Revolutionizing Stroke Management with Wearable Technology: A Narrative Review of Clinical Applications, Opportunities, Challenges, and the Future Path Towards Equitable Implementation.

Abstract: Stroke remains a leading global cause of mortality and disability, necessitating innovative approaches to address gaps in prevention, acute care, and rehabilitation. This narrative review synthesizes evidence on the transformative potential of wearable technology (WT) across the stroke care continuum and identifies critical challenges to its equitable implementation. A systematic search of PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, and Google Scholar (up to December 2024) identified 50 studies following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-guided screening and thematic analysis. In prevention, WT facilitates primordial strategies through physical activity tracking and sleep monitoring, while in primary prevention, it enables continuous management of hypertension, atrial fibrillation (AF), diabetes, and sleep apnea. Large-scale trials, such as the Apple Heart Study, validate WT's efficacy in AF detection (84% positive predictive value), though confirmatory medical-grade testing remains essential. For acute care, WT demonstrates promise in early stroke detection through accelerometer-based algorithms and remote neurological assessments. Post-stroke rehabilitation strategies utilize wearable sensors, robotics, and virtual reality to enhance motor recovery, with exoskeletons improving gait speed and sensorimotor feedback increasing upper limb function. Despite these advances, critical barriers persist: fragmented evidence from heterogeneous studies, scarce randomized controlled trials evaluating long-term outcomes, and ethical concerns regarding data privacy and algorithmic bias. Socioeconomic disparities further limit access, particularly in low-resource settings where 70% of stroke deaths occur. To realize WT's potential, stakeholders must prioritize pragmatic trials, standardized protocols, affordable designs, and policies aligning innovation with equity. This review underscores WT's role in global stroke care and advocates for collaborative, patient-centered strategies to bridge gaps.