using a convergent mixed-methods approach.

Discussion: This review will synthesize current evidence on user preferences, experiences, and determinants related to wearable devices in cardiac rehabilitation. The anticipated findings are expected to clarify how factors such as comfort, usability, privacy, and trust influence acceptance and adherence. By integrating quantitative and qualitative evidence, the review will provide a more comprehensive understanding of technology use in CR. These insights may inform patient-centered device design, guide clinical implementation strategies, and highlight priorities for future research and digital health innovation.

Systematic review registration: PROSPERO CRD420251170358.