Smart textiles for personalized healthcare

Abstract

Incorporating sensing and therapeutic capabilities into everyday textiles could be a powerful approach in the development of personalized healthcare. The creation of such smart textiles has been driven by the fabrication of various miniaturized platform technologies, and has led to the construction of compact, autonomous and interconnected functional textiles. Here we review the development of smart textiles for application in personalized healthcare. We examine the different platform technologies, the various fabrication strategies and the range of clinical scenarios in which they are used. We also explore the current commercial and regulatory landscapes, and consider issues of data management. Finally, we highlight the key steps required to transition these technological platforms to commercial applications.

Diagnostic, therapeutic and post-care rehabilitative solutions for the global population vary in accessibility, quality and clinical outcome^1–3, and centralized, one-size-fits-all healthcare models have proved to be inefficient in providing accessible, affordable and quality healthcare⁴. Personalized healthcare can potentially be used to improve healthcare outcomes^5–7, but adoption remains a considerable challenge. Wearable devices could help decentralize healthcare access, but their application is limited by device bulkiness, power supply restrictions, ergonomic comfort limitations and variations in quality and durability⁸. Even discreet skin-adhering stretchable devices exhibit limitations, including skin breathability issues and the need for adhesives⁹. Incorporating sensing and therapeutic capabilities into everyday wear could be used as a pervasive approach to deliver bespoke healthcare services to a wide population, without the drawbacks of other wearable solutions¹⁰. Wearable bioelectronics were first introduced in the 1990s^11–13 and have now developed into a sophisticated range of technologies that can be integrated into textiles¹⁴. Such smart textiles, which can sense, react and interact with a range of ambient stimuli (for example, mechanical, thermal, chemical, radiant, magnetic and acoustic) and do not require electrical components to interact with external stimuli^15–19, remain an underexploited asset in healthcare provision.

Smart textiles can provide insight into a person’s physiological state²⁰ and can be used for in situ clinical monitoring²¹ and intervention²². Such textiles could provide medical and economic benefits ranging from disease prevention, improved clinical outcome and quality of life, to enhanced productivity, reduced healthcare burden and decreased healthcare costs²³. Data-mining capabilities stemming from a large-scale rollout of smart textiles could also provide long-term, data-driven benefits²⁴.

Hardware and software limitations—as well as industrial issues of manufacturing and scalability, network integration and user-readiness—have hampered the use of smart textiles within personalized healthcare. However, developments in miniaturized and low-power consumption technologies, and their successful incorporation into textiles, mean that versatile smart textile healthcare platforms with suitable wearability profiles²⁵ are now available. The expansion of 5G networks, and the permeation of the Internet of Things (IoT), moreover mean that data-relaying and interventional turnaround speed limitations are being addressed²⁶. Furthermore, the existence of technologically savvy, wearable-adopting sections of society suggests that this is an optimal time for the expansion of smart textiles in personalized healthcare^27–29.

In this Review, we examine the development of smart textiles for personalized healthcare. We consider the different platform technologies employed and their various fabrication strategies, and explore the diagnostic and therapeutic applications of smart textiles. We also examine the current commercial and regulatory landscapes and assess issues of data management. Finally, we highlight key challenges in academia and industry that need to be addressed to realize the full potential of smart textiles.

Platform technologies employed in smart textiles

Textile sensors have been developed to help diagnose and prevent disease²¹. Drug-impregnated¹⁸ and antimicrobial materials have also been used in wound management and infection prevention. Since the introduction of smart textile use as a healthcare interface^30–35, many signal-to-function associative smart textile platform technologies have been developed. Figure 1 summarizes the majority of the technologies particularly well suited to personalized healthcare^36–45.

Fig. 1 |. Timeline of platform technology development for smart healthcare textiles.

Embedding electronics into clothing began in the 1990s and was in turn applied to the field of healthcare. Nanoelectronics and material science platform technology developments saw the introduction of a plethora of diagnostic, therapeutic and energizing applications. References represented in the timeline: Electroluminescence³⁶, Electrography³⁷, Capacitance³⁸, Piezoelectricity³⁹, Piezoresistivity⁴⁰, Photovoltaics⁴¹, Thermoelectricity⁴², Electrochemistry⁶³, Electromagnetism⁴³, Field-effect transistors⁴⁴, Triboelectricity⁴⁵, Magnetoelasticity²⁸.

Electroluminescent platforms.

Light reflection and refraction provide useful biometric diagnostic information when interacting with tissues⁴⁶, and on a therapeutic front, light-emitting smart textiles have also shown many applications^47–51.

Piezoresistive platforms.

Piezoresistive semiconductors change electrical resistivity when exposed to mechanical stress. This mechanism has been harnessed for highly sensitive biomechanical sensing⁵². Chemical interactions⁵³ and temperature changes⁵⁴ have also been exploited for personalized biomolecular analysis and the monitoring of body temperature.

Thermoelectric platforms.

Thermoelectric generators can convert heat changes into electricity using the thermoelectric effect⁵⁵. These textile thermoelectric generators have been explored to leverage body heat and generate electricity for healthcare applications⁵⁶.

Photovoltaic platforms.

Solar cells can convert sunlight directly into electricity⁵⁷. Integrating photovoltaic technologies within textiles has provided powering capabilities for diagnostic and therapeutic devices within personalized healthcare settings⁵⁸.

Electrographic platforms.

Electrographic platforms can help in the diagnosis of heart and neurological conditions⁵⁹. Their textile integration has been shown to provide highly flexible, comfortable and long-lasting personalized healthcare platforms⁶⁰.

Capacitive platforms.

Textile capacitors exploit capacitance changes brought about by biomechanical pressure⁶¹. In view of their high sensitivity, fast response time and high stability, they have often been used in diagnostic devices⁶². Textile supercapacitors can moreover serve as an energy-storage unit to power biomedical sensors or therapeutic devices⁶³.

Electromagnetic platforms.

Electromagnetic generators have been explored to convert human motion into electricity⁶⁴ and have been used to harvest biomechanical energy for healthcare applications⁶⁵.

Transistor platforms.

Transistors are one of the building blocks of healthcare electronics⁶⁶. Fibre/textile-based organic field-effect transistors and electrochemical transistors have been widely used for biomarker sensing⁶⁷, vital signs monitoring⁶⁸ and biomolecular analysis⁶⁹. Moreover, fibre/textile transistors can be used to construct on-body circuits⁷⁰ to acquire data and to compute clinical interventions directly in situ.

Piezoelectric platforms.

Piezoelectric nanogenerators (PENG) rely on the piezoelectric effect to generate electricity and detect biomechanical motion via mechanical deformation⁷¹. Fibre-based PENGs possess high pressure sensitivity⁷² and their easy implementation and self-powering capabilities have made them a more modern smart textile platform technology for use in healthcare applications (sensing⁷³, electrical stimulation⁷⁴ and energy harvesting⁷⁵).

Electrochemical platforms.

Electrochemical platforms have been explored that make use of the conversion of chemical energy to electricity via known redox reactions⁷⁶. Such platforms have shown the ability to leverage ordinary perspiration, harnessing it as a renewable biofuel⁷⁷, as well as a bioanalytically relevant metabolite source for clinical insight.

Triboelectric platforms.

Triboelectric nanogenerators (TENG) convert mechanical motion into electricity, using contact electrification and electrostatic induction coupling^78–80. TENGs effectively convert biomechanical movements into high-voltage and low-current signals⁸¹. This performance, and the vast array of available biocompatible triboelectric materials, have led to the integration of TENGs into smart healthcare textiles for use in diagnostic⁸², therapeutic⁸³ and power-supplying applications^84–86.

Magnetoelastic platforms.

The magnetoelastic effect is usually observed in rigid bulky metals, metal alloys and ferromagnetic ceramics. However, in 2021, the giant magnetoelastic effect was discovered in soft systems and developed into stand-alone bioelectronic systems (magnetoelastic generators, MEGs)⁸⁷. This technology has shown promise in vital sign monitoring and diagnosis, therapeutics, and biomechanical energy harvesting for the powering of healthcare device.

Smart textile fabrication strategies

A growing number and variety of functional materials, fabrication technologies and architectures have been used in smart textiles, with material classes chosen depending on the desired functionality (Fig. 2a). The diagnostic and therapeutic abilities of smart textiles rely on a range of functionalized materials.

Fig. 2 |. Fabrication strategies of smart healthcare textiles.

a, The raw materials employed in smart textiles. Functional materials are embedded onto as-fabricated textile substrates. b, The fabrication strategies employed for smart textiles. Functional materials can be directly fabricated within the fibres using techniques such as coating, spinning, printing and thermal drawing. c, The architectures used for smart textiles. Various fibre-level arrangements help functionalize smart textiles. d, Textile-level structuring means yarns can be woven, knitted or integrated in non-woven ways, and spun into large-scale smart textiles.

Functional materials.

Electrically conducting materials have traditionally been used as smart textile electrodes in the form of metals (for example, Ag, Cu, Ti, Au and Ni)⁸⁸, conducting polymers (poly(3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS))⁸⁹ and certain carbon-based materials (for example, carbon nanotubes and graphene)⁹⁰. Metal-textile fibre solutions provide high conductivity capabilities (~10⁵ S cm⁻¹), and polymers and carbon materials have been developed to introduce easier fabrication and overall fibre flexibility⁹¹. Having the capability to interact with the external environment is essential to smart textiles, and semiconducting or conducting functional materials have been employed to this end. Semiconducting functional materials, influenced by their mechanical (polyvinylidene difluoride (PVDF))⁹², thermal (carbon nanotubes, CNTs)⁹³, optical (metal-organic frameworks, MOFs)⁹⁴ and electromagnetic (MXenes)²⁷ activities, have been integrated as a powerful tool for use in smart textile development. A detailed list of functional materials is provided in Table 1.

Table 1 |.

Functional materials used in smart textiles

Materials for smart textiles	Functionality and applications
Conductive materials
Metals89 (~105 S cm−1) (for example, Ag, Cu, Ti, Au) Conducting polymers90 (~10−3–103 S cm−1) (for example, PEDOT:PSS, polyaniline) Carbon materials91 (~10–104 S cm−1) (for example, CNT, graphene)	Fibre/textile electrode/textile circuits for connection and computing/electrography
Active materials
Electrochemically active materials (for example, LiMn2O4, Ag2O/Ag, CNT, graphene, MOFs)	Biochemical sensing textiles/energy-storage textiles/drug-delivery textiles
Mechanically active materials (for example, PVDF, ZnO, PZTa, BaTiO3, MXenes)	Biomechanical sensing textiles/biomechanical energy-harvesting textiles
Thermoactive materials (for example, PEDOT:PSS, CNT, Sb2Te3-Bi2Te3)	Temperature-sensing textiles/body heat energy-harvesting textiles/thermotherapy textiles
Photoactive materials (for example, TiO2, P3HT:PCBMa)	Photovoltaic textiles/phototherapy textiles
Encapsulating materials
Natural materials (for example, silk, cotton)	Waterproof layer for textile electronic components/shielding layer for human skin
Synthetic materials (for example, PDMS, EVA)	Waterproof layer for textile electronic components/shielding layer for human skin

^aPZT, lead zirconate titanate; P3HT:PCBM, poly(3-hexylthiophene) and [6,6]-phenyl C₆₁-butyric acid methylester; EVA, ethylene vinyl acetate.

Fabrication technologies.

Developing scalable and batch-consistent smart textiles requires sturdy fabrication solutions. Various fabrication strategies have been developed (Fig. 2b), with spinning⁹⁵, coating⁹⁶, printing⁹⁷ and thermal drawing⁹⁸ remaining the most prominent. Spinning can produce stand-alone functional fibres or be used to functionalize traditional textile/fibre substrates, and has been tested for large-scale manufacturing^99,100. By manipulating the initial fabrication process, continuous fibres of varying diameters can be fabricated in parallel from a single or multiple functional materials. Wet spinning¹⁰¹, dry spinning¹⁰², melt spinning¹⁰³ and electrospinning¹⁰⁴ have all been used in smart textile fabrication using a range of functional materials. On another front, functional materials can also be transferred onto textile substrates by coating. Coating processes are usually used to form functional layers on the surfaces of materials. By controlling the coating thickness and the coating area, desired changes in active layer morphology can be produced based on desired functionality¹⁰⁵. Widely adopted coating methods include spray coating¹⁰⁶, dip coating¹⁰⁷ and electrochemical coating¹⁰⁸, providing a low-cost, convenient and effective way to fabricate smart textiles. Printing¹⁰⁹, including three-dimensional (3D) printing⁹⁷, has also been used in smart textile fabrication, with functional material inks both deposited locally on textiles and extruded as 3D structures. This fabrication technique has already been implemented at an industrial level given its predisposition to large-scale, autonomous and low-cost processes. Screen printing¹¹⁰ and inkjet printing¹¹¹ have been used before. Thermal drawing, an industrial approach for producing fibres in a simple and scalable way¹¹², has also been employed in smart textile fabrication. This technique enables targeted functional materials to be positioned in a prepared model known as a ‘preform’¹¹³. Assembly of various shapes and structures can be used to form complex fibre electronics, while allowing simultaneous extrusion of multiple material fibres that can produce fibre electronics within a one-body design. Thermally drawn fibres can moreover be miniaturized to the nanoscale¹¹⁴, helping in the optimization of smart textile solutions.

Smart textile architectures.

Fibre architectures can provide clothing with flexibility, breathability, wear and tear resistance, and material integration. Such properties are normally provided by traditional fibres when used alone, or mixed in different fabric forms, and through weaving architecture design. In addition to the above, smart textiles for personalized healthcare must provide diagnostic or therapeutic capabilities. The presence of functional materials and knowledge of the various physicochemical processes (as detailed in section ‘Platform technologies employed in smart textiles’) provide a myriad of microscaled mechanisms of actions that can be engineered to provide personalized healthcare solutions at the fibre-level, the textile level or in both in parallel. Various versatile textile architectures exist within smart textiles.

First, at the fibre-level, ex novo fibres can be developed using novel functional materials, existing traditional textile material fibres can be endowed with smart textile qualities, and ex novo fibres can be designed with specific multi-material internal architectures to provide diagnostic or therapeutic modes of action. Second, on a macro and fabric-level scale, existing traditional textiles can be upgraded with smart qualities via applicative processes, and pre-determined fibre organization and weaving can be used to bring about specific therapeutic or diagnostic modes of action.

In the first approach, functional materials can be directly fabricated as fibres using techniques such as wet/dry spinning¹¹⁵ or thermal drawing¹¹³ or can be applied to modify conventional fibre surfaces by means of additive processes¹¹⁶. Specific architectural structures can subsequently be applied to functionalized fibres in various configurations, including coaxial, twisted or parallel (Fig. 2c)¹¹⁷. These fabrication approaches can allow for extremely complex smart textile solutions that employ multiple functional materials. For instance, in a TENG-based coaxial structure¹¹⁸, one electrode layer, a pair of triboelectric layers, another electrode layer and a final encapsulation layer can be assembled in sequential fashion. In a twisting configuration, an electrode layer can be used as a second fibre and wound together with a triboelectric fibre at specific intertwined angles⁸⁶. A twisted configuration provides the constitutive active materials with better interactions on which external interfacing, such as photoreactivity and chemical reactivity, can occur¹¹⁹, a methodology well suited to smart textiles comprising solar cells and biosensors¹²⁰.

In the second approach, functional materials are embedded onto traditional textile substrates using the above fabrication technologies, as well as lamination¹²¹ or in situ chemical treatment processes¹²². These techniques are used to upgrade traditional textiles and provide smart textile qualities, resulting in easier-to-access, cost-effective and scalable solutions that are widely used in the research community. In a Parkinson’s disease evaluation smart textile solution, a PEDOT:PSS-coated fabric (triboelectric layer 1), a polytetrafluoroethylene (PTFE) film (triboelectric layer 2) and an Al film (electrode) are stacked to devise a textile TENG that is used to monitor walking¹²³. Challenges in uniform layer deposition and the formation of thin and defective functional layers on rugged textile surfaces can, however, limit the electronic performance of smart textiles conceived in this way¹²⁴. Moreover, the additive functional materials can compromise the flexibility, conformity and air permeability of the textile substrates³⁰.

As discussed, in the second approach, fibre organization can determine an application. Indeed, the various types of fibre described above can be arranged into woven, knitted, non-woven and sewn structures to develop energy-producing⁸⁵, diagnostic⁸² and therapeutic applications²² (Fig. 2d). Engineered smart fibres have been developed to mimic desired traditional textile properties, including breathability and flexibility, but given their multicomponent nature, they can show a higher sensitivity to damage from wear and tear, mechanical deformation, friction and the effects of the elements³⁰. Smart textiles degrade more readily, meaning that maintaining thin, uniform and durable functional layers on constantly mobile fibre surfaces remains a challenge that requires focused research efforts¹²⁵. On this front, we invite colleagues to consider interdisciplinary research that leverages computational modelling and expertise from the clothing industry to help develop body-wide smart textiles that are optimized for various nonlinear parts of the body.

Smart diagnostic textiles

Diagnostic smart textile solutions have boomed in recent years^73,126,127, providing continuous monitoring of biophysical¹²⁸, biochemical¹²⁹ and environmental factors¹³⁰. Textile-based wearable generators that harvest passive on-body energy sources to power smart textile diagnosis have also been developed.

Textile physical sensors.

Textile physical sensors convert physically stimulating inputs from physiological activities into information-rich electrical signals, which are used to deduce physiological information¹³¹. Biomechanical sensors comprise the most advanced physical sensor category used in textiles and are found in the form of triboelectric⁸¹, piezoelectric⁷³, resistive⁵² or capacitive⁶¹ pressure or strain sensors. Such sensors can be used for broad biomechanical vital signal monitoring (heart rate, respiratory and ambulatory sensing). TENGs are particularly useful in this field, providing functional and attractive smart textile solutions such as flower-shaped textile TENGs, which are used in pulse rate monitoring and sleep apnoea diagnosis (Fig. 3a,b)²⁰. In 2021, MEGs were developed for biomechanical-to-electrical energy conversion by combining the giant magnetoelastic effect with electromagnetic induction (Fig. 3c)⁸⁷. A textile MEG was fabricated by weaving 1D soft fibres with conductive yarns (Fig. 3d)¹³¹, converting arterial pulse into electrical signals, even in the presence of heavy perspiration or under water, without encapsulation (Fig. 3e). TENG arrays have also been developed as knitted smart textile sensors that track chest expansion/retraction respiratory cycles¹³², simultaneously gathering breathing and heart rate information. As well as classic biomonitoring, biomechanical smart textile sensors can provide insight into neurological diseases^133,134 using motion tracking. Large-scale sensing textiles have been fabricated using knitted nanocomposite-based piezoresistive fibres (Fig. 3f)¹³⁵, and existing solutions such as tactile-sensitive smart textile socks can be repurposed for the early-stage detection of neurological diseases by tracking pressure distribution. Integration of such sensing capabilities with machine-learning-based movement analysis could help with the diagnosis of neurological conditions such as dystonia, Parkinson’s disease, epilepsy and Alzheimer’s disease¹³⁶.

Fig. 3 |. Smart diagnostic textiles.

a, Schematic illustration of a flower-shaped textile sensor for wireless measurement of cardiovascular parameters. b, Acquired pulse waveforms as carried out on an elderly patient. c, Giant magnetoelastic effect in soft systems for biomechanical-to-electrical signals conversion. d, Textile MEG formed by weaving the 1D soft fibres with conductive yarns. e, Textile MEGs can accurately convert the arterial pulse wave into electrical signals under heavy perspiration or under water, without encapsulations. f, Photograph of large-scale tactile sensing textile. Scale bar, 0.5 cm. g, A conductive flexible silk patch consisting of PEDOT serving as an epidermal sensor to monitor electromyogram signals. h, An electrochemical sensing textile for glucose, [Na⁺], [K⁺], [Ca²⁺] and pH monitoring. i, Textile able to harvest renewable energy from the human body and its surroundings, providing a sustainable power source for diagnostic devices. j, A photo-rechargeable textile comprising a textile solar cell and a textile battery. Figure reproduced with permission from: a,b, ref. ²⁰, Elsevier; c, ref. ⁸⁷, Springer Nature Ltd, d,e, ref. ¹³¹, Springer Nature Ltd; f, ref. ¹³⁵, Springer Nature Ltd; g, ref. ¹³⁸, Wiley; h, ref. ¹⁴⁹, Wiley; i,j, ref. ¹⁵⁸, Elsevier.

Textile electrodes for the detection of bioelectrical signals (electrocardiograms (ECGs), electroencephalograms (EEGs) and electromyograms (EMGs)) have also been studied^59,60,137; these feature good wearing comfort, without causing the skin irritation normally associated with conventional gel electrodes. Conductive flexible artificial silk textile patches made of PEDOT have been developed for at-home and clinical use¹³⁸, with a design that enables simple skin-conformable positioning for continuous EMG monitoring (Fig. 3g).

Textile physical sensors can, moreover, include optical properties, to both detect and produce light¹³⁹, and have been used to monitor physiological parameters including sweat metabolites¹⁴⁰, heart rate¹⁴¹, blood pressure¹⁴² and oxygen saturation¹⁴³. In a recent example, fabrics embedded with light-emitting diode fibres and photodetecting p–i–n diode fibres were developed to measure heart rate¹⁴¹. On another front, textile-embedded thermally sensitive resistors have also been used to detect resistance-correlated temperature changes⁵⁴ and help in the continuous and non-invasive monitoring of body temperature. The use of this type of smart clothing could help prevent thermally related clinical conditions such as hyper- and hypothermia, but also contribute to extreme sport activities as well as helping to monitor the emergence of wound infections and fever¹⁴⁴. Reduced-graphene-oxide-coated yarns¹⁴⁵, knitted into textile form, have shown suitability in this area. These solutions are already beginning to come to the market. Siren Sock, a smart textile sock with thermal sensors, was developed to help alert patients and doctors to the presence of leg inflammation as a sign of ulcer formation in diabetes¹⁴⁶.

Textile chemical sensors.

In addition to textile physical sensors, various textile chemical sensors have been developed¹⁴⁷, such as electrochemical sensors for use on body fluid metabolites (for example, glucose and d-lactate concentrations) and electrolyte analysis (for example, Na⁺, K⁺ and Ca²⁺ ions)^148,149. Multiwalled-CNT twisted-fibre electrochemical sensors have shown great promise, given their ability to detect multiple disease biomarkers in vivo²¹. Textile chemical sensors can monitor healthcare parameters directly from the epidermis (sweat-based) and following contact with other fluids (even urine)⁶⁹. An example worth mentioning is an electrochemical textile developed by weaving a broad range of sensing fibre units (Fig. 3h)¹⁴⁹. These sensing units (fabricated by coating chemically active materials onto CNT-fibre substrates), have proved effective in monitoring a range of parameters, including glucose, [Na⁺], [K⁺], [Ca²⁺] and pH, showing continuous performance despite the application of repeated mechanical stress.

Furthermore, certain textile sensors that detect humidity can also be used in personalized healthcare¹⁵⁰, detecting breathing rate¹⁵¹ and monitoring healthcare-relevant environmental conditions¹⁵². In one example, a smart textile sensor for humidity detection was developed by coating a MIL-96(Al) MOF layer onto a fabric electrode¹⁵³. This MOF-based textile humidity sensor specifically detected water vapour concentration, even in the presence of several other compounds. On a chemical front, smart textiles have also been developed to directly diagnose physiological status using redox reactions between the textile itself and bodily secretions⁷⁶. Textile biofuel cells consisting of lactate oxidase-modified CNT bioanodes and Ag₂O/Ag-based biocathodes have been engineered to use the enzymatic oxidation of transpired lactate. This solution was able to produce voltage signals proportional to lactate concentration¹⁵⁴, providing an example of a distinctly new type of smart textile analyte-detection platform.

Smart textiles for diagnostic device powering.

Portable power supplies such as batteries present limitations, including limited lifespan, bulkiness, and environmental and health hazards¹⁵⁵. Smart textiles can produce energy from several passive activities, which can be used to power third-party healthcare diagnostic devices¹⁵⁶ (Fig. 3i). Harvesting passive energy sources can lead to uncontrollable power output linked to unstable (environmental) energy inputs³⁰, and smart textile solutions have been developed to address this¹⁵⁷. A photo-rechargeable textile was developed to form a self-charging power unit¹⁵⁸, including a solar energy-harvesting component, and a rechargeable flexible textile battery component (Fig. 3j). With increasing light intensity, this energy textile could generate an improved stable output to power on-body biosensors.

Smart therapeutic textiles

Besides diagnosis, personalized healthcare also includes access to specific therapeutic solutions, which consider patient safety margins and personal life factors¹⁵⁹. Smart textiles featuring therapeutic functions can interact with the human body for continuous and one-time therapeutic solutions, adjusting treatments according to a person’s evolving health profile¹⁶⁰. Smart textiles for personalized therapy are expected to offer an alternative to traditional one-size-fits-all therapeutic approaches, although their development is still at an early stage. A few specific areas have, however, started seeing an increase in smart textile therapeutic applications, including smart textile use for third-party therapeutic device powering.

Assistive technology.

Assistive technology allows disabled, ill and/or elderly patients to regain access to activities that are essential to leading an independent life¹⁶¹. Given the growing elderly population, developing upgraded everyday wear for various smart and assistive functions is critical. Smart textiles have been engineered to this end, with textile-based and mobility-assisting exoskeletal support¹⁶², textile hearing aids and textile prostheses¹⁶³ developed as smart textile assistive technology applications. Communication for speech-impaired patients has also benefited from smart textile use, with smart textile gloves developed for sign-to-speech translation¹⁶⁴ (Fig. 4a). This assistive application has helped with the conversion of American Sign Language hand gestures into voice (Fig. 4b) on a mobile user interface (Fig. 4c). In addition to these therapeutic academic examples, the commercially developed Palarum Smart Socks have been shown to help prevent patient falls using electrical rehabilitative therapy¹⁶⁵, with fabric pressure sensors measuring real-time changes in movement and pressure, ensuring a quick response to balance problems. Considering the large portion of the population expected to need assistive technologies by 2030 (ref. ¹⁶¹), smart textiles are being exploited as a potential therapeutic platform to help address this need.

Fig. 4 |. Smart therapeutic textiles.

a, Smart glove as an assistive therapy for sign-to-speech translation and communication. PCB, printed circuit board. b, Generated electrical signal patterns from American Sign Language hand gestures and their letter representations. c, A mobile user interface for sign language translation. d, A Ti₃C₂T_x MXene textile featuring self-controllable joule heating for thermotherapy and killing bacteria surrounding a wound. e, A smart wound dressing textile for drug delivery with tailored dosage and medication time administration. f, A threefold increase in granulation tissue deposition in a wound bed with drug-releasing textile compared to controls. g, A TENG textile based on weaving of ionically conductive organogel fibres, able to generate an electric field and accelerate wound healing. h, Immunostaining images of CD34 expression in the wound region after 14 days in control and gel-textile TENG conditions. i, An integrated textile system consisting of power supply, display and information-input modules. Scale bar, 2 cm. Figure reproduced with permission from: a–c, ref. ¹⁶⁴, Springer Nature Ltd; d, ref. ¹⁶⁷, American Chemical Society; e,f, ref. ²², Wiley; g,h, ref. ¹⁷⁵, Elsevier; i, ref. ¹⁷⁶, Springer Nature Ltd.

Thermotherapy.

Thermotherapy is widely used in the treatment of musculoskeletal injuries, soft tissue injuries and body aches¹⁶⁶. Active smart textiles with integrated joule heating and thermoelectricity have been developed to help with this¹⁶⁷. For example, a textile thermotherapy system was developed by combining a woven Kevlar fibre with copper–nickel nanowires and reduced graphene oxide dispersed polydimethylsiloxane (PDMS)¹⁶⁸. This textile thermotherapy system showed effective joule heating and reflected therapeutic infrared radiation onto the patient’s skin. In another example, a more sophisticated self-controllable joule heating solution was developed as a Ti₃C₂T_x MXene textile (a 2D transition metal comprising carbides and/or nitrides). This MXene textile was able to perform low-voltage thermotherapy to not only help with a therapeutic effect, but also kill bacteria surrounding a wound (Fig. 4d)¹⁶⁷.

Drug delivery.

Drug delivery enhanced by wearable devices provides a non-invasive, convenient and highly controllable solution for drug dosing and improved administration time adherence—crucial elements for personalized healthcare treatments^169–171. Considering the large portions of the population requiring daily drug administration, smart textiles can be used to conform to the skin for a long period of time, without pain or irritation, and enable long-term and personalized administration of drugs without third-party or doctor intervention¹⁷². Smart textile wound dressings have been developed for intelligent drug delivery with tailored dosage and administration times (Fig. 4e). In one example, interwoven drug release fibres, forming a core electrical heater, were covered by a layer of thermoresponsive hydrogel drug carriers loaded with antibiotics and vascular endothelial growth factors²². Their use was shown to improve the healing rate of diabetic wounds (Fig. 4f). Given the prevalence of diabetes, this solution could open a new avenue of therapeutic smart textile solutions for diabetes and its effects.

Electrical stimulation.

Electrical stimulation has been shown to be a promising therapy in the fields of chronic wound treatment, muscular dystrophy, tissue damage and neuromodulation¹⁷³, and is emerging as a stand-alone personalized healthcare field. Smart textiles for electrical stimulation, such as self-powered textile TENGs⁸³ and e-sleeves¹⁷⁴, show good wearing comfort and can provide personalized, continuous electrotherapy. Such a therapeutic approach using TENG smart textiles has been used to help accelerate wound healing¹⁷⁵ (Fig. 4g,h).

Third-party therapeutic device powering.

Smart textiles have also been developed to harvest ambient (environment) energy to continuously power therapeutic devices. To this end, a textile system was developed using smart-textile-powered supply modules, display modules and information-input modules¹⁷⁶. Photovoltaic smart textiles were used for energy harvesting and zinc-ion battery fibres for energy storage (Fig. 4i), although with limited energy conversion efficiency. Improving the energy conversion and storage efficiencies are active research areas, as is new energy transduction mechanisms. Radiofrequencies, for instance, represent an ideal energy source for electricity generation using smart textiles. Recently, a flexible rectenna, fabricated on a polymer substrate¹⁷⁷, has been shown to be able to harvest WiFi-band electromagnetic radiation. Such a platform technology could be further developed into textile form, providing an environmentally friendly and pervasive energy solution to sustainably drive healthcare devices. A thorough summary of typical research-based smart textiles for personalized healthcare (both therapeutic and diagnostic) is provided in Table 2.

Table 2 |.

Typical research-based textile devices for personalized healthcare

Textile devices	Main mechanisms	Active materials	Healthcare application	Ref.
Diagnostics
Wireless textile-based sensor	Triboelectric effect	Polyester/Ag	Obstructive sleep apnoea–hypopnoea syndrome diagnosis	20
Textile MEGs	Magnetoelastic effect	Silicone rubber/magnets	Cardiovascular disease	131
Muscle fibres inspired piezoelectric textiles	Piezoelectric effect	BaTiO3/PVDF	Pulse-wave measurement	73
All-textile pressure sensors	Piezoresistive effect	CNT-coated fabric	Pulse-wave measurement	52
Textile-based capacitive sensor	Capacitive effect	Ni-coated fabrics	Physiological monitoring during rehabilitation exercises	216
Wearable textile sensors	Thermoresistive effect	Graphene flakes	Body temperature monitoring	145
Nanoporous polyethylene microfibres	Radiative cooling	Polyethylene	Personal thermal management	217
Photoplethysmogram bandage	Photoplethysmography	Spirally wrapped CNT	Heart rate measurements	218
Electronic textile	Electrography	Ag flakes/elastomer	EMG	59
Bioinspired conductive silk microfibre	Electrography	PEDOT/silk	ECG and EMG	138
Textile biofuel cell	Electrochemical reaction	Glucose oxidase/CNT	Sweat analysis	154
Single-ply sensing fibre	Electrochemical reaction	Multiwalled CNT	Venous blood analysis	21
Therapeutics
Yarn-based stretchable sensor arrays	Triboelectric effect	PDMS/polyester	Sign-to-speech translation	164
Smart Ti3C2Tx MXene fabric	Electrothermal effect	Ti3C2Tx nanosheets	Bactericide for wound healing	167
MXene-decorated polyester textiles	Electrothermal effect	PPy modified Ti3C2Tx sheets	Thermotherapy	27
Large-area display textiles	Electroluminescence	ZnS phosphors	Assistive communication	176
Textile nano-energy nanosystem	Triboelectric effect	Silicone rubber/nitrile-coated textile	Muscle and nerve stimulation	83
Ionic patch	Triboelectric effect	Organogel/silicone rubber	Wound healing	175
Textile dressing	Electrothermal effect	PEGDA-alg hydrogel	Drug delivery	22
MOF-coated optical fibres	Light-triggered reaction	UiO-66 MOF	Drug delivery	94
Protective fabrics	Light-triggered reaction	Al-porphyrin MOF	Sulfur mustard detoxification	19
Nanofibrous membranes	Light-triggered reaction	Photobiocide-treated PVA-co-PE nanofibrous	Antibacterial and antiviral	18

PEGDA, poly(ethylene glycol) diacrylate; PVA-co-PE, poly(vinyl alcohol-co-ethylene).

Smart healthcare textiles in industry

The medical smart textiles market is expected to exceed US$2 billion by 2027 (ref. ¹⁷⁸). Bringing a smart textile personalized healthcare solution to the market, however, requires developing economically viable, technically sturdy and scientifically accurate solutions that are recognized as useful by the medical community and accepted by the public. So far, most smart textile-enabled personalized healthcare solutions have focused on diagnosis or biomonitoring. Many fitness-focused examples have been developed, but we have not included them in this healthcare-focused review. On a smaller scale, smart textile therapeutic products have also been launched in specific fields. A summary of commercially available smart textiles for personalized healthcare is shown in Table 3.

Table 3 |.

Commercialized smart textiles for personalized healthcare

Textile product	Company	Healthcare field	Clothing solution	Platform technology
Neurofabric146	Siren	Inflammation, diabetes	Smart socks	Thermoresistorsa
Smart Socks165	Palarum	Mobility, physical therapy	Smart socks	Pressure sensorsa
Texisock184	Texisense	Mobility, physical therapy	Smart socks	Pressure sensorsa
Sensoria Smart Socks185	Sensoria Health	Neurological	Smart socks	Pressure sensorsa
Hexoskin179	Carre Technologies Inc.	Cardiovascular, physical therapy	Vest	Multiplea
MasterCaution180	HealthWatch	Cardiovascular, physical therapy	Vest	Multiplea
SimpliECG192	Nanowear	Cardiovascular, physical therapy	Vest	Elastomerica
Cardioskin186	BioSerenity	Cardiovascular	Vest	Electrodes
Neuronaute186	BioSerenity	Neurological	Vest and cap	Electrodes
e-skin182	Xenoma	Mobility, physical therapy	Body suit	Multiplea
Skiin183	Myant Inc.	Mobility, physical therapy, thermotherapy	Body suit	Multiplea
Nextiles Fabric181	Nextiles	Mobility, physical therapy	Fabric	Piezoresistor
Intexar187	DuPont	Reproductive, respiratory, physical therapy	Fabric	Conductive inka
Hitoe188	Toray Industries	Reproductive, respiratory, physical therapy Fabric		Elastomerica

^aInformation not clearly elucidated—deduced from published patents and/or publicly available information.

Within diagnosis there has been a major focus on vital sign monitoring, with many companies developing clothing equivalents (vests) as stand-alone smart textile solutions. Vital signs monitoring companies for consumer use include Canada’s Carre Technologies, which produces Hexoskin¹⁷⁹ and also employs actigraphy for step counting and gait monitoring, and Israeli company HealthWatch, the product of which focuses on heart electrophysiology monitoring¹⁸⁰. Earlier-stage commercial products have also focused on posture health, such as MIT spin-out Nextiles, which uses conductive and piezoresistive-based smart textiles for gait and grip monitoring to optimize posture and training protocols for athletes¹⁸¹. Theragnostic (both therapeutic and diagnostic) vest smart textile solutions have also been developed commercially. Xenoma, in Japan, has developed wearable body suits and clothing that can be tailored to motion tracking, electrical stimulation, biomonitoring and physical therapy¹⁸², while Canada’s Myant Inc. has developed its Skiin product for biomonitoring and thermotherapy applications¹⁸³.

Smart sock solutions have also, perhaps surprisingly, been a key target of both diagnostic and theragnostic commercial focus. Companies such as Palarum¹⁶⁵, Siren¹⁴⁶, Texisense¹⁸⁴ and Sensoria Health¹⁸⁵ have developed solutions to provide assistive therapy, inflammation monitoring, posture monitoring and Parkinson’s disease management, respectively. Impractically, however, vest and sock solutions include rather large modular (detachable) components for data storage and/or data relay to a remote device, highlighting how industry has yet to fully address the bulky nature of these components. Moreover, although some of these options can carry out data analysis directly in situ, their level of sophistication is still not clear.

Certain business-to-business smart textile healthcare solutions have also been launched commercially and seem to include a service component. French company BioSerenity¹⁸⁶, focused on smart textiles for clinical trial use, has developed the products Cardioskin (ECG monitoring) and Neuronaute (EEG monitoring). These solutions are offered as part of a data analytics service-based model, rather than as stand-alone smart textiles for personalized healthcare.

Although major commercial efforts have been put in place to help in the development of function-specific products, some companies have focused on platform smart textile fabrication. DuPont, for instance, has demonstrated the large-scale ability to print metallic conductive inks on flexible polymeric films and produce light and stretchable conductive fibres that can be applied on any textile. They are offering therapeutic and monitoring/diagnostic applications in healthcare through their Intexar product line¹⁸⁷. Nipponic Toray Industries, with the biomonitoring ‘hitoe’ fabric¹⁸⁸, also seem to have addressed scalability. By filling nanofibre spaces with conductive polymeric materials, their solution apparently provides long-term wearability and washability resistance, although it is unclear what their commercialization strategies are.

Despite international efforts in commercializing smart textile solutions for personalized healthcare, the product focus remains limited, especially in the therapeutic space. Beyond this, miniaturization and smart textile integration of data-processing and relaying solutions seem to remain largely unaddressed by industry, as is the expansion into disease-specific solutions. Moreover, to our knowledge, global pharmaceutical companies and medical device companies have not yet started to develop smart textile solutions for personalized healthcare, and novel players are defining the industry.

Regulatory considerations.

The desire to push smart textiles in the fields of well-being and healthcare is strong, but regulatory restrictions need to be considered. The American Association of Textile Chemists and Colorists (AATCC)¹⁸⁹, the American Society for Testing and Materials (ASTM)¹⁶, the Institute of Printed Circuits (IPC)¹⁹⁰ and the International Organisation for Standards–International Electrotechnical Commission (ISO IEC)¹⁹¹ have all started to establish nomenclature and testing references for either e-textiles or smart textiles. However, from a medical use perspective, clinical regulation is also necessary. Within a clinical and regulatory setting, smart textiles can be largely considered as medical devices, with pathways for authorized use depending on regional regulatory agencies’ approval. To our knowledge, the only clinically approved smart textiles so far include the Food and Drug Administration (FDA) 510(k)-cleared Nanowear’s SimpleSense¹⁹², a heart-rate-monitoring textile¹⁹³, and HealthWatch’s MasterCaution, a vital signs monitor, which also holds a CE mark. Interestingly, SimpleSense was regulated by the FDA as a ‘radiofrequency physiological signal transmitter and receiver’¹⁹⁴, whereas MasterCaution received ‘telephone electrocardiograph transmitter and receiver’¹⁹⁵ nomenclature, suggesting an adapted and ad hoc classification for these smart textile healthcare solutions, rather than a dedicated regulatory framework. Consequently, it is important to establish broader and more far-reaching specific regulatory approval committees and pathways in smart textiles. To achieve this, initiatives to promote discussions between scientists, clinicians, regulators and industrial parties are necessary to unify efforts and translate smart textiles into clinically effective, approved solutions. We encourage translational research scientists to educate themselves on regulatory processes pertaining to medical devices by partaking in FDA¹⁹⁶, European Medicines Agency¹⁹⁷, Pharmaceuticals and Medical Devices Agency¹⁹⁸, National Medical Products Administration¹⁹⁹ and other regulatory agency meetings and workshops, as highlighted in the above references. Beyond regulatory bodies, government-level initiatives have been established in this regard. The European Commission’s CONTEXT initiative²⁰⁰ was developed as a European network to foster research and innovation efforts on advanced smart textiles, and has a dedicated Healthcare and Medicine working group that reports to the European Commission, which we invite readers to consult. This type of set-up should be embraced by regulatory bodies to set up cross-disciplinary roundtables and help establish future regulatory frameworks, which are key to developing medically approved smart textiles for personalized healthcare. Moreover, from a payer perspective, in large, privatized healthcare markets such as the United States, specific regulatory reimbursement codes must be devised, and state health systems should set up committees to establish reimbursement schemes and the integration of such smart textile-based personalized healthcare devices.

Computing capabilities

Computing capabilities are essential to the advancement of smart textiles for personalized healthcare. Data management—including data acquisition, analysis, transmission and storage—is an essential component for the correct functioning of smart textiles¹²⁷. Data analysis expectations can range from implementing simple signal-to-function association to carrying out sophisticated computational data flow processes¹². Heart rate monitoring can, for instance, involve tracking pulses in a simple (binary) on/off manner¹³² or involve in-depth ECG monitoring with multi-lead positioning³⁵, with insights into heart electrophysiology. Data analysis in ultraviolet exposure monitoring²⁰¹ can, in another way, be carried out using linear association to track sun (over)exposure. Varying levels of data management complexity can therefore be relayed when using smart textiles.

Some wearable devices can act independently of data analytics, such as (homeostatically inspired) closed-loop solutions that self-regulate using analyte-induced physicochemical reactions²⁰², although most wearable solutions follow a pattern of data acquisition, analysis and clinical intervention (diagnostic or therapeutic)²⁰, governed and established by a third-party powered and modular decision-making unit (DMU) component¹³⁵. For smart textiles, such components are usually wirelessly connected to a nearby computational device (smartphones, tablets) for data management or third-party, cloud-based relays for remote monitoring. Efforts are now in place to transition data management onto the textile devices themselves, for in situ computing²⁰³. Besides hardware innovation, which, as seen previously, has still to catch up in commercially available products, integrating machine-learning algorithms will also be required to help smart textiles adapt to aging and evolving patient health²⁰⁴ and to integrate health changes, for example, pre- and post-diabetic changes, stroke or musculoskeletal injuries’ implications.

Autonomous textile body area networks.

The development of autonomous, independent and smart-textile embedded data management capabilities is a great opportunity to deliver fully fledged personalized healthcare solutions. To this end, we wish to propose a new concept and the use of autonomous textile body area networks (ATBANs) as a practical smart textile-based solution. The smart textiles used in personalized healthcare have relied on three core functionalities—energy provision²⁰⁵, data management (acquisition, analysis, transmission and storage)²⁰⁴ and clinical intervention (diagnostic or therapeutic)²⁰—with at least one of these functionalities dependent on outside intervention. Fortunately, recent technological advancements in materials science, nanoelectronics and miniaturization capabilities²⁰⁶ have freed smart textiles from this external dependence, integrating key functionalities directly within the textiles themselves. Moreover, from an interconnectability perspective, the growing presence of 5G infrastructure can now integrate smart textiles into the IoT via continuous wireless external communication²⁶. By leveraging these capabilities, ATBANs can provide a fully closed-loop personalized healthcare solution that includes diagnostic technologies, therapeutic platforms, powering technologies, communication relays and DMU computational capabilities. All these components can be fully integrated into an intelligent system supported by a cooperative, self-adaptive and intelligent node-based network²⁰³ (Fig. 5a).

Fig. 5 |. ATBAN for personalized healthcare.

a, An autonomous textile body area network (ATBAN) on clothing, enabling parallel monitoring of metabolites (biomolecular analysis), mobility (pressure monitoring), cardiovascular function (heart rate monitoring) and pyretic state (temperature monitoring). Drug-delivery, phototherapeutic, electrotherapeutic and thermotherapeutic nodes ensure constant medical intervention capabilities when required, and as directed by the central processing unit node. Energy nodes supply constant power by harnessing passive energy sources, including to the communication control unit node used for integration with the IoT. b, The various types of ATBAN personalized healthcare functionality via diagnostic (green), therapeutic (yellow), energy (blue) and data-processing (grey) nodes. These include autonomous in situ intervention, data-based user-driven intervention and cloud-based integration within a plethora of remote translational research applications. c, Summary of key hardware and software focus points essential for optimal ATBAN development.

To explain the potential of ATBANs for specific clinical conditions, a closed-loop configuration for diabetic patients could be imagined. Such a system could include a smart textile with glucose-monitoring nodes, therapeutic insulin-delivery nodes and energy-harvesting nodes, working together to ensure intelligent and self-adaptive glucose level control. The presence of communication nodes could continuously communicate glucose level data through a user’s smartphone or remote cloud systems, sending alerts in the case of hyper- or hypoglycaemic states. In parallel, smart textiles could also save and index data into the patient’s clinical record, allowing archiving and remote clinician monitoring/intervention.

With the emergence of translational research, moreover, the development of ATBANs could expand implementation capabilities and achieve, in clinical trials, the introduction of scalable and autonomous dosage, monitoring and follow-up with enrolled patients. This approach would, de facto, remove the need for costly and centralized facilities. ATBANs would provide personalized healthcare solutions that are independent and energetically self-sufficient in data management and clinical intervention capabilities, shifting healthcare from the bench to the bedside. We have seen examples of this in BioSerenity’s business model, as described earlier¹⁸⁶.

A versatile and modular ATBAN that can be fine-tuned to integrate specific functionalities, depending on each patient’s personal clinical profile, could provide a clinical platform of interest, and could be systematically upgraded alongside technological advancements, incorporating increasingly complex and autonomous computational nodes, and software updates. ATBANs present many advantages, including the capability to deliver timely, patient-specific, independent and intelligent clinical monitoring, as well as autonomous computation and clinical interventions directly in situ, removing patient burden linked to travelling to a clinic. Such technologies will help democratize access to quality healthcare globally, providing a novel way to help thrust personalized healthcare into an optimized and cost-effective era (Fig. 5b).

Developing ATBANs highlights the substantial limitations of using highly engineered textiles. Pushbacks to ATBANs’ use also include user adoption²⁰⁷. To address these issues, developing smart textile wearables with detachable components could help remove water-damage risks and simplify user interaction. We invite multidisciplinary collaboration to optimize hardware, software and device-to-device communication within ATBANS (Fig. 5c).

Outlook

The future development of smart textiles requires consideration of key areas by academia and industry. In academia, this should include material innovation, device structures, reliability and stability, functional integration and performance standardization. In industry, this should include product standardization, value chain creation, manufacturing and clinical integration.

Academic considerations.

The use of novel raw materials and the development of novel composites will be important in addressing issues of washability, performance and resistance (Fig. 6a). Materials such as hybrid composites with programmable functionalities are promising in this regard²⁰⁸ and should be explored further. Non-biocompatible or physiologically inadequate materials should be avoided, and focus should instead be placed on developing corrosion-resistant self-healing textiles²⁰⁹. Furthermore, the use of rare or expensive materials is unlikely to lead to industrially scalable solutions, and viable alternatives should be sought.

Fig. 6 |. Future trends in smart healthcare textiles.

a, Fundamental material areas of focus in smart technologies. b, Optimized device design using advanced manufacturing techniques. c, Improving the reliability of smart textiles for practical applications. d, Systematic-level integration and optimization of textile electronic components to improve healthcare outcomes. e, Applicative scenarios of smart healthcare textiles in clinical practice and translational research. f, Macroscopic considerations linked to scaling healthcare textiles at the industrial level.

Smart textile devices often integrate functional materials with harsher mechanical properties. Miniaturization of fibres (at the nanoscale) and coating with mechanically soft materials, could help address this. Furthermore, heterogeneous functional layer deposition issues²¹⁰, which arise during fabrication, could be addressed using interface engineering to allow stable interfacial bonding and reduce the occurrence of fibre cracks and delamination (Fig. 6b)²¹¹. Moreover, advice from textile experts, including recognized fashion institutes of textiles and technology, should be sought regarding comfort-enhancing weaving techniques, rather than developing technologies afresh. Focus should also be placed on alternative weaving architectures and thread thickness to define novel healthcare functions, such as three-dimensional weaving structures. These are expected to deliver overall better healthcare applications²¹², producing structural properties with inherent flexibility, robustness, porosity and softness³⁰.

Smart textiles should offer breathability, washability, robustness, thermal stability and air/moisture permeability (Fig. 6c), all of which are current weak points. Thus, focus should be placed on protection from oxidation, humidity and mechanical deformation. Well-sealed textile sensors using polymer encapsulation (covering curvilinear surfaces) can provide a solution to this end⁸². Exploring ultrahydrophobicity could also help provide exciting solutions.

Developing efficient processing techniques to integrate multiple textile healthcare devices with a comfortable design will be an essential step towards fabricating complex smart textiles and ATBANs (Fig. 6d). Digital sewing machines hold promise, as recently demonstrated with the fabrication of a fully integrated textile system consisting of textile display, keyboard and power supply components¹⁷⁶. Researchers should focus on scalable and automated processes relying on existing, low-barrier fabrication technologies.

Establishing objective performance comparisons among smart textiles solutions is currently extremely challenging due to the heterogeneity of academic solutions developed. To allow effective and true comparison between academically devised smart textile healthcare solutions, we invite academics to research and, insofar as possible, imitate textile testing methods based on ISO standards (such as ISO/TC 38/SC 24 testing standards)²¹³. For personalized healthcare smart textiles, previous (similar) work and example testing conditions should be mimicked, and a comparative analysis given within the manuscript, rather than creating ex novo testing conditions. Editors and peer reviewers should consider making this aspect a prerequisite to publishing articles related to smart textile solutions for personalized healthcare.

Industrial considerations.

Growing efforts are being made regarding standardizing certain aspects of the smart textile industry, beginning with the nomenclature and differentiation between e-textiles, smart textiles and wearable bioelectronics. Providing clarity and guidelines will be essential. Alongside infrastructural issues, which arise with novel hardware-heavy industry, broader and more abstract standardization considerations must be addressed. For instance, regulatory consensus on the clinical testing, validation, approval and medical device clearance guidelines will need to be developed (Fig. 6e).

Even though the traditional textile industry is mature and established, a well-defined value chain is still absent in smart textiles. Transitioning from small-scale, ad hoc academic focus to industry requires adaptation. High raw material costs, rarity and toxicity, as well as the need for a highly trained workforce skillset, also limit scaling up. Medical-grade manufacturing standards requirements in healthcare also add a layer of complexity to smart textile production for clinical use. Initiatives have emerged to help on this front. The European Commission has set up the SmartX European Smart Textiles Accelerator to specifically help with academia–industry bridging and smart textile value-chain creation²¹⁴, including a specific medical division. This initiative is dedicated to small- and medium-sized enterprises for smart textile solution development, and we encourage researchers and start-ups to initiate conversations with such bodies.

To address scaling-up manufacturing issues²¹⁵, we suggest both a top-down scaling approach and a bottom-up scaling approach. Diagnostic, large-rollout, generalized smart textiles solutions could benefit from a top-down manufacturing strategy solution. Here, economies-of-scale factors, including lower raw material cost and provision, uniform design production, adaptation to existing machinery and mirroring of established protocols would prevail and be applied in continuous manufacturing mode. Cheaper semiconductive functional materials (physicochemically sensitive PTFE or PVDF) and monolithic platform technologies (PENG and MEG) would also provide easier scalability. Fabrication strategies such as spinning, demonstrated at scale⁹⁹, could be used to develop standardized clothing apparel with preset sensing areas (chest for heart and respiratory rate, integrated glove for oxygen saturation detection, and multi-position sensorial bodies for motion traction), possessing embedded metal conducting threads for plugging into data-relaying units or nodes. These could be developed at scale and replace hospital gowns, and be easily recycled. Owing to material selection, these solutions would also be the most well suited to washability and long-term comfort for everyday use.

A bottom-up scaling approach for therapeutic or highly functionalized solutions would, conversely, be driven by the specificity of the desired therapeutic function. Bottom-up scaling, requiring more technical expertise and raw material variety, could be carried out using batch manufacturing. Drug-delivering smart textiles such as thermoresponsive hydrogel drug carriers²² could hold platform scaling-up potential, with various drugs being loaded onto the smart textile in parallel batch steps, to produce a portfolio of drug-releasing smart textiles. Insulin-releasing, wound-healing and post-operative surgery management smart textiles could all be a part of this more sophisticated bottom-up approach.

Ensuring scientific and clinical effectiveness recognition by the medical community is essential to smart textile adoption. Considering the substantial electrical engineering and materials science focus of these devices, this could present alienation problems. Training clinicians (and patients) to appreciate the working modes of smart textiles will require dedicated focus. Optimized user interfaces, network integration and accessibility should also be closely developed alongside clinicians.

Given the multidisciplinary nature of smart textiles in personalized healthcare, cross-collaboration between materials scientists, electrical engineers, clothing industry experts, regulatory bodies, clinicians, patients, user-interface developers and government entities will be required to optimize future development and integration (Fig. 6f). We hope that access to the initiatives mentioned above will help colleagues contribute to the establishment of the value chain of smart textiles for personalized healthcare.