Reply: Matters Arising ‘Investigating sources of inaccuracy in wearable optical heart rate sensors’
Open accessAbstract
This is a response to the Matters Arising (MA) that examines our original article, ‘Investigating inaccuracies in wearable optical heart rate sensors’ 1 . We performed this original study to address the concern that there was inadequate published research on the potential effect of skin tone on wearable device accuracy. The central hypothesis tested in the original study was that darker skin tones have decreased photoplethysmography-based heart rate measurement accuracy as compared with lighter skin tones. The MA suggests improvements surrounding two aspects of the original study: the sample size and the use of the Fitzpatrick skin tone (FP) scale to categorize skin tones. The original study was designed and powered according to the above hypothesis. We acknowledge that visual skin tone scales are imperfect, and that a study can never prove the null hypothesis to be true. We, too, encourage more work examining wearable device accuracy across skin tones. In this reply, we aim to address questions surrounding the sample size, covariates, and choice of skin tone scale in the original article.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The skin color of the subject has been a major point of discussion concerning the quality of PPG recordings.
“Prominently, the skin color of the subject has been a major point of discussion concerning the quality of PPG recordings14,47,48.”
From Data quality evaluation in wearable monitoring (2022) · cites this paper as [48]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Investigating sources of inaccuracy in wearable optical heart rate sensors
Bent, B., Goldstein, B. A., Kibbe, W. A., & Dunn, J. P. (2020) · npj Digital Medicine · doi:10.1038/s41746-020-0226-6 · Cited by 673 · see citing works
Self-citationShcherbina, A., Mattsson, C., Waggott, D., Salisbury, H., Christle, J., Hastie, T., Wheeler, M., & Ashley, E. (2017) · Journal of Personalized Medicine · doi:10.3390/jpm7020003 · Cited by 625 · see citing works
Goldsack, J. C., Coravos, A., Bakker, J. P., Bent, B., Dowling, A. V., Fitzer-Attas, C., Godfrey, A., Godino, J. G., Gujar, N., Izmailova, E., et al. (2020) · npj Digital Medicine · doi:10.1038/s41746-020-0260-4 · Cited by 557 · see citing works
Self-citationVariations in skin colour and the biological consequences of ultraviolet radiation exposure
Bino, S. D., & Bernerd, F. (2013) · British Journal of Dermatology · doi:10.1111/bjd.12529 · Cited by 261 · see citing works
Influence of skin type and wavelength on light wave reflectance
Fallow, B. A., Tarumi, T., & Tanaka, H. (2013) · Journal of Clinical Monitoring and Computing · doi:10.1007/s10877-013-9436-7 · Cited by 162 · see citing works
Validation of Biofeedback Wearables for Photoplethysmographic Heart Rate Tracking.
(2016) · PubMed Central · Cited by 150 · see citing works
Motion Artifact Reduction for Wrist-Worn Photoplethysmograph Sensors Based on Different Wavelengths
Zhang, Y., Song, S., Vullings, R., Biswas, D., Simões-Capela, N., van Helleputte, N., van Hoof, C., & Groenendaal, W. (2019) · Sensors · doi:10.3390/s19030673 · Cited by 140 · see citing works
(2020) · PubMed · Cited by 108 · see citing works
The European standard for sun-protective clothing: EN 13758
Gambichler, T., Laperre, J., & Hoffmann, K. (2006) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/j.1468-3083.2006.01401.x · Cited by 105 · see citing works
Gambichler, T., Boms, S., Stücker, M., et al. (2006) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/j.1468-3083.2006.01629.x · Cited by 74 · see citing works
Reflectance spectrophotometer: the dermatologists’ sphygmomanometer for skin phototyping?
Pershing, L. K., Tirumala, V. P., Nelson, J. L., Corlett, J. L., Lin, A. G., Meyer, L. J., & Leachman, S. A. (2008) · Journal of Investigative Dermatology · doi:10.1038/sj.jid.5701238 · Cited by 72 · see citing works
Treesirichod, A., Chansakulporn, S., & Wattanapan, P. (2014) · Indian Journal of Dermatology · doi:10.4103/0019-5154.135476 · Cited by 65 · see citing works
Relationship between skin color and cutaneous response to ultraviolet radiation in Thai
Leenutaphong, V. (1995) · Photodermatology Photoimmunology & Photomedicine · doi:10.1111/j.1600-0781.1995.tb00169.x · Cited by 65 · see citing works
Skin color analysis using a spectrophotometer in Asians
Yun, I. S., Lee, W. J., Rah, D. K., Kim, Y. O., & Park, B. Y. (2010) · Skin Research and Technology · doi:10.1111/j.1600-0846.2010.00434.x · Cited by 63 · see citing works
Pichon, L. C., Landrine, H., Corral, I., Hao, Y., Mayer, J. A., & Hoerster, K. D. (2010) · PubMed · Cited by 56 · see citing works
Human skin detection in the visible and near infrared
Mendenhall, M. J., Nunez, A. S., & Martin, R. K. (2015) · Applied Optics · doi:10.1364/ao.54.010559 · Cited by 53 · see citing works
Comparing alternative methods of measuring skin color and damage
Daniel, L. C., Heckman, C. J., Kloss, J. D., & Manne, S. L. (2008) · Cancer Causes & Control · doi:10.1007/s10552-008-9245-3 · Cited by 52 · see citing works
Reeder, A. I., Hammond, V. A., & Gray, A. R. (2010) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-09-1300 · Cited by 39 · see citing works
Zong, C., & Jafari, R. (2015) · 2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/embc.2015.7320268 · Cited by 39 · see citing works
Heart Snapshot: a broadly validated smartphone measure of VO 2 max for collection of real world dataPreprint
Webster, D. E., Tummalacherla, M., Higgins, M., Wing, D., Ashley, E. A., Kelly, V. E., McConnell, M. V., Muse, E. D., Olgin, J., Mangravite, L. M., et al. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.07.02.185314 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
A Review of Wearable Multi-Wavelength Photoplethysmography
Ray, D., Collins, T., Woolley, S., & Ponnapalli, P. (2023) · IEEE Reviews in Biomedical Engineering · doi:10.1109/rbme.2021.3121476 · Cited by 155 · see citing works
Data quality evaluation in wearable monitoring
Böttcher, S., Vieluf, S., Bruno, E., Joseph, B., Epitashvili, N., Biondi, A., Zabler, N., Glasstetter, M., Dümpelmann, M., Van Laerhoven, K., et al. (2022) · Scientific Reports · doi:10.1038/s41598-022-25949-x · Cited by 91 · see citing works
- Authors
- Bent, B., Enache, O. M., Goldstein, B., Kibbe, W., & Dunn, J. P.
- Affiliations
- Duke University (US)
- Corresponding author
- Dunn, Jessilyn P.
- Venue
- npj Digital Medicine
- Published
- 2021-02-26
- Volume
- 4
- Issue
- 1
- Pages
- 39-39
- ISSN
- 2398-6352 (ISSN-L)
- PMC
- PMC7910441
- OpenAlex
- W3130393823
- Cited by
- 17
- References
- 20
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 3 · 2023: 4 · 2022: 2 · 2021: 1
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- npj Digital Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Whitehead Scholar
- Forge Fellow
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- photoplethysmography, skin tone, measurement accuracy, sample size, covariates, darker skin tones
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
