RELIABILITY & VALIDITY PRPP-ASSESSMENT IN CHILDREN 183 7 The PEDI assesses self-care, ambulation and social functioning but does not focus on domestic life, play or other major life areas for children, such as education, and is a norm-referenced test. In the current study the wide ranging complexity of tasks is presented in the Wright map (figure 3), and the PRPP-Assessment was shown to be valid when used to assess children performing this wide range of meaningful tasks and activities. Despite the inclusion of children from different functioning profiles, the research faced a lack of variability within the PRPP-Assessment scores. We anticipated that this could underestimate the reliability values since reliability is the ratio of variability between the subjects to the total variability[40, 54]. This was confirmed by another study with low variability and low ICCs[28] whereas studies with larger variation found moderate to acceptable levels of inter-rater reliability [21, 61]. Overall, the children scored relatively high on the PRPP-Assessment, which could be remarkable as children with different levels of functioning were included, from fully dependent to independent functioning in daily life. However, the heterogeneity of the children did not lead to a heterogeneity in task performance due to the criterion-referenced basis of the PRPP-Assessment. For example, tasks such as ‘Caring for body parts’ was observed to be one of the most difficult tasks, and was performed primarily by children who required high levels of assistance. Whereas more complex tasks such as school or vocational training were performed by children who required minimal assistance and were primarily independent in daily functioning. Criterion based assessments such as the PRPP-Assessment enable occupational therapists to observe and evaluate cognitive functioning on a wide range of tasks, irrespective of the perceived level of difficulty for typically developing children. Tasks can be calibrated as ‘easy’ or ‘hard’ relative to each individual child, not to the entire sample of children being assessed or in respect to all children with similar diagnoses. Thus, it can be concluded that in this study, tasks were selected and/or criterions were formulated in a way that the outcome of the PRPP-Assessment was quite high. In practice, this could be problematic when the objective of the PRPP-Assessment is to implement and/or measure effectiveness of child-family centered interventions. In that case, tasks and/or criterion should be carefully selected to give enough room for improvement. Overall, it is recommended to be careful in task selection and formulating the criterion. In practice, a method could be to question parents on the desired improvement on the activity, and specifically within that activity. This should give room for improvement when used for planning interventions or measuring change. Either by choosing a more challenging task, or by formulating a stricter criterion while keeping focus on meaningful occupational performance.
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