PRPP-ASSESSMENT BASED ON PARENT-PROVIDED VIDEOS 143 6 points of interest arising from cycle four. The refresher training was followed by 13 OTs: two OTs declined further participation due to personal circumstances which limited their available time. In the psychometric study (Lindenschot et al., submitted), 65 activities were videotaped. The videos were randomly assigned to the 11 OTs in such a way that each OT scored five or six children with an average of 14 activities in total. These OTs participated in semi-structured interviews (n=7) to identify challenges in PRPP-Assessment based on parent-provided videos, and a focus group interview (n=5) on ways to overcome these challenges. Three OTs participated in both. Two of the 11 OTs did not participate in the interviews due to limited time. Due to COVID-19 restrictions, all interviews were conducted online. Data were transcribed and analyzed by inductive coding. The results could be divided into three themes related to challenges on the level of: 1) assessing children with mitochondrial disorders; 2) assessing with the PRPP-Assessment based on video material; and 3) assessing children with the PRPP-Assessment in general. Most profound was the importance of clarity of the criterion on the part of parents and/or teachers and the difficulty of assessing children with very limited functional abilities, both leading to difficulties in conducting the task analysis as part of the PRPP-Assessment. Also, formulating steps in the task analysis when tasks are short or parents (undesirably) intervening in task performance can be challenging. An extensive report on Dutch results can be found in Drueten et al. (2021) and upon reasonable request from the corresponding author. As an outcome of the focus group, several recommendations could be made for training OTs and, in the manual, for applying the PRPP-Assessment. This led to the conclusion that the second aim was reached. Based on the results, the PRPP-Assessment on parent-provided videos of children with mitochondrial disorder is feasible and applicable for use in a hospital or research. Overall Distant Outcomes During the optimization, several lessons were learned, fitting with the two aims and the distant outcomes that are a feature of development research (De Villiers, 2005). The lessons learned can be divided into four areas: 1) instructing parents; 2) handling video material as part of the process of gaining video material; 3) PRPP-Assessment based on parent-provided videos; and 4) PRPP-Assessment of children (with very limited functional abilities) as part of adequately assessing the video material. Next, we will elaborate on these four areas. In Table 3, a concise overview of the lessons learned is presented. Overall, the lessons learned can support OTs with implementation of the PRPP-Assessment based on parent-provided videos or other video-based observation instruments in practice.
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