GENERAL DISCUSSION 233 9 while it has the potential to be in the top three. The reason for this potential is that the PRPP-Assessment is a standardized, criterion referenced, ecologically valid, client-centred and occupation-based assessment designed for use with a person of any age, gender, culture or disability, performing any meaningful activity in real-world contexts62-64. The PRPP-Assessment can only be conducted by OTs as it is constructed based on OT-concepts and requires OT-skills. Not surprisingly, PRPP-Assessment training clarifies and strengthens OTs in their professional identity69. However, it is known that the most common reasons for using assessments are not content-related, but are availability at work and familiarity with the assessment68. The PRPP-Assessment might not be the ‘easiest’ choice as it requires a 5-day training course, gaining experience in practice, and can be time consuming in the acquisition phase70. Still studies on clinical utility show that it is an assessment that OTs want to use, with its ecological and flexible nature valued in practice69-71. Due to the applicability to different cultures and levels of functioning, it is also perfect for use in international research studies or rare diseases. Within the field of rare disease, the PRPP-Assessment fits with the need for patient-oriented outcomes measures72-74. However, it is an objective measurement that can add relevant information to subjective patient-oriented outcome measures, like the Canadian Occupational Performance Measure (COPM). Currently, the PRPP-Assessment is used as an outcome measure in several Dutch N=1 studies in children with rare conditions, for example children with the NANS-deficieny Congenital Disorder of Glycosylation (CDG-NANS) and children with a deficiency of Glutamata Recepter Ionotropic N-Methyl D-Aspartate 2B (GRIN2B). The flexibility of the PRPP-Assessment makes it extremely valuable for children75-77. As shown in our studies; we could use it with children who performed complex activities and children who weren’t able to perform activities, but were observed on the behavioural level 38, 78. Therefore, in my opinion, the PRPP-Assessment should be implemented both in practice and research with children. Still, if the PRPP-Assessment is so valuable, why isn’t it common practice? An answer could be that OTs find the PRPP-Assessment not easy to implement in their daily practice, which hinders utilizing the value of the PRPP-Assessment69, 70. The most profound challenge, which we also identified in our action design study78, is a deviation from impairment-focused assessment practices and a norm- referenced thinking to an criterium-referenced approach which can be challenging in multidisciplinary contexts69, 79-81. However, the desired criterium-referenced approach is in line with basic concepts of OT-practice47, 65, 66, 69, 82. This is why I believe, based on our results, that it is possible to overcome this implementation challenge. When using the PRPP-Assessment a prerequisite, but also challenge, is to have a clear criterion which can be used during scoring to enable adherence to the criterium-referenced feature of the assessment78, 83. In addition, we should
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