Accuracy, acceptability, and feasibility of transdermal alcohol sensors: Two systematic reviews

Transdermal alcohol sensors (TAS) are able to monitor alcohol consumption continuously, over time, objectively, overcoming limitations of other alcohol measurement methods. This systematic review aims to assess their accuracy, acceptability, and feasibility. It was initially proposed as one review, however, on review of the results, we reported them as two, one focusing on accuracy and the second on acceptability and feasibility outcomes.

A systematic search was conducted of the CINAHL, EMBASE, Google Scholar, MEDLINE, PsycINFO, PubMed and Scopus bibliographic databases in February 2021. Two members of the study team independently screened studies for inclusion, extracted data and assessed risk of bias. Each study methodological quality was appraised using the Mixed Methods Appraisal Tool. The primary outcomes were TAS accuracy, acceptability, and feasibility.

We identified and analysed 32 studies reporting accuracy, and 22 reporting acceptability and feasibility outcomes. Study designs included: laboratory and ambulatory-based studies, mixed designs, randomised controlled trials and focus groups and the length the device was worn ranged from days to weeks. Results found TAS to be positively correlated with BrAC, BAC and self-report data (moderate to large). However, there were some discrepancies between study findings (WrisTAS sensitivity ranges between 24%-85.6%). While views on TAS were generally positive with high compliance, there were factors that were indicated as potential barriers to use and suggestions to overcome these.

We found a lack of consistency regarding study procedure and analysis, making it difficult to draw direct comparisons. We also found a lack of research investigating the acceptability and feasibility of TAS as a tool to monitor alcohol consumption in clinical and non-clinical populations. While there is some preliminary evidence suggesting device potential used in short term, laboratory-based studies with volunteers, more research is needed to establish long-term, daily use with other populations, specifically clinical and the criminal justice system.