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Socially Assistive Robots for Helping Pediatric Distress and Pain

A Review of Current Evidence and Recommendations for Future Research and Practice

Trost, Margaret J., MD*,†; Ford, Adam R., BS*; Kysh, Lynn, MLIS*,†; Gold, Jeffrey I., PhD*,†; Matarić, Maja, PhD

The Clinical Journal of Pain: May 2019 - Volume 35 - Issue 5 - p 451–458
doi: 10.1097/AJP.0000000000000688
Review Articles

Objectives: Interacting with socially assistive robots (SAR) has been shown to influence human behaviors and emotions. This study sought to review the literature on SAR intervention for reducing pediatric distress and pain in medical settings.

Methods: Databases (PubMed, Cochrane Library, CINAHL, PsycINFO, ERIC, Web of Science, Engineering Village, Scopus, Google Scholar, IEEE Xplore) were searched from database inception to January 2018 with the aid of a medical librarian. Included studies examined any SAR intervention for reducing pain or improving emotional well-being in children related to physical or psychiatric care, with outcomes assessed by some quantitative measure. Study quality was assessed using the modified Downs and Black checklist (max. score, 28). The review is registered in PROSPERO (CRD42016043018).

Results: Eight studies met the eligibility criteria and represented 206 children. Of the 2 studies using Wong-Baker’s FACES scale, 1 study claimed to be effective at reducing pain (Cohen d=0.49 to 0.62), while the other appeared effective only when parents and child interacted with SAR together. Distress was evaluated using validated measures in 4 studies, 3 of which showed reduction in distress while one showed no difference. Satisfaction surveys from 4 studies showed that children were interested in using SAR again. Quality scores ranged from 8 to 26.

Conclusions: There is limited evidence suggesting that SAR interventions may reduce distress and no clear evidence showing reduction in pain for children in medical settings. Engineers are conducting interventions using SAR in pediatric populations. Health care providers should be engaged in technology research related to children to facilitate testing and improve the effectiveness of these systems.

*Departments of Anesthesiology, Pediatrics, and Psychiatry & Behavioral Sciences, University of Southern California, Keck School of Medicine

Children’s Hospital Los Angeles

University of Southern California, Viterbi School of Engineering, Los Angeles, CA

M.J.T.: coordinated and conducted article review, drafted the initial manuscript, and approved the final manuscript as submitted. A.R.F.: also coordinated and conducted article review, codrafted the initial manuscript, and approved the final manuscript as submitted. L.K.: created and supervised the article search strategy, wrote and edited the methods section of the manuscript, and approved the final manuscript as submitted. J.I.G.: critically reviewed the edited the manuscript and approved the final manuscript as submitted. M.M.: contributed to writing the robotics sections of the article, and critically reviewed and edited the manuscript throughout the writing process.

M.J.T. is an institutionally funded Clinical and Translational Scholar. This work was supported by grant UL1TR001855 from the National Center for Advancing Translational Science (NCATS) of the US National Institutes of Health, Los Angeles, CA. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no conflict of interest.

Reprints: Margaret J. Trost, MD, Division of Hospital Medicine, Children’s Hospital Los Angeles, 4650 Sunset Blvd., MS#94, Los Angeles, CA 90027 (e-mail:

Received May 9, 2018

Received in revised form January 10, 2019

Accepted January 22, 2019

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