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Childhood cancers affect approximately 400,000 children and adolescents worldwide each year. Although advances in treatment have significantly improved survival rates, children undergoing cancer treatment continue to experience a wide range of treatment-related symptoms and complications. Among these, fatigue and sleep disturbances are particularly common and may persist throughout treatment and survivorship, negatively affecting psychological well-being, cognitive functioning, and overall quality of life. Reduced physical activity during treatment is strongly associated with worsening fatigue, impaired sleep, and decreased quality of life in pediatric oncology patients. However, treatment side effects, prolonged hospitalization, infection risk, and lack of motivating play-based activities often limit children's participation in physical activity during treatment. Recent evidence suggests that physical activity interventions may help reduce fatigue and improve well-being in children with cancer, yet engaging and age-appropriate non-pharmacological interventions remain limited, especially for younger children.
This pilot randomized controlled trial aims to evaluate the feasibility and potential effects of a robot-dog-assisted walking intervention on sleep quality, fatigue, and quality of life among children aged 2-7 years undergoing cancer treatment.
This pilot randomized controlled trial will evaluate the feasibility and preliminary effects of a robot-dog-assisted walking intervention for children aged 2-7 years receiving active cancer treatment. The intervention is designed to promote physical activity through interactive and play-based walking sessions supported by a robotic dog companion.
Children undergoing cancer treatment frequently experience fatigue, sleep disturbances, reduced physical activity, and decreased quality of life during treatment. Hospitalization, treatment-related side effects, infection precautions, and limited access to motivating activities may contribute to sedentary behaviors in this population. Previous studies have suggested that physical activity interventions may improve symptom management and well-being in pediatric oncology patients; however, engaging and developmentally appropriate interventions for young children remain limited.
Participants will be randomly assigned to either the robot-dog-assisted walking intervention group or the control group receiving standard care. The intervention will consist of structured walking activities integrated into the child's routine during hospitalization or outpatient treatment visits. Feasibility outcomes will include recruitment, retention, adherence, acceptability, and safety of the intervention. Preliminary clinical outcomes will include sleep quality, fatigue, and quality of life.
The findings of this study will provide preliminary evidence regarding the feasibility and potential benefits of integrating robot-assisted play and movement interventions into supportive pediatric oncology care.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ROBO-PAWS Group | Experimental | Children in the intervention group will receive standard care in addition to participating in robot-dog-assisted walking sessions twice daily (morning and evening) for one month. Each walking session will last 15 minutes and will be conducted within the clinical setting under the supervision of a nurse/researcher to ensure participant safety. The total daily walking duration will be 30 minutes. Before the intervention and after completion of the intervention period, parents will complete questionnaires assessing sleep quality, quality of life, and fatigue. If the child experiences fatigue, dizziness, discomfort, or any other adverse symptoms during the walking sessions, the intervention will be immediately discontinued. The robotic dog will be disinfected before each use to maintain hygiene and infection control standards. |
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| Control Group | No Intervention | Children in the control group will receive standard medical treatment and routine nursing care only. Within routine clinical practice, children are allowed to leave their rooms and walk freely when they wish, although they are generally on bed rest for most of the day. They may also participate in unstructured playroom activities such as reading books, drawing, or playing games. However, no structured or supervised physical activity program aimed at increasing physical activity levels is routinely provided. Therefore, children in the control group will continue their usual daily activities within the standard clinical care environment. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Robot-Dog-Assisted Walking | Device | The intervention will use AIBO (Sony Interactive Entertainment, ERS-1000), an artificial intelligence-based robotic dog designed to support social interaction and engagement with children. AIBO is equipped with advanced sensors, interactive movement capabilities, microphones, speakers, and touch-responsive features that allow it to respond to voice commands, physical contact, and environmental stimuli. Its natural dog-like movements, facial expressions displayed through OLED eyes, and playful behaviors are intended to attract children's attention and encourage participation in walking activities. In addition, the device includes motion and distance sensors that enable safe navigation within the clinical environment. Participants in the intervention group will receive standard medical and nursing care in addition to a robot-dog-assisted walking intervention using AIBO (Sony Interactive Entertainment, ERS-1000). Children will participate in supervised walking sessions twice daily (mornin |
| Measure | Description | Time Frame |
|---|---|---|
| Sleep quality | Sleep quality will be assessed using the Visual Sleep Scale (VSS), a child-friendly visual instrument developed for pediatric populations. The scale is rated from 1 ("Very Poor") to 10 ("Very Good") and includes visual cues such as sad, neutral, and smil | Baseline (Day 1, prior to intervention initiation) and Week 4 (post-intervention assessment after completion of the 4-week intervention period). |
| Health-related quality of life | Health-related quality of life will be assessed using the Pediatric Quality of Life Inventory (PedsQL), a validated 23-item instrument designed for children and adolescents aged 2-18 years. The scale evaluates physical, emotional, social, and school functioning. Items are scored on a 0-100 scale, with higher scores indicating better perceived quality of life. Total Scale Score, Physical Health Summary Score, and Psychosocial Health Summary Score will be calculated. Parent proxy-reports will be used in this study. | Baseline (Day 1, before intervention initiation) and Week 4 (post-intervention assessment after completion of the 4-week intervention period). |
| Measure | Description | Time Frame |
|---|---|---|
| Fatigue | Fatigue will be assessed using the Visual Fatigue Scale, a single-item self-report measure developed to evaluate fatigue severity. The scale ranges from 0 ("No fatigue") to 10 ("Severe and overwhelming fatigue"). Higher scores indicate greater fatigue severity. The instrument has demonstrated acceptable validity and reliability in clinical populations and will be used to monitor changes in fatigue levels throughout the intervention period. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Remziye Semerci Åžahin, PhD | Contact | +90 535 011 2821 | remziyesemerci@gmail.com |
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No individual participant data (IPD) will be shared.
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| ID | Term |
|---|---|
| D007319 | Sleep Initiation and Maintenance Disorders |
| D005221 | Fatigue |
| D009369 | Neoplasms |
| ID | Term |
|---|---|
| D020919 | Sleep Disorders, Intrinsic |
| D020920 | Dyssomnias |
| D012893 | Sleep Wake Disorders |
| D009422 | Nervous System Diseases |
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This study will be conducted as a parallel-group, two-arm pilot randomized controlled trial with blinded outcome assessors/data analysts.
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Outcome assessors and data analysts will be blinded to group allocation in order to reduce assessment and analysis bias. Due to the nature of the intervention, participants and intervention providers cannot be blinded.
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| Baseline (Day 1, prior to intervention initiation) and Week 4 (post-intervention assessment after completion of the 4-week intervention period). |
| D001523 |
| Mental Disorders |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |