Currently submitted to: JMIR Research Protocols
Date Submitted: Jun 25, 2026
Open Peer Review Period: Jun 26, 2026 - Aug 21, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
A Serious Game to Improve Health-Related Quality of Life in Pediatric Patients: Protocol for a Randomized Controlled Trial
ABSTRACT
Background:
Children and adolescents with chronic or past medical conditions often experience reduced health-related quality of life (HRQoL), which may be influenced by multiple factors, including fatigue, sleep disturbances, psychological stress, and reduced physical activity. Despite the broad impact of these factors on daily functioning and well-being, accessible interventions targeting multiple determinants of HRQoL simultaneously remain limited. To address this gap, we developed Terra Troopers, a serious game designed to support HRQoL by integrating physical activity, mindfulness, sleep monitoring, and behavioral strategies into one accessible and motivating platform.
Objective:
The aim of this study is to describe the protocol of the Terra Troopers study.
Methods:
Terra Troopers was developed through a participatory design process involving children and adolescents with and without chronic or past medical conditions, healthcare professionals, and game developers. The intervention will be evaluated in a single-blind randomized controlled crossover trial using an AB/BA design. Participants aged 8–18 years will be randomized to either immediate access to the intervention or care as usual, followed by crossover. The primary outcome is HRQoL. Secondary outcomes include fatigue, physical activity, mindfulness, sleep, and acceptance. Outcomes will be assessed at baseline, post-intervention, and follow-up using validated questionnaires. Data will be analyzed using repeated-measures analyses of variance and exploratory linear regression models.
Results:
Development of Terra Troopers will be finalized in May 2026. Recruitment is expected to begin in 2026 and continue until summer 2027. Data analysis and dissemination are planned thereafter.
Conclusions:
This study will evaluate the effectiveness of a co-created serious game designed to improve HRQoL in children and adolescents with chronic or past medical conditions. If effective, Terra Troopers may provide an accessible, engaging, and scalable intervention to support HRQoL in pediatric populations. Clinical Trial: NL-009815
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.