LO63: Humanoid robot-based distraction to reduce pain and distress during venipuncture in the pediatric emergency department: A randomized controlled trial

Abstract

Introduction: Intravenous insertion (IVI) is identified by children as extremely painful and the resultant distress can have lasting negative consequences. There is an urgent need to effectively manage such procedures. Our primary objective was to compare the pain and distress of IVI with the addition of humanoid robot-based distraction to standard care, versus standard care alone. Methods: This two-armed randomized controlled trial (RCT) was conducted from April 2017 to May 2018 at the Stollery Children's Hospital emergency department (ED). Children aged 6 to 11 years who required IVI were included. Exclusion criteria included hearing or visual impairments, neurocognitive delays, sensory impairment to pain, previous enrolment, and discretion of the ED clinical staff. Primary outcomes were measured using the Observational Scale of Behavioural Distress-Revised (OSBD-R) (distress) and the Faces Pain Scale-Revised (FPS-R) (pain). A total of 426 pediatric patients were screened and 340 were excluded. Results: We recruited 86 children, of which 55% (47/86) were male; 9% (7/82) were premature at birth; 82% (67/82) had a previous ED visit; 30% (25/82) required previous hospitalization; 78% (64/82) had previous IV placement and 96% (78/81) received topical anesthesia. The mean total OSBD-R score was 1.49 ± 2.36 (standard care) compared to 0.78 ± 1.32 (robot group) (p = 0.047). The median FPS-R during the IV procedure was 4 (IQR 2,6) in the standard care group alone, compared to 2 (IQR 0,4) with the addition of humanoid robot-based distraction (p = 0.10). Change in parental state anxiety pre-procedure versus post-procedure was not significantly different between groups (p = 0.49). Parental satisfaction with the IV start was 93% (39/42) in the robot arm compared to 74% (29/39) in the standard care arm (p = 0.03). Parents were also more satisfied with management of their child's pain in the robot group (95% very satisfied) compared with standard care (72% very satisfied) (p = 0.002). Conclusion: A statistically significant reduction in distress was observed with the addition of robot-based distraction to standard care. Humanoid robot-based distraction therapy reduces distress and to a lesser extent, pain, in children undergoing IVI in the ED. Further trials are required to confirm utility in other age groups and settings.

Exploring the needs of children and caregivers to inform design of an artificial intelligence-enhanced social robot in the pediatric emergency department

“…Within pediatrics, SARs have been increasingly implemented to ameliorate pain and distress, with positive outcomes [7,10–13]. Specifically, robots have been shown to reduce distress for needle-related procedures in the pediatric emergency department (ED) [7]. Similar results exist for pre-procedure and vaccination-related pain and distress [14,15].…”

“…Socially assistive robotics (SARs) have the potential to be uniquely beneficial as a novel technology with potential to create a more immersive experience for children than other known digital distraction modalities. Several recent studies have shown promising results regarding the application of SAR to mitigate children's procedure-related pain and distress [7,8].…”

Socially-Assistive Robots Using Empathy to Reduce Pain and Distress during Peripheral IV Placement in Children

“…Furthermore, the guiding principles for using books, bubbles, pinwheels, games, and videos have been seated within a framework that "distraction" was the primary mechanism of action. Previous studies have used the socially assistive robot NAO (Aldebaran Robotics ® ) to distract children and reduce pain during vaccination [10] and more recently during IV placement where early study results also showed no change in FACES pain scale but improvement in distress by the Observational Scale of Behavioural Distress-Revised (OSBD-R) [24]. Our study differs significantly from this work because the empathic IVEY is not acting as simple distraction.…”

Using AI-Enhanced Social Robots to Improve Children’s Healthcare Experiences

“…The system will be tested in the target environment throughout the project period, culminating in a two-site randomised clinical trial at the end of the project. The target robot platform is the Nao robot from SoftBank Robotics (Figure 1), which has been widely used in child-robot interaction studies, including several in the identical clinical context we are targeting [2,12]. Concretely, this project is addressing the following research questions: To explore these questions we are employing a range of interdisciplinary techniques: the robot behaviours will be defined and developed through a co-design approach that includes children, family members, and healthcare providers; the robot software will be implemented using state-of-the-art AI techniques, and will be evaluated using approaches from usability testing; the clinical trial will be carried out using standard tools and techniques; while the investigation of ethical and social implications will rely on techniques from content analysis.…”

“…Recently, several studies have explored the use of social robots in this context, specifically providing psychological interventions during needle-based procedures [2,12,27]. The results of these studies have generally been positive, showing high acceptance among the target population as well as promising initial clinical results.…”