CHAPTER 9 232 and their families), 2) cost-effective (you do not have to conduct more studies that cost money), and 3) efficient (you have a result that can be generalized to multiple target groups more quickly and it is easier to include persons). In addition, the importance of adapting the data-collection method to the child has been mentioned earlier in this chapter. Therefore, heterogenic groups can be beneficial to homogenic groups and I feel it could be beneficial to focus on children with multiple (dis)abilities instead of a certain diagnose. Moreover, to further increase the validity of research with children, heterogenicity in data-collection methods should be encouraged to individualize data-collection. Based on this reasoning, I argue that is irrelevant to talk about ‘heterogeneous target groups’ as it is possible to argue homogeneity and heterogeneity on the same target group from a participation-focused approach. For example, on the one hand target groups can be seen as heterogenic as all children perform different activities, on the other hand they can be seen as homogenic as children all perform meaningful activities on a customized way. Therefore, as long as studies have a clear focus, for example on improving daily activities, reviewing study relevance and appropriateness should be customized to the target group under research and requires both external and internal validity in line with the primary focus, e.g. the sample, the used methods and outcome measures, the context of which the study takes place. Therefore, I recommend to think carefully about internal and external validity when designing or judging research with a participation-focused approach. Utilizing the value of the PRPP-Assessment In our research we chose for the PRPP-Assessment as possible eligible instrument to assess children with mitochondrial disorders’ performance in meaningful activities. The PRPP-Assessment is developed to assess the occupational performance in people with information-processing difficulties62-64. While some children with a mitochondrial disorder experience mainly motor problems, assessing cognitive difficulties is still interesting as adapting to motor difficulties requires information processing and fatigue can impact cognitive abilities. In addition, the features of the PRPP-Assessment fit with the needed flexibility to use it among all children with a mitochondrial disorder. The PRPP-Assessment focuses on, what we call, applied cognition, not on cognitive functions. With applied cognition we mean the way in which a person uses their cognitive abilities to perform activities to the best of their ability. Therefore, applied cognition always takes into account the complexity of the activities, the personal and environmental factors, which fits with the concepts of OT47, 48, 65-67. Strikingly, the PRPP-Assessment is not in the top ten of assessments most often used to assess cognitive abilities or applied cognition within OT-practice68,
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