RELIABILITY & VALIDITY PRPP-ASSESSMENT IN CHILDREN 159 7 Participants Children Videos of children with a genetically confirmed mitochondrial disorder were included in this study. Dutch children, aged between two and 18 years, who were registered patients in the specialist center for mitochondrial medicine of the university hospital, were eligible for participation in the study. No exclusion criteria considering physical, cognitive and communication (dis)abilities were formulated to include a clinically representative sample. The treating physician sent a patient information letter to 25 eligible children and their parents; 13 parents responded positively. All children lived at home with their parents. Children were in the age of preschool (one child), primary school (five children) and secondary school (six children). Age, gender, functional capacities, and the underlying etiology (see table 1) varied. To differentiate between the functional capacities of the children, three profiles were used; global low functioning, low cognitive functioning with moderate-to-normal ambulation (referred to as ‘mixed’), and, global moderate functioning[33]. The functional capacities were extracted from patient files and based on age-related norm referenced tests. Occupational Therapists Dutch pediatric occupational therapists (OTs) certified in the PRPP-Assessment were invited to participate in this study. Inclusion criteria were (1) experience in pediatric occupational therapy, (2) frequent usage of the PRPP-assessment with children (at least once a month) and (3) be willing to complete an additional four-hour training session. This refresher training was executed by two experienced OTs and focused on scoring the PRPP-assessment in children with mitochondrial disorder by parent-provided videos, and on standardized scoring rules of the PRPP-Assessment and focused on additional points for scoring video-material (in comparison to ‘live observation’) as identified in previous research[18]. After training, 11 OTs scored the video-material. OTs had an average age of 43 years (range 31 – 54), an average Pediatric-OT work experience of 15 years (range 5 – 23 years), and the mean PRPP-Assessment certification was four years (range 1 – 7 years). As OTs rated child performance with the PRPP-Assessment, they will be called ‘raters’ in this study. Measures PRPP-Assessment The PRPP-System of Task Analysis (PRPP-Assessment) is a two-stage, criterion-referenced measure instrument that uses task analysis methods to examine the effectiveness of cognitive information processing during the performance of daily activities. The PRPP-Assessment incorporates a task analysis procedure in stage
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