Wearable technology can count steps, track sleep, measure heart rate, and record activity. For Ross Bindler, PharmD, a Research Investigator at the WSU College of Nursing, its value lies in what people can do with that information.
Bindler’s work explores how wearable devices and digital health tools can help researchers, clinicians, and patients better understand health outside the clinic. Across multiple WSU Health Sciences collaborations, he has helped study tools that track sleep, activity, pain, stress, respiratory symptoms, recovery, and workforce readiness.
The goal is not to simply collect more data. It is to help people use that data to make decisions.
“I think teaching individuals how to turn the data into useful information is still the biggest part,” Bindler said.
Bindler came to the College of Nursing in 2019 after earning his PharmD from WSU in 2014 and completing a two-year residency-style graduate fellowship at the College of Pharmacy and Pharmaceutical Sciences’ Drug Information Center. That experience introduced him to research design, data collection, data management, statistical analysis, and dissemination.
His work with wearable and mobile health technology began through a project led by WSU College of Nursing Assistant Dean for Research, Dr. Julie Postma, RN, that studied wildfire smoke exposure and asthma symptoms in young adults. The project, funded through the National Institute of Nursing Research, used a custom smartphone application called TRAK, developed with support from Urbanova. TRAK included a custom version of SmokeSense, originally created by the Environmental Protection Agency, and MIR digital spirometry collection and logging. Participants could receive GPS-based air quality alerts, report symptoms, and use a portable spirometer to monitor lung function during wildfire smoke events.
“It was a really cool project to learn about some of the backend development of this new wearable tech, or this new electronic health tech, mobile health tech,” Bindler said.
The study also showed the practical challenges that come with digital health research, including data security, battery life, data use, phone compatibility, and the differences between Android and Apple devices.
The work has since been published in Public Health Nursing, the Journal of Asthma, and the Journal of Adolescent Health.
Bindler’s research expanded into chronic pain through Dr. Marian Wilson’s COMFORT project, which studied virtually delivered nonpharmacologic therapies for adults with chronic pain who were prescribed opioids. When the COVID-19 pandemic shifted the project online, the research team used NightOwl, a fingertip sleep monitoring device now produced by ResMed, to track participants’ sleep.
The device measured time in bed, time asleep, movement, oxygenation, and wake events. Bindler said participants responded well because the device was less intrusive than many traditional sleep tools.
“We had a couple participants in that study that were unhoused at that time. One was living in their car, and it still worked perfectly in them,” Bindler said. “We got great data.”
For people with chronic pain, sleep information can be especially useful. Poor sleep can worsen pain, affect function, and make recovery harder. A small, low-burden device can give researchers, clinicians, and patients more information without requiring an overnight sleep lab or extensive equipment.
“Sleep tests, one, are very expensive,” Bindler said. “Two, you have to get all those monitors, you have this breathing mask, and it really doesn’t replicate a normal sleep pattern.”
Findings from the sleep monitoring work were presented in the journal Sleep. Related COMFORT project findings have also been published in Sage Research Methods: Doing Research Online and Pain Management Nursing.
More recently, Bindler has worked on research using Apollo Neuro, a wearable device that uses vibration patterns intended to support calm, focus or sleep. In a pilot study with medical and pharmacy students, participants were randomized to receive the device or join a waitlist control group.
“What we saw is that the individuals that were randomized to get the device saw significant improvements in their well-being scores,” Bindler said. “We saw significant improvements in their burnout, so less burnout levels.”
That study was published in the American Journal of Medicine, with additional work accepted in the American Journal of Lifestyle Medicine.
Bindler and collaborators are now interested in studying Apollo Neuro with adults who have chronic pain, paired with Fitbit Inspire 3 devices. That combination could help compare self-reported improvements with objective sleep and activity data.
“We’d really like to see, too, some sleep outcomes,” Bindler said. “Did it really help with sleep, or was it perceptions of sleep?”
One of the College of Nursing’s largest wearable-supported projects is connected to Wilson’s RELIEF Pain Hub, an online pain self-management resource. The research team distributed more than 100 Fitbit Inspire 3 devices to participants in a beta-testing randomized controlled trial. Participants were assigned either to a guided approach or a self-directed approach to using the Pain Hub.
The guided group completed assessments, received recommendations, started with activity pacing, and explored resources such as exercise, physical therapy, and yoga therapy. The self-directed group was encouraged to check in and use the site as desired with less guidance.
The guided group used the site more regularly and set goals focused on activity. Some participants worked on increasing step counts, doing yoga, reconnecting with physical therapy, or even building biking routines.
“We saw significant improvements in pain intensity, pain interference and chronic pain acceptance,” Bindler said. “Also, people reported significantly less sleep disturbance than at the beginning of the project.”
The RELIEF work has also generated a large amount of Fitbit data. Bindler said 84 of the 100 participants activated their devices and provided data, creating a strong foundation for future analysis with collaborators at Eastern Washington University.
For Bindler, the broader question is how these tools can help people move toward the lives they want.
“The goal is finding the best program to help people with pain get back to the quality of life they want to have,” he said.
That same goal applies to other areas of his work, including substance use recovery. Bindler has collaborated with College of Medicine researchers on projects where wearable sleep data can help participants see progress over time.
“You hear people that are coming in and they’re like, ‘I’ve been on methamphetamines for 10 years, and I haven’t used it in three months,’” Bindler said. “I can look at this sleep device, and it says I’m sleeping. I haven’t slept in so long.”
Wearable technology can also reduce some of the burden of traditional research participation. Surveys and self-reported information remain important, Bindler said, but devices can collect some information in real time without requiring participants to remember, record or report every detail.
“The more you can get without having people use up their time, their energy, everything, I think that you get better compliance with the study protocols,” Bindler said. “You’re not worried about as much missing data.”
Wearable data may also help keep participants engaged. Instead of completing a survey every few months, participants can see their own progress through step counts, sleep scores or activity trends.
For nursing, Bindler sees several areas of promise.
Wearable technology may help nurses better understand what patients experience between visits. It may support more personalized care by showing patterns in sleep, activity, pain, stress or readiness. It may also help nurses respond to the growing number of patients who already bring health data from consumer devices into clinical conversations.
“I think every level of nursing has the ability to interpret the data that’s coming in, within their expertise,” Bindler said.
He said nurses do not need to defer automatically to physicians when wearable data falls within their scope and clinical expertise. Instead, nurses can help patients understand what the information means, what it does not mean, and how it may fit into a care plan.
“So much of it is about individual care,” Bindler said. “How is someone taking care of themselves? How can we better help care for them? How can we assist in the treatment process?”
Wearable tools may also support nurses themselves.
Bindler is also connected to research involving ReadiBand and ReadiWatch devices produced by Fatigue Sciences, which measure sleep and activity. In the Providence Nurses’ Health Study, researchers used ReadiBands to study exercise, diet, and sleep habits among full-time nurses working during the COVID-19 pandemic. The study was published in Applied Nursing Research.
Future work under review includes an Agency for Healthcare Research and Quality (AHRQ) R01 led by WSU Sleep and Performance Research Center Director, Dr. Lois James, focused on sleep education for nurses. The study would use ReadiWatches to calculate a SAFTE score, a fatigue and readiness measure, along with a web-based psychomotor vigilance test.
The goal is to help nurses, especially shift workers, better understand sleep, fatigue, and readiness for patient care.
The research also points toward possible future applications in hospitals and clinics. Bindler said nurses spend significant time collecting and documenting information such as temperature, pain scores, comfort scales, blood pressure, and heart rate. In the future, wearable or connected tools may be able to collect some of that information and integrate it into electronic health records.
“It takes away from their caregiver responsibilities, because they’re doing all this charting,” Bindler said. “You hope that at some point, some of this tech that can do some of this stuff for you would be able to take that place and integrate with that EHR, so that the nurses could then have more time to provide care.”
Still, Bindler is careful to point out the limitations.
Cost remains a major barrier. Some devices require expensive phones, reliable internet, Bluetooth connections, or regular charging. Some patients may not have stable access to those resources. Others may not want to wear a device on their wrist, ankle, or chest. Tech literacy can also be a barrier, especially as devices and apps become more complex.
“Money is obviously a gigantic hurdle,” Bindler said.
Data accuracy and validation are also important. Some consumer devices are well studied and widely used. Others are newer and may make claims that have not been tested or verified in clinical research.
“Some of these smaller companies that are developing some of these new products, they should be taken with caution,” Bindler said. “Sometimes they make kind of lofty claims.”
That is one reason education matters. Patients, nurses, and clinicians need to know what a device can measure, how accurate the data may be, and whether a tool is designed for general wellness, tracking, diagnosis, or treatment.
“No one should think that any one device is a magic device that’s going to improve everything,” Bindler said.
Looking ahead, Bindler sees the future of wearable health research in integration. Devices, apps, pain self-management resources, peer support, medications, sleep education, electronic health records and clinical care all need to work together in ways that are useful and understandable.
He is also interested in companion tools for the RELIEF Pain Hub, including web-based applications that could help users track goals, complete assessments, receive reminders, and stay engaged. As those ideas develop, the team is interested in connecting with WSU’s Office of Research Innovation and Entrepreneurship to explore commercialization potential and possible development support.
“I think there’s a lot of space for development there,” Bindler said.
Projects under development include a community-based pain nurse navigator pilot using Fitbit Inspire 3 devices, a companion application for the RELIEF Pain Hub, pairing Apollo Neuro with Fitbit in adults with pain, gamified sleep education for nurses, and sleep-focused research involving veterans and first responders with PTSD and co-occurring alcohol use disorder.
For Bindler, the promise of wearable technology is not in a single device. It is in learning how to use data in ways that support people, clinicians, and care teams.
“I’m really excited about figuring out where these devices best fit into the care process, and how they are best used by both the end user and the clinician,” Bindler said.