Abstract
BACKGROUND: Smart rings enable continuous physiological monitoring through finger-worn sensors. Despite growing consumer adoption, their clinical utility beyond sleep tracking remains unclear. OBJECTIVES: To systematically review evidence for smart ring applications in clinical medicine, assess measurement accuracy, and evaluate clinical outcomes. METHODS: We searched PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science through 31 July 2025. Two reviewers independently screened studies and extracted data. Risk of bias was assessed using ROBINS-I and RoB 2.0. RESULTS: From 862 citations, 107 studies met inclusion criteria including approximately 100,000 participants. Studies were equally distributed between sleep (47.7%) and non-sleep applications (52.3%). Smart rings demonstrated high accuracy: heart rate r(2) = 0.996, heart rate variability r(2) = 0.980, and sleep detection 93-96% sensitivity. Predictive capabilities included COVID-19 detection 2.75 days pre-symptom (82% sensitivity), inflammatory bowel disease flare prediction 7 weeks early (72% accuracy), and bipolar episode detection 3-7 days early (79% sensitivity). However, 65% of studies had moderate-to-high bias risk. Limitations included small samples, proprietary algorithms (89%), poor diversity reporting (35%), and declining adherence (80% at 3 months to 43% at 12 months). CONCLUSION: Smart rings have evolved into clinical tools capable of early disease detection. However, algorithmic opacity, population homogeneity, and adherence challenges require attention before widespread implementation.