Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: May 7, 2025
Date Accepted: Oct 24, 2025
Socially Assistive Robots for Pain Management and Emotional Responses in Pediatric Hospital Care: A Systematic Review and Meta-Analysis
ABSTRACT
Background:
Pain and emotional distress are frequently encountered in pediatric hospital settings, which may lead to long-term outcomes if inadequately managed. The application of socially assistive robots (SARs) has been proposed as a non-pharmacological adjunct to reduce pain and support emotional well-being. More extensive research is still needed to evaluate its impact on children in the hospital context.
Objective:
This systematic review and meta-analysis aimed to evaluate the effectiveness of SARs in reducing pain and emotional outcomes, including anxiety, fear, and distress in pediatric hospital settings.
Methods:
This review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews) 2020 guidelines. Six databases (PubMed, Embase, Cochrane Library, IEEE Xplore, Scopus, and ProQuest) were searched to May 6, 2025. Eligible studies were randomized controlled trials (RCTs) involving children (<19 years) in hospital settings. Two reviewers independently screened, extracted data, assessed risk of bias, and graded certainty of evidence. Meta-analyses were performed with random-effects models (Hartung–Knapp–Sidik–Jonkman), and funnel plots were used to explore publication bias.
Results:
13 RCTs (n=619) were included, of which 7 studies (n=359) contributed to meta-analyses. For pain, five studies demonstrated a statistically significant pooled reduction favoring SARs (Difference in means = –0.89, 95% CI: –1.32 to –0.47; 95% PI: –1.29 to –0.49; I² = 11.9%, τ² < 0.0001). By contrast, pooled effects for anxiety (3 studies; Difference in means = –1.00, 95% CI: –2.44 to 0.44; 95% PI: –3.45 to 1.45; I² = 73.8%, τ² = 0.2172), fear (2 studies; Difference in means = –0.04, 95% CI: –1.72 to 1.64; 95% PI: –2.70 to 2.63; I² = 0.0%, τ² = 0), and distress (2 studies; Difference in means = –0.23, 95% CI: –6.00 to 5.54; 95% PI: –8.99 to 8.54; I² = 65.0%, τ² = 0.2693) were statistically nonsignificant. Funnel plots indicated possible small-study effects. According to the risk of bias and graded assessment, all outcomes were rated as moderate certainty, with downgrades due to risk of bias, imprecision, and small sample sizes.
Conclusions:
This systematic review and meta-analysis found consistent evidence that SARs can reduce pain in pediatric hospital care, whereas pooled outcomes for anxiety, fear, and distress were nonsignificant and limited by heterogeneity, imprecision, and small sample sizes. Clinical Trial: Prospero CRD420251026751
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