Telerehabilitation-Based Dance Therapy in Pediatric Cancer

Effects of Telerehabilitation-Based Dance Therapy on Motor Proficiency, Quality of Life, Participation, and Motivation in Pediatric Cancer: A Randomized Controlled Trial

Childhood cancer requires prolonged and intensive treatment, resulting in significant biopsychosocial challenges for affected children and their families. During and following treatment, children frequently experience impairments in fine and gross motor skills, reduced physical capacity, emotional difficulties, and decreased participation in daily activities. Within the framework of the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY), these impairments in body structure and function may negatively influence activity, participation, and overall quality of life.

Dance therapy is a holistic rehabilitation approach that integrates rhythm, structured movement, and emotional expression to enhance motor performance, body awareness, and psychosocial well-being. Emerging evidence suggests that dance-based interventions may contribute to improved pain management, psychological resilience, and emotional health in pediatric oncology populations. However, access to structured physical activity programs remains limited due to treatment-related fatigue, infection risk, travel burden, time constraints, and financial costs.

Telerehabilitation may overcome these barriers by delivering therapy remotely, thereby improving accessibility, reducing logistical constraints, and ensuring continuity of care.

The aim of this randomized controlled trial is to evaluate the effects of an 8-week telerehabilitation-based dance therapy program (twice weekly, 35-40 minutes per session) on fine and gross motor skills, health-related quality of life, participation in home, school, and community settings, and motivation in children undergoing or recently completing cancer treatment.

Children diagnosed with cancer frequently experience persistent biopsychosocial difficulties during and after treatment. Common symptoms include fatigue, pain, gastrointestinal disturbances, emotional distress, reduced motivation, and social isolation, all of which negatively affect health-related quality of life. In addition, both the disease process and treatment-related side effects may lead to impairments in fine and gross motor skills, thereby limiting activity performance and participation in daily life.

Rehabilitation and structured physical activity programs have been shown to be safe and beneficial for pediatric oncology populations, with positive effects on fatigue, physical functioning, and overall well-being. Dance therapy is a movement-based intervention that combines structured physical activity with rhythmic stimulation and emotional expression. It aims to enhance motor proficiency, body awareness, emotional regulation, and social participation. Although preliminary evidence suggests that dance- or music-based interventions may reduce anxiety and pain while improving mood in children with cancer, randomized controlled trials evaluating dance therapy as a structured exercise modality in pediatric oncology are lacking.

Access to in-person rehabilitation services may be restricted due to transportation challenges, financial burden, infection risk, and treatment-related fatigue. Telerehabilitation provides a feasible alternative by delivering remote, technology-supported therapy that improves accessibility, reduces logistical barriers, and promotes continuity of care. Emerging evidence indicates that telerehabilitation is both feasible and acceptable for children undergoing or completing cancer treatment.

This randomized controlled trial aims to evaluate the effectiveness of an 8-week telerehabilitation-based dance therapy program delivered twice weekly for 35-40 minutes per session. The primary focus is to assess changes in fine and gross motor proficiency. Secondary outcomes include participation in home, school, and community activities, health-related quality of life, and motivation. The study population consists of children aged 6-14 years with a history of childhood cancer who are undergoing or have recently completed treatment.

The intervention will be delivered via WhatsApp video calls as a medium-technology telerehabilitation model. Participant and caregiver feedback regarding feasibility and acceptability will also be collected to inform the future development of more advanced, personalized telerehabilitation systems.

Telerehabilitation-based dance therapy is expected to provide an accessible, enjoyable, and sustainable rehabilitation approach that supports functional recovery and enhances participation in daily life among children with cancer.

Inclusion Criteria:

• Children aged 6-14 years diagnosed with a hematological malignancy or solid tumor by a pediatric oncology specialist.
• Currently undergoing treatment or within 6 months after completion of treatment (for hematological malignancies: during maintenance therapy or ≤6 months post-treatment; for solid tumors: during treatment or ≤6 months post-treatment).
• Medically stable and cleared by the treating clinical team to participate in moderate physical activity/dance therapy.
• Able to stand independently and perform movements without assistive devices.
• Access to a digital device (smartphone, tablet, or computer) equipped with a camera, audio capability, and a stable internet connection.
• Parent/guardian able to read and write in Turkish.
• Written informed consent from the parent/guardian and assent from the child (as appropriate for age).

Exclusion Criteria:

• Pre-existing genetic, neurological, developmental, or motor disorders diagnosed prior to cancer diagnosis that may affect motor performance.
• Medical contraindications to exercise (e.g., unresolved fractures, severe avascular necrosis, recent bone marrow transplantation, or other conditions restricting physical activity as determined by the treating physician).
• Inability to maintain stable internet connectivity required for telerehabilitation sessions.
• Previous structured dance therapy participation within the last 6 months.