The Journal of The Textile Institute

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Design and development of textile-based wearable

sensors for real-time biomedical monitoring; a review

Musaddaq Azeem, Muhammad Shahid, Ivan Masin & Michal Petru

To cite this article: Musaddaq Azeem, Muhammad Shahid, Ivan Masin & Michal
Petru (2025) Design and development of textile-based wearable sensors for real-time
biomedical monitoring; a review, The Journal of The Textile Institute, 116:1, 80-95, DOI:
10.1080/00405000.2024.2318500

To link to this article: https://doi.org/10.1080/00405000.2024.2318500

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Group

Published online: 20 Feb 2024.

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THE JOURNAL OF THE TEXTILE INSTITUTE
2025, VOL. 116, NO. 1, 80–95
https://doi.org/10.1080/00405000.2024.2318500

REVIEW ARTICLE

Design and development of textile-based wearable sensors for real-time

biomedical monitoring; a review
Musaddaq Azeem, Muhammad Shahid, Ivan Masin and Michal Petru
Technical University of Liberec, Liberec, Czech Republic

ABSTRACT ARTICLE HISTORY

The growing field of smart textiles has captivated researchers, focusing on advancing functionalities to Received 17 July 2023
enhance human well-being and elevate daily comfort. Wearable sensors, integral to healthcare, hold Accepted 6 February 2024
immense promise for real-time biomedical monitoring, presenting a transformative potential for dis­
ease management and enhanced patient outcomes. Within this domain, textile-based wearable sen­
sors have emerged as a particularly promising technology, boasting advantages such as comfort,
flexibility, and noninvasiveness. This article provides a meticulous overview of the design and develop­
ment of textile-based wearable sensors for real-time biomedical monitoring. A comprehensive litera­
ture review explores existing wearable sensor technologies, emphasizing the advantages and
limitations specific to textile-based sensors. The discussion encompasses considerations for sensor
design, selection, and integration into wearable systems, delving into the evaluation of various sensor
modalities, textile materials, and fabrication techniques. Signal processing techniques, essential for
extracting pertinent biomedical information, and data analysis methods for real-time monitoring are
scrutinized. Biocompatibility, comfort, and user acceptance factors are conscientiously considered,
alongside thorough discussions on calibration procedures and accuracy assessment methods to ensure
the reliability of measurements. The article further explores potential applications of textile-based sen­
sors in real-time biomedical monitoring, encompassing vital signs monitoring, activity tracking, and
disease detection. Human factors and user studies are critically examined to comprehend user accept­
ance, informing design improvements tailored to user needs. Lastly, the article discusses future
research directions and challenges, including considerations for durability, washability, and scalability.
This comprehensive review aspires to equip researchers and practitioners with invaluable insights into
the nuanced realm of textile-based wearable sensors for real-time biomedical monitoring. By fostering
advancements in the field, this review aims to facilitate the seamless translation of this cutting-edge
technology into clinical practice.

GRAPHICAL ABSTRACT

Graphical abstract of Textile-Based Wearable Sensors for Biomedical.

1. Introduction
reacting to changes in the environment originating from
The integration of nanotechnology, smart textiles, and elec­ chemical, mechanical, electrical, and thermal sources, are at
tronics in the textile industry, particularly in healthcare, has the forefront of these developments (Cochrane et al., 2016;
led to significant advancements in modern times. Smart tex­ Ghahremani Honarvar & Latifi, 2017). The increasing
tiles, which encompass textiles capable of sensing and demand for personalized healthcare and the need for

CONTACT Musaddaq Azeem [email protected].

� 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted
Manuscript in a repository by the author(s) or with their consent.
 THE JOURNAL OF THE TEXTILE INSTITUTE 81

continuous monitoring of physiological parameters have These systems encompass the necessary hardware compo­
spurred significant advancements in wearable sensor tech­ nents, communication protocols, and power management
nologies. Smart fabrics can interact with the body of the systems required for seamless data transmission and pro­
wearer and sense the physiology and needs to sustain the longed operation. Integration with mobile applications or
wellness of an individual (Coyle & Diamond, 2016). cloud-based platforms allows for remote monitoring, data
Wearable sensors offer a promising solution for real-time storage, and analysis, enabling personalized healthcare and
biomedical monitoring, enabling early detection and inter­ facilitating the timely detection of abnormalities (A. Ahmed
vention in various health conditions (Barman et al., 2022). et al., 2022; Ding et al., 2021).
Among the diverse array of wearable sensor platforms, tex­ Briefly, the design and development of textile-based
tile-based sensors have gained considerable attention due to wearable sensors for real-time biomedical monitoring hold
their unique advantages, including comfort, flexibility, and great promise in advancing healthcare. These sensors pro­
noninvasiveness. The integration of sensor technology into vide a comfortable and unobtrusive means of capturing vital
textiles enables the development of wearable garments that physiological data, allowing for continuous monitoring in
seamlessly collect and transmit biomedical data, revolutio­ various settings (Zhao et al., 2020). Through the integration
nizing the way we monitor and manage our health (Berglin, of sensing elements into everyday textiles, they offer a con­
2013; Coyle et al., 2009). venient and user-friendly approach to healthcare manage­
Traditional approaches to biomedical monitoring often ment (Fang et al., 2022). This article aims to explore the
rely on cumbersome and intrusive devices, limiting the user’s various aspects involved in the design and development of
mobility and comfort. However, textile-based wearable sen­ textile-based wearable sensors, including sensor selection,
sors offer an alternative paradigm by incorporating sensing fabrication techniques, signal processing, integration with
elements directly into everyday fabrics, such as shirts, socks, wearable systems, and real-time biomedical monitoring
or even undergarments (Choudhry et al., 2021). This integra­ applications. By advancing this field, researchers and practi­
tion provides a discreet and unobtrusive means of capturing tioners can contribute to the realization of personalized,
vital physiological data, allowing individuals to engage in accessible, and efficient healthcare systems (A. Ahmed et al.,
their daily activities without the constraints of conventional 2022; Choudhry et al., 2021; Coccia et al., 2021; Coyle &
monitoring devices. The design and development of textile- Diamond, 2016). Additionally, the design and development
based wearable sensors for real-time biomedical monitoring of textile-based wearable sensors for real-time biomedical
encompass a multidisciplinary approach, merging fields such monitoring center on critical factors such as biocompatibil­
as textiles, materials science, electronics, and data analysis. ity and comfort, ensuring a harmonious interface with the
An essential consideration in this domain is the selection of human body. Calibration and accuracy are paramount,
suitable sensing modalities that can accurately capture and demanding rigorous exploration of calibration methods to
quantify relevant biomedical information (Y. Wang et al., guarantee precise biomedical data. Furthermore, human fac­
2021). Depending on the specific monitoring requirements, tors and user studies play a pivotal role, in determining the
textile-based sensors can encompass a range of modalities, success of these wearable by assessing user acceptance and
including but not limited to electrocardiography (ECG), elec­ satisfaction for seamless integration into daily life.
troencephalography (EEG), electromyography (EMG), respir­
ation rate, temperature, and movement tracking (Tseghai
2. Research overview
et al., 2021). Textile-based sensors offer inherent advantages
over their rigid counterparts, as they conform to the body’s Wearable sensor technologies for biomedical monitoring
contours and allow for seamless integration with clothing. have exploded in the past several years, with numerous
They can be fabricated using a variety of techniques, such as devices available on the market. Many of these devices are
embroidery, printing, or weaving, enabling the sensors to be based on textile-based sensors, which have several advan­
seamlessly integrated into the fabric structure. Additionally, tages over traditional sensors, including flexibility, comfort,
advancements in conductive textiles, flexible electronics, and ease of use, and non-invasiveness. Textile-based sensors are
wireless communication have further facilitated the develop­ also capable of collecting a wide range of data, including
ment of textile-based wearable sensors (Goud et al., 2021; temperature, pressure, motion, and physiological signals.
Khoshmanesh et al., 2021). Recent research has focused on developing textile-based sen­
Real-time monitoring of biomedical signals requires sors for specific biomedical applications, including monitor­
sophisticated signal processing and data analysis techniques. ing heart rate, respiratory rate, and blood pressure (Cay
Signal processing algorithms are employed to filter out et al., 2022; Hatamie et al., 2020; Lo Presti et al., 2019).
noise, extract relevant features, and identify patterns indica­ The wearable integrates various sensors, electrodes, and
tive of various health conditions. Moreover, data analysis bus structures within a textile garment, allowing the patient
methods enable the interpretation of collected data, facilitat­ to engage in normal daily activities without discomfort. The
ing clinical decision-making and providing actionable system includes a custom app for real-time visualization of
insights for users and healthcare professionals (Amitrano signals and a software desktop for offline plotting and signal
et al., 2020; Choudhry et al., 2021; Cohen, 2019; Subasi, processing. The device design underwent a validation ana­
2019). The integration of textile-based sensors into wearable lysis focusing on ECG measurement and digital processing,
systems is another crucial aspect of their development. and the results were encouraging, demonstrating the
82 M. AZEEM ET AL.

prototype’s ability to obtain reliable measurements. However, textile-based sensors also have certain limita­
However, the paragraph also highlights the need to improve tions that need to be considered. One limitation is the
electrode adherence to reduce motion artifacts, which can potential degradation of sensor performance over time due
interfere with signal processing and impact the overall per­ to mechanical stress, repeated washing, and environmental
formance of the device (Coccia et al., 2021). Sweatsock, factors (Blachowicz et al., 2021). Another limitation is the
when utilized by nurses and therapists during their working complexity of signal processing and data interpretation
hours, has the potential to effectively monitor postural and (Coccia et al., 2021). Textile-based sensors often generate
dynamic variables in activities commonly linked to bio­ large amounts of data, requiring advanced algorithms for
mechanical strain. These activities encompass frequent signal analysis and pattern recognition to extract meaningful
patient handling, pushing and pulling, adopting awkward information (Y. Zhang et al., 2020). Furthermore, textile-
postures, prolonged standing, and significant sideways twist­ based sensors may face challenges in terms of sensitivity
ing (Coccia et al., 2021). A previous study suggested that and specificity compared to traditional rigid sensors (Heo
non-metallic fibers may become increasingly popular in the et al., 2020; Niu et al., 2019).
future. The most prevalent wearable technologies for the
arm and hand are smart watches and wristbands, which pri­ 2.2. Recent research and developments
oritize comfort and freedom of movement. The paragraph
also mentions the commercial applications of wristbands, Researchers are exploring new materials and fabrication
specifically in terms of orientation. It emphasizes that wear­ methods to improve the performance of textile-based sen­
able devices generally include sensors, processing units, and sors. Developments in nanotechnology have led to the cre­
power sources, highlighting the significance of meeting the ation of advanced functional textiles, including those that
criteria of natural clothing, including comfort and appear­ can detect changes in temperature, moisture, and physio­
ance, in wearable products (Seçkin et al., 2022). logical signals. Recent research has also focused on develop­
With the increasing sophistication and complexity of ing wearable sensors for remote monitoring of chronic
wearable systems, issues such as outfit deformation during diseases, such as diabetes and asthma. Several challenges
use and limited launderability have emerged as potential must be overcome to make textile-based wearable sensors
barriers to the widespread adoption of these smart systems. more widely used in healthcare, including regulation, stand­
However, with growing consumer awareness and demand ardization, and data privacy and security concerns (Adak &
for lifestyle products, it is expected that wearable monitoring Mukhopadhyay, 2023; Ballaji, 2022). The concept behind
outfits will find broader applications among individual con­ wearable sensing devices is to facilitate seamless integration
sumers. Particularly, considering the aging population, these of the sensor technology into daily life routines. When
selecting materials for sensor development, factors such as
clothing systems can play a crucial role in promoting the
lighter weight, stretchability, and wearability are considered
independence of disabled and elderly individuals, enabling
advantageous. These characteristics are sought not only in
them to carry out their daily activities while being moni­
health monitoring applications but also in fields like bio­
tored by online monitoring systems (Zahid et al., 2022).
medical research, sports performance tracking, and military
applications (Zahid et al., 2022). Advancements in manufac­
2.1. Advantages and limitations of textile-based sensors turing techniques have led to the maturation of various
printing processes, particularly the remarkable progress in
Textile-based sensors have gained significant attention in three-dimensional (3D) printing, which has demonstrated
recent years due to their unique advantages in various appli­ great potential in advanced manufacturing. Although chito­
cations. One of the notable advantages is their inherent san-based hydrogels (CS-Gels) have made significant strides
compatibility with wearable electronics, as textiles are flex­ in their application for flexible wearable devices, there are
ible, lightweight, and conformable to the human body. This still substantial opportunities and challenges surrounding
allows for seamless integration of sensors into garments, their preparation, functionality, and practical implementa­
enabling continuous and unobtrusive monitoring of physio­ tion. Presently, the detection capabilities of CS-Gels sensors
logical signals such as heart rate, respiration, and body are relatively limited, and there is a need to enable multi-
movement. Moreover, textile-based sensors offer improved dimensional signal monitoring to enhance their practical
comfort compared to traditional rigid sensors, enhancing utility. In addition to capturing stress-strain signals, moni­
user compliance and long-term wearability (Hasan & toring changes in physiological parameters such as tempera­
Hossain, 2021; Nigusse et al., 2021). Another advantage of ture, humidity, and pH within the human body can
textile-based sensors is their ability to monitor large surface effectively reflect alterations in an individual’s health status.
areas, providing spatially distributed sensing capabilities. Therefore, the development of CS-Gels sensors with fast
This feature is particularly useful in applications such as response rates, high sensitivity, and a wide detection range
pressure mapping for smart textiles and posture monitoring for signals such as temperature, humidity, and pH holds sig­
for healthcare and sports performance analysis. Additionally, nificant potential in the field of smart wearable and
textile-based sensors can be easily integrated into the fabric implantable devices (Wu et al., 2023).
during the manufacturing process, offering cost-effective MXenes, novel inorganic nanomaterials characterized by
and scalable production (M. R. Ahmed et al., 2022). their ultrathin atomic thickness, are composed of layered
 THE JOURNAL OF THE TEXTILE INSTITUTE 83

transition metal carbides and nitrides or carbonitrides, rep­ stability and durability, managing power and communication
resented by the general structural formula Mnþ1XnTx requirements, addressing data security and privacy concerns,
(n ¼ 1–3). The distinctive structural properties of MXenes, and enhancing user acceptance are key areas for improve­
including their ultrathin atomic layers and high specific sur­ ment. Overcoming these challenges is crucial for the contin­
face area, coupled with their exceptional physicochemical ued evolution of textile-based wearable biosensors, which
characteristics such as high photothermal conversion effi­ have the potential to revolutionize health monitoring, medical
ciency and antibacterial properties, have led to their exten­ management, and personal health care, offering more accur­
sive utilization in the field of biomedicine. The focused ate, convenient, and personalized support in the future (S. Li
analysis of their applications in various areas such as biosen­ et al., 2023).
sors, diagnosis, therapy, antibacterial agents, and implants
has been practiced (H. Li et al., 2023). Ionic liquid (IL)-
3. Sensor selection and design considerations
based gels, also known as ionogels, have gained significant
attention due to their unique advantages in terms of ionic Various sensor modalities are available for textile-based
conductivity and their ability to exist in a biphasic liquid- wearable sensors, such as piezoresistive, capacitive, piezo­
solid phase. Ionogels retain the nonvolatile IL within a 3D electric, and optical sensors. Consideration of factors such
interconnected pore structure. These physical characteristics, as sensitivity, accuracy, and power consumption is crucial
along with the chemical properties of carefully selected ILs, while selecting an appropriate sensor modality. The sensors
have sparked interest in their antibacterial properties and should have a biocompatible, flexible, and washable nature,
biocompatibility. With diverse functionalities, ionogels which is compatible with wearable electronics (X. Liang
designed for biomedical applications can be categorized into et al., 2022; Wang et al., 2021). Two main biomedical wear­
various active domains, including wearable strain sensors, able sensors prevail in the field of textiles. The description
therapeutic delivery systems, wound healing, and biochem­ of these sensors is given in Figure 1.
ical detection (Fan et al., 2023). The field of flexible wearable antenna sensors has gained
Recent advancements in technology have spurred the significant attention from both the industry and the scien­
development of smart sensors using flexible materials, over­ tific community. As the interest continues to grow, several
coming traditional structural barriers. The integration of key issues and challenges have been identified for future
flexible polymeric materials into wearable sensors allows for research in this area: (1) There is a need to improve the
seamless incorporation into woven textile fabrics, maintain­ accuracy and effectiveness of the techniques used to manu­
ing fabric flexibility while withstanding mechanical deforma­ facture and measure flexible wearable antenna sensors.
tions. These sensors, acting as antennas, enable real-time, Advancements in these areas will contribute to the develop­
noninvasive health monitoring, contributing to innovations ment of more reliable and high-performance sensors. (2)
in telemedicine, biomonitoring, and rehabilitation. The market would benefit from the introduction of yarns
Polymers, particularly electroactive and intrinsically con­ and conductive fabrics that exhibit lower resistivity or
ductive polymers, play a vital role in wearable devices, pro­ higher conductivity. These advancements would enable the
viding optical and electrical properties for smart creation of more efficient and responsive antenna sensors.
monitoring. Ongoing research is focused on enhancing sen­ (3) The exploration of novel materials specifically designed
sor capabilities, addressing challenges like mechanical dur­ for embroidery techniques or the introduction of innovative
ability, power management, and user acceptance, with the manufacturing techniques would expand the possibilities for
ultimate goal of providing more accurate, comfortable, and creating flexible wearable antenna sensors. Such develop­
personalized health support (Zahid et al., 2022). ments would enhance the flexibility, comfort, and function­
Geographically, North America is projected to hold the ality of these sensors. (4) The integration of antenna sensors
largest market share, attributed to the presence of key players, into textile substrates that can be comfortably worn on the
heightened consumer awareness, and widespread adoption of body holds great potential. This approach would allow for
wearable sensors. The commercial wearable sensors market is seamless integration of sensors into clothing or wearable
anticipated to witness continued growth, fueled by increased accessories, enabling unobtrusive monitoring and data col­
utilization for health monitoring, fitness tracking, and diverse lection. Different types of Antenna sensors are described in
applications, alongside technological advancements and grow­ Figure 2 (El Gharbi et al., 2020).
ing consumer demand for smart, interconnected devices Design and development of textile-based wearable sensors
(Mukhopadhyay et al., 2022; B. Yang et al., 2021). The char­ for real-time biomedical monitoring requires careful selec­
acteristics of stretchability, comfort, breathability, and bio­ tion of sensor modalities and considerations of various fac­
compatibility in fabric materials contribute to the success of tors such as sensitivity, accuracy, and power consumption.
textile-based wearable biosensors, offering a comfortable Different textile fabrication techniques like screen printing,
wearing experience. In healthcare, these biosensors play a embroidery, and knitting could be used to fabricate sensors
crucial role in real-time, non-invasive monitoring of physio­ on textiles. Integration of electronic components with the
logical indicators, providing valuable insights into respiratory textile substrates could be achieved using various methods,
rate, pulse, blood pressure, and more. Despite their potential, including bonding, stitching, and embroidery. Care should
challenges persist, such as issues with target parameter select­ be taken to maintain the mechanical properties and wash­
ivity and signal interference in multimodal sensors. Ensuring ability of the textile-based wearables while integrating the
84 M. AZEEM ET AL.

Figure 1. Textile-based wearable sensors for biomedical.

sensor unit exhibits remarkable characteristics, including

exceptional sensitivity (14.4 kPa−1), an impressively low
detection limit (2 Pa), rapid response time (approximately
24 ms), minimal power consumption (less than 6 mW), and
outstanding mechanical stability even when subjected to
severe deformations. The sensor’s capabilities encompass the
recognition of finger movements, hand gestures, acoustic
vibrations, and real-time pulse waves. Additionally, we have
successfully developed large-area sensor arrays on a single
textile substrate, enabling the spatial mapping of tactile
stimuli. These sensor arrays can be seamlessly integrated
into fabric garments, allowing for stylish designs without
Figure 2. Types of antenna sensors.
compromising comfort. This development highlights the
immense potential of smart textiles and wearable electronics
electronic components. These wearable sensors provide an (M. Liu et al., 2017).
innovative and noninvasive way for continuous and remote
monitoring of various physiological parameters (Coccia 4. Signal processing and data analysis
et al., 2021).
The textile pressure sensor is a highly promising option Textile-based wearable sensors are being developed for real-
for the next-generation sensing platform due to its seamless time biomedical monitoring, allowing for remote and con­
integration into modern garments, offering breathability and tinuous health assessment. These sensors can collect large
conformability. This summary introduces the principles, amounts of data, requiring advanced signal-processing tech­
materials, techniques, and recent advancements in textile- niques for extracting relevant biomedical information. Signal
based pressure sensors. However, challenges such as cost, processing involves the manipulation of raw sensor data to
lack of standards, reliability, sensitivity range, and service extract useful information about the wearer’s health. This
life hinder the rapid expansion of textile-based pressure sen­ involves techniques for noise reduction, feature extraction,
sors. Overcoming these challenges requires technology mat­ and classification. Noise reduction algorithms are used to
uration, mass production, and the development of remove unwanted signals from the raw data, such as motion
functional electronic textiles (E-textiles). Pressure sensors artifacts, environmental noise, or baseline wander, to
are crucial for electronic skin (e-skin), human-computer improve the accuracy of the measurements. Advanced tech­
interaction, and physiological signal monitoring, requiring niques such as adaptive filtering, wavelet transform, and
high sensitivity across a wide measurement range. Failure to principal component analysis can be used for effective noise
provide a linear response within the effective test range can suppression (D. Yang et al., 2018).
lead to reduced real-time response speed and increased Improvements are necessary in the field of electrochem­
power consumption (J. Zhang et al., 2022). The textile ical methods as the obtained signal must be compared either
 THE JOURNAL OF THE TEXTILE INSTITUTE 85

with a calibration curve or a standard method. A significant nanorods, nanoparticles (NPs), and thin films. Nanotechnol­
concern arises from the stability of wearable sensors, par­ ogies also facilitate the development of functional materials,
ticularly electrochemical sensors, due to issues like passiv­ devices, and nanorobots, potentially addressing critical med­
ation and biofouling of the electrode surface. These factors ical issues and aging-related health problems. The review
increase the risk of incorrect responses during operation, emphasizes the challenges associated with the commercial-
which is especially critical when employing enzymes or bio­ scale production of nanomaterials for biomedical applica­
logical recognition agents for on-body measurements. tions, highlighting the need for cost-effective, scalable syn­
Furthermore, power sources continue to pose challenges for thesis methods. Despite the progress, there are relatively low
such sensors. Ideally, an optimal power source should be percentage of publications focused on nanotechnology appli­
compact, provide stable and sufficient energy, offer flexibil­ cations in biomedical and biological engineering, indicating
ity for increased comfort, and be near the sensor. Therefore, a need for further exploration and analysis in this area. The
it is essential to design more robust and stable sensing review aims to fill this gap by providing detailed informa­
mechanisms and components to enable accurate measure­ tion on recent trends and advances in nanotechnology for
ments, ensuring enhanced chemical and mechanical stability biomedical applications, focusing on nonbiological materials
for long-term use. Moreover, while nanomaterials have (Mabrouk et al., 2021; Singh & Patel, 2022).
shown promise in flexible sensors for improved sensing per­
formance, their potential biocompatibility and toxicity must
be thoroughly considered and investigated (Hatamie et al., 5. Biocompatibility and comfort
2020). Biocompatibility is the ability of a material to perform with
Feature extraction involves identifying relevant features an appropriate host response in a specific application with­
from the sensor data and mapping them to specific physio­ out causing harm or injury to the host. Textile-based wear­
logical parameters, such as heart rate, respiration rate, or skin able sensors require biocompatible materials to ensure they
temperature. Techniques such as Fast Fourier Transform, lin­ do not cause irritation or harm to the skin, especially in
ear and nonlinear regression, and peak detection can be used long-term continuous wear applications. Common biocom­
to extract relevant features. Classification algorithms are used patible materials used in textile-based sensors include cot­
to categorize the extracted features into specific disease states ton, silk, nylon, and polyester because they are naturally
or physiological conditions. Supervised and unsupervised hydrophilic, porous, and do not cause skin irritation.
learning algorithms, such as artificial neural networks, deci­ Hydrogels are used as a conductive medium and provide
sion trees, support vector machines, and clustering algorithms, excellent biocompatibility, but their low strength and high-
can be used for classification. Data analysis approaches are water content limit their use in textile-based sensors.
important for real-time monitoring and health assessment, Strategies for ensuring skin contact safety and comfort
allowing clinicians to make informed decisions based on the include incorporating breathable materials, using soft and
sensor data. Simple statistical methods, such as mean and flexible substrates, and avoiding rough surfaces and sharp
standard deviation, can be used for real-time analysis. edges. Textile-based sensors should be washable, and their
Advanced methods, such as time-frequency analysis, entropy electrical properties should not be degraded after washing to
metrics, and spectral analysis, can be used for more sophisti­ maintain the sensor’s effectiveness. User acceptance and
cated data analysis. Overall, effective signal processing and usability factors, such as clothing comfort and fit, are essen­
data analysis techniques are essential for the development of tial for the widespread adoption of textile-based wearable
accurate and reliable textile-based wearable sensors for bio­ sensors. Overall, designing and developing textile-based
medical monitoring, enabling continuous and remote health wearable sensors for real-time biomedical monitoring
assessment for a variety of applications (Majumder et al., require careful consideration of biocompatibility and com­
2017; Sonawani et al., 2023). The groundbreaking progress in fort to ensure patient safety and user acceptance (Ates et al.,
the biomedical field, particularly in the realms of nanotechnol­ 2022).
ogy and material science, has led to significant advancements Thermal comfort has become a key issue for determining
in the development of flexible smart sensors for healthcare. building thermal-energy performance and, in general, the
well-being and productivity of occupants indoors. Human-
centric measurement techniques represent the key turning
4.1. Nanotechnology and materials in biomedical
point to support people-centric design and control of the
sensors
built environment to guarantee well-being, energy saving,
Recent developments in nanotechnology and material sci­ and environmental sustainability. This is the reason that
ence have revolutionized the biomedical field, particularly in motivated this review effort, framing all the sensing techni­
the design of smart sensors using flexible materials for ques and achieved results so far, deserving a further effort
applications such as healthcare. Nanotechnologies play a to be exhaustively exploited for indoor thermal comfort
vital role in various fields, including medicine, offering the measurement. In terms of new technologies used for ther­
creation and control of nanoscale materials for healthcare mal comfort investigation, this review highlights that wear­
applications. The integration of nanostructured materials able devices may represent a promising alternative for
with biological subjects has paved the way for innovative estimating thermal comfort over time in transient condi­
applications, such as biosensors using nanotubes, nanofibers, tions. The application of wearable devices is incentivized by
86 M. AZEEM ET AL.

their improved portability, as well as by new technologies promising signs indicating progress and innovation in this
and designs with low time of application, low invasiveness, field (Yuan et al., 2022).
and competitive costs. However, wearable devices are still As a result, a variety of invasive and noninvasive wear­
prone to collect artifacts, introducing inevitably uncertainties able devices that can capture biosystematic data have been
in the collected data that lead to incorrect results. For this developed, and they have proven to be useful in disease
reason, complex data processing should be considered as diagnosis and detection. However, their effective acceptance
still needed for their large-scale exploitation in real life by wearers/patients has been hampered by their perform­
(Khan et al., 2016). ance life-span, wearability, expense, and comfort.
The assessment of thermal comfort has become crucial in Furthermore, its psychological impact has been identified as
evaluating the thermal-energy performance of buildings and a contributing factor in slow recovery rates. Fortunately,
ensuring the well-being and productivity of occupants with the advancement in miniature technology and the tex­
indoors. To achieve people-centric design and control of the tile industry, this new fusion can be the solution to the pre­
built environment, human-centric measurement techniques dicaments faced by traditional wearable devices. The
play a pivotal role, enabling the optimization of well-being, solution lies in bridging textile-based wearable biomedical
energy efficiency, and environmental sustainability. devices with textile-based energy harvesters which can pro­
Motivated by this objective, this review aims to comprehen­ vide a continuous source of power that can be generated
sively explore sensing techniques and the results achieved from the wasteful energy.
thus far in the field, to fully leverage them for indoor ther­ A wide range of invasive and noninvasive wearable devices
mal comfort measurement. Regarding the use of new tech­ capable of capturing biosystematic data have been developed,
nologies in thermal comfort research, this review proving to be valuable in disease diagnosis and detection.
However, their acceptance by wearers and patients has been
emphasizes the potential of wearable devices as a promising
hindered by factors such as limited performance lifespan,
alternative for assessing thermal comfort in transient condi­
wearability issues, high cost, and discomfort. Additionally, the
tions over time. Wearable devices are attractive due to their
psychological impact of these devices has been identified as a
enhanced portability, advancements in technology and
contributing factor to slow recovery rates. Fortunately, the
design, shorter application times, lower invasiveness, and
fusion of miniature technology and the textile industry offers
competitive costs. However, it is important to acknowledge
a potential solution to address the challenges faced by trad­
that wearable devices are susceptible to collecting artifacts,
itional wearable devices. By combining textile-based wearable
which can introduce uncertainties and result in inaccurate biomedical devices with textile-based energy harvesters, a
data. Consequently, complex data processing is still neces­ continuous source of power can be generated from wasted
sary for their effective large-scale utilization in real-life scen­ energy, overcoming the limitations of battery life. This inte­
arios (Mansi et al., 2021). gration holds promise in improving the performance, wear­
Flexible wearable sensors offer unique advantages in terms ability, and comfort of wearable devices. This advancement in
of comfort, flexibility, and direct contact with human skin textile-based wearable biomedical devices and energy harvest­
and tissues, setting them apart from traditional rigid sensors. ers has the potential to enhance user acceptance, reduce cost,
It is crucial to carefully select the appropriate manufacturing and promote faster recovery rates. By leveraging the capabil­
processes and flexible materials to ensure user safety and ities of the textile industry and the advancements in mini­
minimize environmental pollution. The use of soft and self- aturization, a new generation of wearable devices can be
healing materials as substrates can significantly enhance the developed that addresses the limitations of traditional devices
sensor’s service life. However, one challenge faced by flexible and offers improved functionality and user experience (Iyer
sensors is the limited capacity of their batteries to meet long- et al., 2022).
term power supply demands. As the market offers a wide
range of wearable sensors, people’s monitoring needs are
growing alongside the increasing availability of sensor types. 6. Calibration and accuracy assessment
To address these needs, the future direction of development Textile-based wearable sensors are becoming increasingly
will focus on multi-functional sensors that can cater to popular for real-time biomedical monitoring. However, it is
diverse monitoring requirements. Smart sensors with selectiv­ crucial to ensure their accuracy and reliability for wide­
ity tailored to specific monitoring needs will also gain atten­ spread adoption. This is where calibration and accuracy
tion. However, factors such as poor sensitivity and stability, assessment come into play. Calibration is the process of
complex operating procedures, and expensive manufacturing determining the relationship between sensor readings and
equipment hinder the large-scale industrial production of the actual value of the measured quantity (Massaroni et al.,
these sensors. Interference from signal crosstalk and harsh 2016). Calibration of textile-based wearable sensors involves
environmental conditions can disrupt analytical data and the following steps (X. Liu et al., 2022; Presti et al., 2018):
compromise the stability of the sensor system. Enhancing
sensitivity and selectivity is a vital solution to overcome these � Identification of the sensor’s response to a known stimu­
challenges. Additionally, designing cleaner circuits can min­ lus or input.
imize potential noise. Despite the obstacles in developing flex­ � Establishment of a mathematical relationship between
ible wearable sensors for medical monitoring, there are the sensor output and the known input.
 THE JOURNAL OF THE TEXTILE INSTITUTE 87

� Determination of calibration coefficients using statistical He et al., 2023; Heo et al., 2018; T. Liang & Yuan, 2016;
methods. Sonawane et al., 2017):

To ensure the accuracy and reliability of measurements � Incorporating sensors into clothing items such as shirts,
obtained from textile-based wearable sensors, several meth­ socks, and gloves.
ods can be employed (Jang et al., 2022). These methods � Adding sensors to accessories such as headbands, wrist­
include (Choudhry et al., 2021; Kwak et al., 2019): bands, or belts.
� Using a modular approach where sensors can be added
� Ensuring each sensor is calibrated before use. or removed depending on the user’s needs.
� Employing signal processing techniques to remove noise. � Communication protocols and data transmission
� Continuously monitoring and calibrating sensors dur­ methods:
ing use. � Bluetooth Low Energy (BLE) is a commonly used com­
� Reducing interference from other sources. munication protocol for wearable devices.
� Other options include Wi-Fi, Zigbee, and RFID.
Validation studies are essential to determine the accuracy � Data transmission methods should be reliable and secure
and reliability of textile-based wearable sensors. These stud­ to ensure accurate monitoring and interpretation of data.
ies typically involve comparing sensor measurements with
those obtained using gold-standard techniques. These gold By summarizing the existing knowledge on flexible and
standard techniques are well established, and their measure­ textile-based batteries and highlighting future directions, this
ment accuracy and reliability are known. Several validation review also aims to contribute to the advancement of fabric-
studies have been reported in recent years, focusing on dif­ based printed batteries, enabling the realization of wearable
ferent applications such as health and wellness monitoring, and E-textiles with improved power capabilities and longer-
sports performance monitoring, and chronic disease man­ lasting performance (Ali et al., 2021; Khan et al., 2016).
agement. These studies have shown that textile-based wear­
able sensors can provide accurate and reliable � Textile-based sensors often require low power consump­
measurements. Calibration and accuracy assessment are crit­ tion to avoid bulky batteries or frequent recharging.
ical to ensuring the accuracy and reliability of textile-based � Energy harvesting techniques, such as using solar panels,
thermoelectric generators, or piezoelectric generators,
wearable sensors for real-time biomedical monitoring.
can help to extend battery life or eliminate the need for
Employing appropriate calibration techniques and ensuring
batteries.
continuous monitoring and calibration during use can
� Power management strategies should also consider opti­
improve measurement accuracy and reliability. Comparing
mizing the power consumption of other wearable com­
sensor measurements with those obtained using gold-stand­
ponents to maximize overall battery life.
ard techniques can validate the performance of textile-based
wearable sensors (Maselli et al., 2018). The investigation was
also done on the response of a piezoresistive sensing elem­ 8. Real-time biomedical monitoring applications
ent through laboratory tests involving calibration curve ana­
Textile-based wearable sensors have the potential for real-
lysis and hysteresis evaluation. Additionally, it has been
time biomedical monitoring for various applications. These
utilized the sensing element for monitoring the respiratory
sensors can be integrated into clothing or fabrics to monitor
rate of six healthy volunteers. Through the calibration curve
vital signs, activity tracking, and disease detection. These
analysis, we observed that the system exhibited high sensi­
sensors have been used for various biomedical monitoring
tivity, enabling the detection of chest wall movements asso­
applications, including monitoring of cardiovascular activity,
ciated with respiration. This sensitivity is crucial for movement and posture tracking, respiratory rate monitor­
accurately capturing and monitoring respiratory activity. By ing, glucose monitoring, sweat analysis for disease detection,
using the piezoresistive sensing element, a successful moni­ sleep monitoring, and body temperature monitoring (Lanat�a
toring of the respiratory rate has been done of the healthy et al., 2009; Mattmann et al., 2008).
volunteers. This demonstrates the potential application of A novel e-textile-based system called sweatshirt has been
the sensing element in real-time respiratory rate monitoring developed for remote monitoring of biomedical signals. The
(Molinaro et al., 2018). system consists of a textile sensing shirt, an electronic unit
for data transmission, a custom-made Android App for
7. Integration with wearable systems real-time signal visualization, and web software for advanced
digital signal processing. The sweatshirt allows for the acqui­
Textile-based sensors are becoming more popular due to sition of electrocardiographic, bicep electromyographic, and
their versatility, flexibility, and wearable comfort. Integrating trunk acceleration signals. These sensors, electrodes, and bus
these sensors with wearable systems requires careful consid­ structures are seamlessly integrated into the textile garment,
eration of components, communication protocols, and ensuring user comfort without any discomfort. To comple­
power management. Strategies for integrating textile-based ment the hardware, a comprehensive set of algorithms for
sensors into wearable platforms include (Barua et al., 2022; signal processing has been developed, enabling clinicians to
88 M. AZEEM ET AL.

quickly obtain a comprehensive overview of a patient’s clin­ In sports settings, textile-based wearable sensors can be used
ical status. Overall, this study showcases the successful to monitor athletes’ physical activity levels and track their
design and development of the sweatshirt, a wearable e-tex­ performance. In home healthcare settings, textile-based
tile-based system for remote monitoring of biomedical sig­ wearable sensors can be used to monitor patients’ vital signs
nals. The validation analysis confirms the device’s and detect early signs of disease or complications.
effectiveness in capturing accurate and reliable data, high­ Therefore, textile-based wearable sensors have the potential
lighting its potential as a valuable tool in clinical settings to revolutionize real-time biomedical monitoring in various
(Coccia et al., 2021). settings. These sensors can be used for monitoring vital
Additionally, another study describes the development of signs, activity tracking, and disease detection, and provide
a stretchable and sensitive fiber strain sensor by embedding valuable insights into an individual’s health status. With
a large amount of Ag NPs into a stretchable fiber matrix continued advancements in wearable sensor technology, we
using a harmless in situ formation process. Optimization can expect to see even more innovative applications in the
approaches were implemented to improve the sensing per­ future (Kan & Lam, 2021).
formance of the sensor. Despite using a mild and harmless
reducing agent, the fiber strain sensor exhibited excellent
electrical resistance, strain sensing range, sensitivity, and sta­ 8.2. Textile-based wearable sensors and their
bility. The sensor was integrated into textiles for real-time applications
gesture recognition and was demonstrated to help users Smart monitoring garments can be employed in the medical
maintain accurate posture during exercise. The fiber strain sector to facilitate continuous long-term observation of
sensor shows potential for applications in stretchable elec­ patients’ conditions. Capacitive sensors were employed in
tronics, textile electronics, and wearable electronics (Kim the field of pressure sensitivity within the scope of human
et al., 2021). touch, leveraging unique weaving techniques and a die-coat­
ing system (Takamatsu et al., 2012). Capacitive sensors
show high sensitivity and accuracy, but the signals could be
8.1. Monitoring vital signs, activity tracking, and
affected by environmental factors like humidity and stray
disease detection
capacitance. Piezoresistive sensors exhibit high stability, sen­
Vital signs such as heart rate, blood pressure, and oxygen sitivity, and repeatability, which make them ideal for bio­
saturation can be monitored in real-time using textile-based medical monitoring applications. Piezoelectric sensors
wearable sensors. Activity tracking can provide valuable generate electrical signals when subjected to a mechanical
insights into an individual’s physical activity levels, which force, which can be utilized for physiological monitoring.
can be helpful in monitoring and managing chronic dis­ Optical sensors are suitable for low power consumption and
eases. Textile-based wearable sensors can also be used for non-invasive monitoring of various physiological parame­
early disease detection, such as detecting changes in glucose ters. The utilization of piezoelectric and piezoresistive sen­
levels for diabetes patients. In clinical settings, textile-based sors with various polymers has been implemented, and a
wearable sensors can be used to continuously monitor summary of their characteristics and applications used in
patients’ vital signs and detect early signs of deterioration. previous studies has been provided in Table 1.

Table 1. Utilization of piezoelectric and piezoresistive sensors with various polymers.

Polymer Characteristics Applications
Piezoelectric Sensors
Polyvinylidene fluoride (PVDF) (Lanat�a et al., 2009) Supplied with an advanced electronic control unit These sensors are designed to monitor
and wireless communication capabilities. cardiopulmonary activity.
Poly (vinylidene fluoride-co-trifluoroethylene) The melt-spinning process is employed for the Highly responsive to strain and stress stimuli.
(Kechiche et al., 2013) production of filaments.
PVDF, high-density polyethylene (HDPE) (Nilsson Carbon black (CB) is incorporated to enhance the Utilized for the detection of human heartbeat.
et al., 2013) conductivity of composites.
Polypyrrole/polyurethane (PPy/PU) elastomer To amplify the conductivity of the sensor, a A waistband-like sensor designed to monitor
(Balint et al., 2014) dopant called anthraquinone-2-sulfonic acid human breath patterns.
sodium was introduced.
Piezoresistive Sensors
Thermoplastic elastomer (PPyTPE) (Mattmann A silicone film was employed to securely attach Capable of detecting and recognizing 27 different
et al., 2008) the sensor thread to textiles. upper body postures.
Polypyrrole (Munro et al., 2008) Ferric chloride (FeCl3) as oxidant and 1,5 An intelligent knee sleeve designed to monitor
naphthalene sulfonic acid tetrahydrate (NDSA) and track strain levels.
as dopant was used.
Polyaniline (PANI) (Muthukumar & Thilagavathi, Ammonium persulphate was used for Strain sensor
2012) polymerization.
PU/PEDOT:PSS (poly(3,4-ethylenedioxythiophene) Polymer-coated fibers and commercial Spandex A combination of PU/PEDOT: PSS fibers and a
polystyrene sulfonate (PEDOT:PSS)) (Seyedin yarn were combined through a wet spinning commercial Spandex yarn were co-knitted
et al., 2015; Yamaji et al., 2017) process during co-knitting. together.
Elastomer Sensors (Yamaji et al., 2017) CNT (carbon nanotube) is positioned between two A strain sensor designed for the rapid prototyping
polymer sheets, effectively serving as an of human interfaces.
electrode.
 THE JOURNAL OF THE TEXTILE INSTITUTE 89

9. Human factors and user studies various postures, while on the move, and even when the
hand is holding an object. WatchSense estimates fingertip
Examination of user acceptance, comfort, and usability
locations, identities, and touch positions, enabling new types
through human factor studies is paramount in determining
of interactions and supporting continuous input and multi­
the success of wearable sensors. These studies should
touch gestures such as pinch on the back of the hand. The
meticulously assess factors such as comfort, ease of use, and
system combines mid-air gestures with back-of-hand inter­
potential barriers to adoption. User feedback becomes a cru­
actions, enhancing the expressiveness of input. Additionally,
cial tool in identifying current design shortcomings and
finger identification enables the triggering of events and
guiding future improvements. Discussions on user experien­
mapping of controls to specific fingers. The real-time detec­
ces with textile-based wearable sensors are essential to
tion of fingertips, identities, and touch on the back of the
understanding how these devices are utilized and whether
hand poses challenges in computer vision due to wrist
they effectively meet user needs across various scenarios like
motion, oblique viewpoint, occlusions, fast motions, and
physical activity, showering, or sleeping. Unobtrusive and
fingertip ambiguity. The research presents a novel algorithm
user-friendly design improvements, aligned with user prefer­
that addresses these challenges, providing a fast, accurate,
ences, should be implemented based on this feedback.
and robust solution for sensing fingertip locations, identities,
Evaluating factors such as textile material, sensor placement,
and touch on the back of the hand. Furthermore, it demon­
and sensor type according to user preferences ensures the
strates that the back-of-hand input can not only expand the
wearable sensors seamlessly integrate into users’ lifestyles,
input space for smart watches but also enable input for
positively contributing to their overall well-being. Human
ambient devices such as public displays (Sridhar et al.,
factor studies are pivotal in developing relevant, effective,
2017). The increasing availability of computational resour­
and user-friendly wearable sensors for real-time biomedical
ces, such as GPU devices, and the ease of collecting sensory
monitoring, with continuous consideration of user feedback
signals from smartphones and wearable devices have con­
throughout the design process.
Advancements in wearable sensors and AI algorithms tributed to the growth of this field. The article explores the
present significant potential for shifting from population- unique implementation and design, advantages, and limita­
based to individual-based epidemiological studies, capturing tions of various deep neural network models. Additionally,
personalized data on human exposure. Comprehensive it discusses benchmark datasets commonly used for per­
research on personal exposures, considering dietary charac­ formance evaluation and provides insights into their cre­
teristics, exercise patterns, and daily habits, can greatly ation and collection processes (Ramanujam et al., 2021).
enhance personal health monitoring. The integration of
large-scale AI-enabled personal flexible wearable sensors has 10. Future directions and challenges
the potential to elevate the intelligence of medical services
and enhance the overall healthcare experience (Shan et al., Future research directions in textile-based wearable sensors
2020). would be the integration of more advanced sensors for spe­
Numerous review studies have explored wearable tech­ cific purposes such as temperature, pressure, and chemical
nology, but one specific study presents a review of previous sensors (Hatamie et al., 2020). The evolution of wearable
research on wearable computing studies. To the best of the technologies involves the development of specialized sensors
authors’ knowledge, there have been no comprehensive for areas like heart monitoring, sleep analysis, and stress
review studies on wearable wrist-worn devices (WWDs) that detection. Incorporating artificial intelligence and machine
consider multiple aspects. The article discusses various types learning algorithms for data analysis and interpretation is
of WWD studies, identifies important issues, and proposes considered advantageous. The demand for wearable elec­
directions for future research. The next step in the research tronics in personalized medicine, e-skins, and health moni­
is to delve deeper into studies focused on specific domains toring is substantial and continuously expanding. To ensure
or topics that can be addressed using wearable technology. their future application in biomedical engineering and bioa­
This involves investigating and identifying problems in col­ nalytical sciences, integrating ‘green’ characteristics such as
laboration with domain experts to establish specific require­ biodegradability, self-healing, and biocompatibility into these
ments for addressing those issues. By following this devices is crucial. Leveraging natural materials with inherent
approach, the aim is to contribute to the advancement of biodegradable, sustainable, and biocompatible properties will
wearable technology and its application in various fields profoundly impact the fabrication of environmentally
(Al-Eidan et al., 2018). Deploying wearable medical and friendly e-skins and wearable electronics. By harnessing
healthcare devices across diverse anatomical regions pro­ these attributes, the advancement of eco-friendly wearable
vides a comprehensive approach to continuous health moni­ technologies can address the growing need for sustainable
toring and data acquisition as shown in Figure 3. solutions in the biomedical engineering and bioanalytical
One more study contributes to the advancement of sciences field (H. Liu et al., 2021; Y. Liu et al., 2021; Z.
small-form factor wearable computers by introducing meth­ Zhang et al., 2019).
ods for expanding their interaction capabilities. The pro­ Anticipated trends suggest a decline in the popularity of
posed system, WatchSense, enables input on the back of the smart wearables used as jewelry and watch necklaces, with a
hand and the space above it, extending the available input shift toward integration into textiles by embedding sensors
space on wearable devices. This allows for interactions in and electronic circuits within the fabric. The potential rise
90 M. AZEEM ET AL.

Figure 3. Medical and wearable sensors designed to be worn on different body parts.

in significance of subcutaneous applications, involving wear­ purposes. (c) Fabrication of stimuli-responsive ionogels for
ables implanted under the skin, could offer more detailed drug release applications. Magnetic-responsive ionogels, for
information, though widespread adoption may be slow due instance, can be developed by incorporating magnetic ILs,
to privacy concerns and the invasive nature of the proced­ enabling controlled drug release in response to external
ure. Notably, subcutaneous implants are already being uti­ magnetic fields. (d) Establishment of recycling procedures
lized in mandatory health situations. Improving the for ionogels to minimize their environmental impact and
integration of conductive elements into textiles without the reduce costs. Developing efficient methods for the recovery
discomfort associated with soldering is an ongoing area of and reuse of ionogels will contribute to sustainable and
focus. Flexible conductive adhesives are considered a more environmentally friendly practices in biomedical applications
desirable alternative, given that soldering involves heat treat­ (Fan et al., 2023). Moreover, developing a prosperous design
ment that could potentially damage the textile surface for a textile-based sensor necessitates the integration of vari­
(Seçkin et al., 2022). ous specialists from diverse domains, such as textile science,
The future exploration of biomedical applications for polymer chemistry, physics, bioengineering, software engin­
ionogels is centered on key areas of innovation: (a) eering, and mechatronics engineering. The synergy achieved
Customization of cations and anions to engineer ionogels through this multidisciplinary collaboration, combined with
tailored for specific biomedical applications. Through a thorough assessment of the desired sensor attributes, holds
meticulous component selection, ionogels can be designed significant importance in the creation of a promising proto­
to meet the unique requirements of various biomedical uses. type for a groundbreaking fabric sensor (J. Zhang et al.,
(b) Rational design to mitigate the toxicity of imidazolium- 2022).
based ionogels or create alternative biocompatible ionogels Wearable technologies present new opportunities by pro­
suitable for potential applications within the human body. viding healthcare providers, clinical practices, care organiza­
Efforts will focus on enhancing the safety and biocompati­ tions, and patients with access to valuable information and
bility of ionogels to ensure their suitability for biomedical knowledge. The ability to continuously gather data from
 THE JOURNAL OF THE TEXTILE INSTITUTE 91

various sources, including clinical and behavioral data, ena­ prolonged life cycle, ensuring reliable functionality. The
bles the development of analytical tools for a deeper under­ washing performance of E-textiles is crucial for their com­
standing of disease development, early detection, and mercial success, necessitating polymer coating or encapsula­
intervention. This knowledge and these tools have the tion to enhance strength and durability in daily use and
potential to revolutionize clinical practices and empower diverse environmental conditions. However, there is still a
patients to take an active role in self-care and decision-mak­ need for research on compact solutions in this field.
ing. With the significant increase in collected data, stem­ Fortunately, the future looks promising for the washing per­
ming from diverse origins such as clinical parameter formance of smart textile materials. To enable large-scale
monitoring, self-monitoring, and behavioral data, there is a production of new-generation technologies like wearable E-
pressing need to effectively manage and utilize this data. textiles, academic-industry collaborations must address the
Implementing this knowledge into best practices, integrating challenges involved. Since single-use solutions can be costly,
it into existing workflows, and sharing information with industrial production of these technologies becomes vital.
other organizations, patients, and families require the devel­ Thus, exploring mass production methods for E-textiles
opment of interactive treatment methodologies. Although remains an important research area that warrants further
these changes are still in their early stages, they will con­ attention (Ismar et al., 2020). In the future, wearable sensors
tinue to evolve, driving two important processes: the shift will be managed and monitored through smart gadgets, rev­
toward integrated care and co-management with patients, olutionizing the way we address healthcare issues. These
and the development of new tools that bring fresh insights innovative devices will serve as preventive tools, helping to
to clinical practice. These processes will also prompt mitigate health problems. A visual representation of this
changes in data privacy regulations and data sharing, as well future scenario is depicted in the detailed Figure 4, illustrat­
as the implementation of more interoperable and standar­ ing the potential of wearable sensors.
dized tools that seamlessly integrate into care systems. In
parallel to these long-term processes, there is an immediate
challenge of developing mature products that address the 10.1. Challenges related to durability, washability, and
specific needs of care providers and complement the tools scalability
currently used by healthcare professionals. The ultimate
challenge for all stakeholders—including healthcare pro­ Ensuring the enduring durability of wearable sensors is
viders, policy makers, and the industry - is to collaborate paramount due to exposure to environmental factors such
and find ways to implement these solutions for the benefit as moisture, temperature fluctuations, and mechanical stress.
of all populations, prioritizing low-cost and high-quality. By These sensors must exhibit resilience to withstand these
doing so, we can significantly improve care delivery models conditions without compromising functionality or accuracy.
and clinical practices (Lewy, 2015). Sustaining sensor integrity and functionality through mul­
Wearable electronic products, coupled with personalized tiple wash cycles is crucial for long-term use and user com­
algorithms, offer tremendous possibilities. This review fort. As wearable technology becomes more ubiquitous,
explores their fabrication techniques and potential applica­ addressing scalability issues in data collection, storage, and
tions. One area of great interest is electronic wearable tex­ analysis is imperative to manage the substantial information
tiles due to their easy and flexible integration into our daily generated by these sensors. Overcoming these challenges is
lives across a wide range of applications. E-textiles can be pivotal for the widespread adoption and integration of wear­
categorized into five main groups: sports, medical, fashion, able sensors into everyday life, unlocking their potential to
personal protective equipment, and military applications. revolutionize healthcare, fitness, and various industries.
These groups share common characteristics that align with Some key points are outlined to overcome challenges associ­
the fundamental properties of textile materials, such as laun­ ated with durability, washability, and scalability (Gonçalves
dering, stretching, and flexing. Depending on the specific et al.,2018; Heo et al., 2020; Xu et al., 2021);
application, additional characteristics like abrasion resistance
and UV exposure may also be important. E-textiles should � Development of wearable sensors that can be washed
demonstrate durability, viability, and energy efficiency for a without compromising their accuracy and sensitivity.

Figure 4. Future of sensors as smart gadgets in wearable textile.

92 M. AZEEM ET AL.

� Creation of textiles that is more durable, breathable, and parameters continuously, enabling remote health monitoring
comfortable for extended period use. in various settings. Throughout this study, we explored the
� Scaling up the manufacturing process to meet the significant progress in textile-based wearable sensors,
increasing demand for wearable sensors. emphasizing their advantages over traditional monitoring
systems. These sensors, lightweight and flexible, seamlessly
The implementation of wearable technologies in health­ integrate into everyday clothing, ensuring comfort for pro­
care presents challenges for both the healthcare system and longed wear. Their compatibility with wireless communica­
the wearable technologies industry. The healthcare system tion facilitates real-time data transmission to healthcare
must overcome the primary hurdle of restructuring the care professionals, enabling timely interventions and personalized
model and enhancing information sharing to fully leverage healthcare delivery.
these technologies. Successful implementation necessitates Textile-based wearable sensors have diverse applications
collaborative efforts between healthcare professionals and in healthcare, showing promise in monitoring vital signs
patients, extending beyond adoption to involve both parties like heart rate, respiratory rate, and body temperature.
in the development and implementation processes, adhering Additionally, these sensors can monitor biomedical parame­
to established best practices and care pathways. Advancing ters such as muscle activity, electrocardiogram (ECG), elec­
research and development in systems that offer supplemen­ troencephalogram (EEG), and detect abnormal movements,
tary information, complement existing resources, and effect­ sleep patterns, and falls. The versatility and accuracy of
ively integrate them into practice will enhance the overall these sensors make them invaluable for early detection,
quality of care. This requires active engagement of physi­ diagnosis, and intervention in various medical conditions.
cians, recognizing patients as partners in the care process, Integrating textile-based sensors with advanced analytics
educating them, and providing tools, data, and information. and machine learning offers exciting possibilities for person­
Such an approach facilitates the sharing and analysis of alized healthcare, facilitating preventive care, disease man­
patient data from diverse sources, necessitating regulatory agement, and treatment optimization.
changes in data usage, privacy, and security. For the wear­ Despite these opportunities, challenges remain for wide­
able technologies industry, the challenge lies in creating sup­ spread adoption. Ensuring sensor reliability, accuracy, power
porting systems that encourage widespread adoption, taking efficiency, and addressing data security, privacy concerns,
into consideration standardization, privacy, security, and and user acceptance are crucial. Continued research and
existing care models. Developers must be mindful of the development efforts are essential to overcome these chal­
workloads and workflows of healthcare professionals, tailor­ lenges and advance the field.
ing solutions to seamlessly integrate into the current system. In conclusion, textile-based wearable sensors have the
To implement wearable technologies effectively, the industry potential to transform healthcare by enabling real-time,
should prioritize developing more affordable solutions and noninvasive, continuous monitoring of biomedical parame­
new business models that foster widespread adoption by ters. This technology opens avenues for personalized health­
healthcare organizations (Lewy, 2015). care, early disease detection, and remote patient
management. As advancements continue, we anticipate these
10.2. Regulatory and ethical considerations for clinical sensors becoming integral to daily life, empowering individ­
adoption uals to manage their health. The future may see a shift from
smart wearables like jewelry and watch necklaces to incorp­
� Ensuring adherence to relevant safety and privacy regula­ oration into textiles, with sensors and electronic circuits
tions such as HIPAA and GDPR. seamlessly embedded. Subcutaneous applications, involving
� Maintaining ethical policies on data collection and usage implantation beneath the skin, may gain importance for
such as obtaining informed consent. detailed information. The article emphasizes open chal­
� Developing protocols for clinical validation and certifica­ lenges, paving the way for future research enhancements in
tion of wearable sensors to ensure effectiveness and this dynamic field.
safety.
Overall, the future of textile-based wearable sensors holds
great potential in monitoring health, detecting disease, and Disclosure statement
providing personalized medical care. However, there are a The authors declare no conflicts of interest.
few obstacles to overcome before incorporating these devices
into everyday healthcare practices.
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