PRPP-ASSESSMENT TO MEASURE CHANGE 213 8 could perform better, it was congruent with current performance with the new mascara. Thus, to measure actual change, the context needs to be stable. The home-based PRPP-Intervention was experienced as successful in this study and is in line with knowledge on home-based programs. According to Novak and Berry 58 effective home programs adhere to three conditions: the program content needs to be designed upon proven effective interventions; the program should be devised with regard to parent implementation preferences; and the parent should be supported and coached to implement the program. Although in one case the parent implementation preferences were not optimally respected, the body of evidence for the PRPP-Intervention is growing22, 27, 29, 30 and we used a triple-action approach to coach the parents that adhered to the three conditions. In addition, qualitative analyses added three other conditions that determined success: the use of videos enabled parents to reflect on their own interaction with their child, thus increasing their knowledge, which again shows that home-based programs can increase parents’ skill acquisition and self-confidence10; the indispensable involvement of the direct context of the child, preferably the parent, because without them the triple-action approach cannot work; and the importance of the therapeutic relation between parent and therapist, and child and therapist, which is in line with other findings that the therapeutic relationship impacts the effectiveness of interventions59. To further strengthen this therapeutic relationship and increase the possibility to adapt the intervention to the physical context, a hybrid form for the home-based programwas suggested. Overall, the home-based video coaching program with the PRPP-Intervention using a triple-action approach showed very promising results and should be further developed and studied in children with multiple disabilities. As a strength of this study we chose to use the guidelines of the COSMIN33, 49-51, which divide responsiveness11 into longitudinal validity, longitudinal reproducibility and assessing the interpretability of score changes. Whereas the hypotheses on the first and third aspect were all accepted, for longitudinal reproducibility two out of three hypotheses were rejected. The scores considering the two rejected hypotheses (the PRPP-S and quadrant scores) lacked in variability, leading to underestimated ICCs and difficulty in forming solid conclusions about the longitudinal reproducibility. However, based on the COSMIN guidelines, the results of the current study combined with previous research on reliability and validity23 show that the PRPP-Assessment in general has sufficient to good psychometric properties.
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