Using the Social Robot NAO for Emotional Support to Children at a Pediatric Emergency Department: Randomized Clinical Trial

Silvia Rossi, Silvano Junior Santini, Daniela Di Genova, Gianpaolo Maggi, Alberto Verrotti, Giovanni Farello, Roberta Romualdi, Anna Alisi, Alberto Eugenio Tozzi, Clara Balsano, Silvia Rossi, Silvano Junior Santini, Daniela Di Genova, Gianpaolo Maggi, Alberto Verrotti, Giovanni Farello, Roberta Romualdi, Anna Alisi, Alberto Eugenio Tozzi, Clara Balsano

Abstract

Background: Social robots (SRs) have been used for improving anxiety in children in stressful clinical situations, such as during painful procedures. However, no studies have yet been performed to assess their effect in children while waiting for emergency room consultations.

Objective: This study aims to assess the impact of SRs on managing stress in children waiting for an emergency room procedure through the assessment of salivary cortisol levels.

Methods: This was an open randomized clinical trial in children attending a pediatric emergency department. Children accessing the emergency room were randomized to 1 of 3 groups: (1) playing with a NAO SR, (2) playing with a study nurse, or (3) waiting with parents. The salivary cortisol levels of all children were measured through a swab. Salivary cortisol levels before and after the intervention were compared in the 3 groups. We calculated the effect size of our interventions through the Cohen d-based effect size correlation (r).

Results: A total of 109 children aged 3-10 years were enrolled in the study, and 94 (86.2%) had complete data for the analyses. Salivary cortisol levels significantly decreased more in the group exposed to robot interaction than in the other two groups (r=0.75). Cortisol levels decreased more in girls (r=0.92) than in boys (r=0.57).

Conclusions: SRs are efficacious in decreasing stress in children accessing the emergency room and may be considered a tool for improving emotional perceptions of children and their families in such a critical setting.

Trial registration: ClinicalTrials.gov NCT04627909; https://ichgcp.net/clinical-trials-registry/NCT04627909.

Keywords: anxiety; children; emergency department; emotional health; social robots; stress.

Conflict of interest statement

Conflicts of Interest: None declared.

©Silvia Rossi, Silvano Junior Santini, Daniela Di Genova, Gianpaolo Maggi, Alberto Verrotti, Giovanni Farello, Roberta Romualdi, Anna Alisi, Alberto Eugenio Tozzi, Clara Balsano. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 13.01.2022.

Figures

Figure 1
Figure 1
Cohort assembly: study procedure and timing of outcome assessment. CBQ-VSF: Children’s Behavior Questionnaire-Very Short Form; T0-T1-T2: timing of cortisol level measurement; TEC: Test of Emotion Comprehension.
Figure 2
Figure 2
Enrollment and randomization of children.
Figure 3
Figure 3
Salivary cortisol levels (A) in the whole sample, (B) in boys, and (C) in girls. Data are expressed as the median and IQR (*P<.05, **P<.01, ***P<.001). r represents the Cohen d-based effect size correlation.
Figure 4
Figure 4
Heart rate (A) in the whole sample. Data are expressed as the median and IQR (***P<.001; r represents the Cohen d-based effect size correlation). Direct linear regression between heart rate and salivary cortisol levels at T2 in the control group (B), study nurse group (C), and NAO robot group (D).

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