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About Stroke Engine
Activity Card Sort (ACS)
Evidence Reviewed as of before: 06-04-2011
Author(s)*: Annabel McDermott
Editor(s): Nicol Korner-Bitensky, PhD OT
Expert Reviewer: Professor Carolyn Baum
The Activity Card Sort (ACS) is an interview-based tool used to measure an individual's participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More in instrumental, leisure and social activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
. The ACS can be used to gain information regarding a client's activity patterns in order to support development of routines and participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More in meaningful activity.
In-Depth Review
Purpose of the measure
The Activity Card Sort (ACS) measures an individual's occupational performance. The ACS was originally developed in 1995 by Baum in response to the need to measure engagement in activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of older persons with Alzheimer's disease (Eriksson et al., in press; Schreuer, Rimmerman & Sachs, 2006). The ACS was revised by Baum and Edwards in 2001 to include more activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
for a broader population of older adults in a variety of settings. It can be used to monitor change in activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More over time as a means of comparing premorbid engagement in activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
with current activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More (Baum, Perlmutter & Edwards, 2000; Hartman-Maeir, Soroker, Ring, Avni & Katz, 2007). The ACS is useful for initial assessment, goal setting and intervention planningPlanning ability involves anticipating future events, formulating a goal or endpoint, and devising a sequence of steps or actions that will achieve the goal or endpoint" (Anderson, 2008, p. 17)
or to monitor activity following onset of illness (Albert, Bear-Lehman & Burkhardt, 2009; Chan, Chung & Packer, 2006; Packer, Boshoff & DeJonge, 2008).
The ACS also provides information regarding factors such as:
Creating an occupational history
Recording changes in activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More due to a chronic health condition, a strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More or aging.
The ACS does not provide information regarding factors such as:
Length of time spent engaged in activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Frequency of participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More
Social interactions during activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More
Difficulty experienced while performing an activity (Baum et al., 2000; Katz, Karpin, Lak, Furman & Hartman-Meier, 2003)
The Activity Card Sort, 2nd Edition has three versions:
Community Living version for community-dwelling older adults
Institutional version for older adults in a hospital, skilled nursing or rehabilitation hospital
Recovery version for older adults recovering from an injury or disease.
Each version has the same set of photographs but uses different sorting strategies (Chan et al., 2006; Packer et al., 2008).
The original ACS has been modified to suit populations in Hong Kong, Israel, Puerto Rico, The Netherlands, Korea, Singapore and Australia (Chan et al., 2006; Erickkson et al., in press; Katz et al., 2003; Packer et al., 2008), and a checklist version has also been created (Everard, Lach, Fisher & Baum, 2000).
Alternate versions of the ACS are used for research and clinical purposes (Erickkson et al., in press; Katz et al., 2003). The institutional version is useful for developing intervention goals with a client and the recovering version can be used to monitor change in activity (Law, Baum & Dunn, 2005).
Features of the measure
The ACS uses a sorting methodology to assess activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More. The original version of the ACS consisted of photographs of adults performing a variety of social, instrumental and leisure activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
. The Activity Card Sort, 2nd Edition (Baum & Edwards, 2001, 2008) consists of 89 activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
across instrumental, low-physical-demand leisure, high-physical-demand leisure and social domains of human occupation.
The individual sorts the picture cards according to their engagement in each activity. Sort categories vary according to the version used:
Healthy older adult version:
Never done
Not done as an older adult
Do now
Do less
Given up
Institutional version:
Done prior to illness
Not done
Recovering version:
Not done before illness or injury
Continued to due after illness or injury
Do less after illness or injury
Gave up due to illness or injury
Beginning to do again (Baum & Edwards, 2008; Law et al., 2005).
Description of tasks:
The participant views photographs that depict an individual performing an activity and sorts these photographs into piles that represent their own level of engagement in the activity.
Following traditional use of the measure, the clinician can then support the individual to identify the five most important activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
from the list and explore factors that are limiting the individual's engagement in those activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
, as a means of facilitating goal setting and intervention planningPlanning ability involves anticipating future events, formulating a goal or endpoint, and devising a sequence of steps or actions that will achieve the goal or endpoint" (Anderson, 2008, p. 17)
(Chan et al., 2006).
What to consider before beginning:
The ACS can be used with individual's caregiver in the event of cognitive difficulties (Baum et al., 2000; Katz et al., 2003).
Scoring and Score Interpretation:
The individual sorts the picture cards into categories, which vary according to the version used (see above). The clinician calculates a Retained Activity Score by dividing the sum total of current activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
by the sum total of previous activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Current activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
/ Previous activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
= Retained Activity Score
The Retained Activity Score ranges from 0-100 and therefore reflects the percentage of activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
the person currently participates in, compared to premorbid involvement (Hartman-Maeir et al, 2003, 2007). A higher score reflects better maintenance of pre-stroke activity (Edwards et al., 2006). A score of 100 indicates that the individual has re-engaged in all premorbid activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
, while a score of 0 indicates that the individual has not re-engaged in any premorbid activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
, nor introduced any new activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
into his/her daily life (Lyons, Li, Tosteson, Meehan & Ahles, 2010).
The amount of activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
the individual has abandoned is calculated as an inverse of the Retained Activity Score:
1 – Retained Activity Score x 100 = Activity loss
The ACS takes approximately 20 – 30 minutes to administer.
Training requirements:
The ACS can be used by occupational therapists. No special training is required.
Subscales:
In addition to the photographs, the ACS includes:
Test description and methodology
Test development, validation and reliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
Administration and scoring instructions
Examples of test utility
Easy-to-use sample forms on CD-ROM.
Alternative forms of the Assessment
Everard et al. (2000) developed a modified checklist version of the ACS. The Activity Checklist contains 55 items in the four domains of instrumental, social, low-demand physical leisure and high-demand physical leisure activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
. The Activity Checklist gathers information regarding an individual's activity maintenance and engagement using the categories: (i) have never done the activity; (ii) have given up the activity; (iii) do the activity less often; or (iv) doing now (Edwards, Hahn & Dromerick, 2005). Frequency of participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More and need for assistance are also recorded.
Katz et al. (2003) developed a version of the ACS to suit an Israeli population. This version has 88 picture cards with photographs that represent different ethnic groups. Two activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
from the original version were removed and eight culturally-relevant activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
were added. The activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
are organized within the four domains of IADLS (21 pictures), social-cultural activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(21 pictures), low-physical leisure activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(27 pictures) and high-physical leisure activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(19 pictures).
Packer et al. (2008) developed a version of the ACS to suit an Australian population. The ACS-Australia includes 82 activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
, 12 of which are unique to the Australian version. activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
are organized according to three domains of household (12 activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
), social/educational (24 activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
) and leisure (46 activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Chan et al. (2006) developed a version of the ACS to suit a Hong Kong population, which resulted in a final list of 65 activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
relevant to Hong Kong Chinese elderly people.
Orellano (2008) developed a version of the ACS for a Puerto Rican population that comprised 82 activity cards relevant to the Puerto Rican lifestyle.
Versions of the ACS have also been developed for Korea, Singapore and the Netherlands, which include 79, 85 and 79 activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
respectively (Eriksson et al., in press).
Client suitability
Healthy elderly adults (Erickkson et al., in press)
Older adults facing disability transitions (Albert et al., 2009)
Individuals with Alzheimer's Disease (Baum et al., 2000)
Individuals with Multiple Sclerosis (Katz et al., 2003)
Individuals following stem cell transplantation (Lyons et al., 2010)
Individuals with cognitive loss or dementia (Baum, 1995; Erickkson et al., in press; Law et al., 2005)
Individuals with cancer (Erickkson et al., in press)
Individuals with PTSD (Erickkson et al., in press)
Individuals who have speech difficulties (Law et al., 2005)
Individuals with limited English language (Law et al., 2005)
The caregiver or family member of the patient (Law et al., 2005).
The ACS can be adapted for use with different cultures by modifying the pictures to be more culturally relevant, while maintaining the methodology of the measure (Katz et al., 2003).
Should not be used with:
In what languages is the measure available?
Languages of the measure
The ACS has been validated for use in the US, Israel, Australia, Hong Kong, Singapore, Puerto Rico and Korea (Erickkson et al., in press).
What does the tool measure? Activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More
What types of clients can the tool be used for? Older individuals who have experienced change in their activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More as a result of onset of illness
Is this a screeningTesting for disease in people without symptoms.
or assessment tool? Assessment tool
The ACS can also be used for goal setting and monitoring"The process of checking the task over time for 'quality control' and the adjustment of behavior" (Stuss, 2009, p. 9-10)
activity participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More as a measure of function/well-being over time.
Time to administer 20 – 30 minutes
Versions ACS Community Version (US)
ACS Institutional Version (US)
ACS Recovery Version (US)
Activity Checklist (US)
ACS (Israeli version)
ACS – Australia
ACS – Hong Kong
ACS – Korean
ACS – Puerto Rican
ACS – Singapore
ACS – The Netherlands
Other Languages Hebrew, Spanish, Korean, Chinese and Dutch
Measurement Properties
ReliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of "true" variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to "noise" in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .
Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. More:
– Two studies examined the Pearson's correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
– One study reported excellent Cronbach's alpha.
– One study reported adequate to excellent Cronbach's alpha.
Test-retest:
– One study indicated excellent one-week test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the ACS US version.
– One study reported excellent test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the ACS (checklist version).
– One study reported excellent two-week test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the ACS-HK using the ICC.
of the PR-ACS using the ICC.
Intra-rater:
No studies have examined the intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater's subsequent ratings are contaminated by knowledge of earlier ratings.
of the ACS.
Inter-rater:
No studies have examined the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
ValidityThe degree to which an assessment measures what it is supposed to measure.
– The ACS US version was developed in consultation with two groups of older adults living in the United States.
– Subsequent versions of the ACS were developed based on the ACS US version and/or culturally-relevant activity lists, questionnaires or time-use surveys. All versions were reviewed by expert panels of healthy older adults and some versions were also reviewed by specialist health professionals.
Criterion:
Concurrent:
One study reported excellent concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also "gold standard."
between the ACS US version and the ACS (checklist version).
Predictive:
– No studies have reported on the predictive validityA form of criterion validity that examines a measure's ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
– One study reported adequate concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also "gold standard."
between the ACS (Israeli version) and the Occupational Questionnaire.
between the ACS-Aus and the Adelaide ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Construct:
One study reported satisfactory ValidityThe degree to which an assessment measures what it is supposed to measure.
of the original ACS to measure previous activity engagement in a sample of individuals with Alzheimer's disease.
Convergent/Discriminant:
– Two studies investigated convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the ACS US version. A significant association was reported with the Reintegration to Normal Living Index (RNLI). Significant correlations were reported with SF-12 factors.
– One study reported adequate correlations between the ACS-Aus and the Personal Well-being Index (PWI).
– One study reported excellent correlations between the ACS-HK and the Comprehensive Quality of Life scale (ComQoL).
– One study reported excellent convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
between the PR-ACS and the Puerto Rican version of the RAND 36-Short Form Health Survey.
Known Groups:
– Two studies regarding the ACS (Israeli version) have reported satisfactory to excellent ValidityThe degree to which an assessment measures what it is supposed to measure.
to differentiate among groups according to age, illness and carer roles, and satisfactory ValidityThe degree to which an assessment measures what it is supposed to measure.
to identify differences between groups of young and older adults.
– One study reported excellent ValidityThe degree to which an assessment measures what it is supposed to measure.
of the ACS-HK to discriminate between clients presenting with different functional abilities.
– One study reported satisfactory ValidityThe degree to which an assessment measures what it is supposed to measure.
of the PR-ACS to discriminate between clients presenting with different levels of function.
– One study reported satisfactory discriminative ValidityThe degree to which an assessment measures what it is supposed to measure.
of the ACS-Aus.
Floor/Ceiling Effects N/A
SensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also "Specificity."
/ SpecificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
No studies have explored the SensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also "Specificity."
/specificity of the ACS.
Does the tool detect change in patients? Yes – the ACS detects change in an individual's participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More in ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Acceptability Law et al. (2005) reported that the ACS US version is non-threatening and easy to understand. Katz et al. (2003) reported that the ACS (Israeli version) is user-friendly.
Feasibility Law et al. (2005) reported that the ACS US version can be modified to suit the target audience. Katz et al. (2003) reported that the ACS (Israeli version) is suitable for individuals with language difficulties.
How to obtain the tool? The ACS can be purchased from the AOTA online store: http://www.aota.org.
Psychometric Properties
A literature search was conducted to identify all relevant publications on the psychometric properties of the assessment. Twelve articles have been reviewed, although studies relate to different versions of the Activity Card Sort.
Katz et al. (2003) examined the Internal ConsistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. More of the ACS (Israeli version) in 263 participants across five groups: healthy adults aged 50 – 65 (n=61); healthy older adults aged over 65 (n=61); spouses/caregivers of people with Alzheimer's disease (n=40); people with Multiple Sclerosis (n=45); and people 1-year post-stroke (n=56). Internal ConsistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. More of the ACS (Israeli version), as calculated using Cronbach's Coefficient Alpha was excellent for Instrumental ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of Daily Living (α=0.82) and social-cultural ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(α=0.80) but poor for low-physical leisure ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(α=0.66) and high-physical leisure ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(α=0.61). Internal ConsistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. More of both low and high physical leisure ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
combined was adequate (α=0.77), which the authors considered may have been due to the larger number of items (52 collectively: 35 low-physical-demand ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
and 17 high-physical-demand ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Sachs and Josman (2003) investigated correlations between demographic variables and mean scores of the ACS (Israeli version) in two age groups of young adults (mean age of 23.3 years, n=53) and older adults (mean age of 78.2 years, n=131). Using domains different to those of the original ACS, Pearson's correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
was calculated for five student group factors of instrumental ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of daily living (α =0.84), maintenance (α =0.79), leisure (α =0.81), demanding leisure (α=0.83) and social recreation (α =0.73). The social recreation domain showed significant correlations with IADL, leisure and demanding leisure factors domains. Pearson's correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
was calculated for four elderly group factors of IADL (α =0.75), maintenance (α =0.90), leisure (α=0.70) and demanding leisure (α =0.86).
Chan et al. (2006) examined the Internal ConsistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. More of the ACS-HK in a group of 60 elderly individuals (mean age 74 years) who had experienced a strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More a minimum of 6 months prior. Internal ConsistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. More, calculated using Cronbach's alpha, was excellent (α= 0.89).
Orellano (2008) examined Internal ConsistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. More of the PR-ACS in a group of healthy older adults (n=106) and a group of adults with Multiple Sclerosis (n=40). Internal ConsistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. More, calculated using Cronbach's alpha, was excellent for the combined sample and the healthy older adult group (r=0.91), and was adequate for the group of individuals with multiple sclerosis (r=0.77).
One-week test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the ACS US version in a community dwelling sample (n=20) was excellent (0.897) (Baum & Edwards, 2001). Lyons et al. (2010) noted that similar results have been reported for 14-day and 30-day test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
Everard et al. (2000) examined the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the ACS (checklist version) on a sample of 20 community-dwelling older adults. Excellent test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
was found for all categories after 74 days (IADL, 0.95; social, 0.83; low-demand leisure, 0.91; and high demand leisure, 0.88).
Chan et al. (2006) examined test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the ACS-HK in two groups of elderly individuals who had experienced a strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More a minimum of 6 months prior (less active group, n=30; more active group, n=30). Two-week test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
, as calculated using the intra-class correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficient was excellent for the total group (ICC=0.98). Individual group analysis also revealed excellent test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
for both groups (less active group ICC=0.91; more active group ICC=0.96).
Orellano (2008) examined test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the PR-ACS in a group of healthy older adults (n=106) and a group of adults with Multiple Sclerosis (n=40). test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
coefficient was excellent (ICC=0.82).
Intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater's subsequent ratings are contaminated by knowledge of earlier ratings.
has not yet been examined.
Inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
The original version of the ACS was shown to two groups of older adults living in the United States (first sample n=120; second sample n=40). Feedback obtained from the sample groups resulted in the inclusion of another 7 ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
, increasing the number of ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
to 80 (Law et al., 2005).
The ACS (Israeli version) was developed by modifying a translated version of the ACS US in consultation with a convenience sample of healthy adults and older adults (n=50). The final ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
were photographed to depict individuals of different ethnic groups represented within the Israeli population (Katz et al., 2003).
The PR ACS and ACS – Singapore were developed using a translated version of the ACS US, in consultation with a convenience sample of healthy older adults from Puerto Rico and Singapore (respectively). The PR ACS was also reviewed by an expert panel. The resultant selection of culturally-relevant ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
was re-photographed to depict individuals from the respective populations (Erikkson et al., in press).
The ACS – HK was developed from a list of generationally- and culturally-relevant ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
, which was reviewed by two successive expert panels of community-dwelling older adults (first sample n=15; second sample n=15) and a purposive sample of geriatric-specialist healthcare professionals (n=5). The final 65 ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
are represented in photographs of older adults performing the tasks in Hong Kong (Chan et al., 2006).
The ACS – Netherlands was developed from a questionnaire completed by a sample of older adults regarding common ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
and perceived importance of ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(Erikkson et al., in press). The resultant ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
were depicted using photographs of local individuals. The ACS – Netherlands was pilot-tested with specialist health care professionals and elderly patients (Erikkson et al., in press).
The ACS – Australia was developed by a two-round Delphi Survey method with a sample of older Australian adults (n=54), using ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
from the US and Israeli versions and information from time diaries regarding common daily ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(Packer et al. 2008).
The ACS – Korea was developed using information from a literature review and a time-use survey. The resultant list of ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
was evaluated and refined by a panel of experts (Erikkson et al., in press).
Concurrent :
Everard et al. (2000) conducted a comparison of the original ACS with the Activity Checklist on a pilot sample of 20 community-dwelling older adults. Excellent concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also "gold standard."
was reported between the original and checklist versions of the ACS (instrumental: 0.90; social: 0.78; low-demand leisure: 0.82; high-demand leisure: 0.72).
Katz et al. (2003) assessed the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also "gold standard."
of the ACS (Israeli version) category "doing now" by comparison with the Occupational Questionnaire in 263 adults within five groups including healthy adults aged 50 – 65, healthy older adults aged over 65, spouses/caregivers of people with Alzheimer's disease, people with Multiple Sclerosis and people 1-year post-stroke. Results indicated adequate concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also "gold standard."
(r=0.54), as calculated using Pearson correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficient.
Doney & Packer (2008) assessed the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also "gold standard."
of the ACS-Aus in 93 metropolitan-based adults aged 60 to 95 years. As there is no gold standardA measurement that is widely accepted as being the best available to measure a construct.
for comparison, the authors assessed the direction, strength and significance of the correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
between the Current (retained) Activity Level scores of the ACS-Aus and the Adelaide ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Profile. A significant, adequate correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
(r=0.434, P=0.000) was found using Pearson-product moment analysis.
No studies have reported on the predictive validityA form of criterion validity that examines a measure's ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
Baum (1995) examined the validityThe degree to which an assessment measures what it is supposed to measure.
of the original ACS with a sample of individuals with varying stages of Alzheimer's disease (n=60). Scores of previous activity level did not differ significantly across the stages of the disease (F=0.66, p=0.419), indicating that the ACS was a valid measure of previous activity engagement.
Convergent/Discriminant :
Everard et al. (2000) examined the relationship between engagement and functioning using the ACS and the SF-12 with a sample of 244 community-dwelling adults aged 65 years and older. A significant positive association was seen between physical health and maintenance of instrumental ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(p=0.006), social ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(p=0.0001) and high demand leisure ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(p=0.0001). A significant positive association was seen between mental health and maintenance of low-demand leisure ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(p=0.0001) only. A significant negative association was found between physical health and maintenance of low-demand leisure ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
(p=0.015).
Edwards et al. (2006) examined the relationship between life satisfaction and participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More using the Reintegration to Normal Living Index (RNLI) and ACS (percentage of retained pre-stroke ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
) with a sample of patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More (n=219). An association was seen between life satisfaction and participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More in meaningful activity (β=0.14, p=0.001).
Doney & Packer (2008) assessed the convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the ACS-Aus by comparison with the Personal Well-being Index (PWI) in 93 metropolitan-based adults aged 60 to 95 years. convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
between the ACS-Aus current activity level scores and the PWI total score was calculated using Pearson correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficient and was found to be adequate (r=0.354, P=0.01), indicating a positive relationship between participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. More and well-being. The authors noted that this correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
was likely weakened by a potential ceiling effectA ceiling effect occurs when test items aren't challenging enough for a group of individuals. Thus, the test score will not increase for a subsample of people who may have clinically improved because they have already reached the highest score that can be achieved on that test. In other words, because the test has a limited number of difficult items, the most highly functioning individuals will score at the highest possible score. This becomes a measurement problem when you are trying to identify changes – the person may continue to improve but the test does not capture that improvement. Example: A memory test that assesses how many words a participant can recall has a total of five words that each participant is asked to remember. Because most individuals can remember all five words, this measure has a ceiling effect. See also "floor effect." More from the PWI as many participants rated an extremely high quality of life despite normal distribution of the measure.
Chan et al. (2006) evaluated the convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the ACS-HK by comparison with the Comprehensive Quality of Life scale (ComQoL) in 60 elderly adults (mean age 74 years) who had experienced a strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More a minimum of 6 months prior. convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
as calculated by Pearson's correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficients, was excellent (r=0.86, p=0.00), indicating a significant positive relationship between retained activity as measured by the ACS-HK and quality of life as measured by the ComQoL.
Orellano (2008) evaluated the convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the PR-ACS by comparison with the Puerto Rican version of the RAND 36-Short Form Health Survey in healthy older adults (n=106) and adults with Multiple Sclerosis (n=40). convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
, as calculated by Pearson's correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
coefficients, was excellent (r=0.66, p=0.00).
Known Group:
Sachs and Josman (2003) reported satisfactory discriminative validityThe degree to which an assessment measures what it is supposed to measure.
of the ACS (Israeli version), to identify differences between groups of young and older adults.
Katz et al. (2003) examined the construct validityReflects the ability of an instrument to measure an abstract concept, or construct. For some attributes, no gold standard exists. In the absence of a gold standard , construct validation occurs, where theories about the attribute of interest are formed, and then the extent to which the measure under investigation provides results that are consistent with these theories are assessed.
of the ACS (Israeli version) in five groups including: healthy adults aged 50 – 65 (n=61); healthy older adults aged over 65 (n=61); spouses/caregivers of people with Alzheimer's disease (n=40); people with Multiple Sclerosis (n=45); and people 1-year post-stroke (n=56). The mean Retained Activity (RAC) scores and Current Activity Level (CAL) scores were compared by one-way ANOVA. Significant group effects (p<0.0001) were found between groups on all activity areas (IADL, social-cultural ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
, low-physical ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
, high-physical ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
and totals), indicating excellent construct validityReflects the ability of an instrument to measure an abstract concept, or construct. For some attributes, no gold standard exists. In the absence of a gold standard , construct validation occurs, where theories about the attribute of interest are formed, and then the extent to which the measure under investigation provides results that are consistent with these theories are assessed.
to differentiate among groups according to age, illness and carer roles. Post hoc (Scheffe) tests showed significant differences between most groups. Specific to the strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More group, post hoc analysis indicated scores were not significantly different on social-cultural, low-physical or high-physical leisure ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
compared to caregivers, and on high-physical leisure ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
compared to individuals with multiple sclerosis.
Chan et al. (2006) examined the construct validityReflects the ability of an instrument to measure an abstract concept, or construct. For some attributes, no gold standard exists. In the absence of a gold standard , construct validation occurs, where theories about the attribute of interest are formed, and then the extent to which the measure under investigation provides results that are consistent with these theories are assessed.
of the ACS-HK in two groups of elderly individuals who had experienced a strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. More a minimum of 6 months prior (less active group, n=30; more active group, n=30). Independent t tests were used to compare mean Retained Activity Scores between the two groups. Significant group differences were found (t=-14.24, p=0.00), with the less active' group demonstrating significantly lower level of retained activity than the more active' group. These results indicate that the ACS-HK is able to discriminate between clients presenting with different functional abilities.
Orellano (2008) examined known-group validityThe degree to which an assessment measures what it is supposed to measure.
of the PR-ACS in a group of healthy older adults (n=106) and a group of adults with Multiple Sclerosis (n=40) and reported that the PR-ACS is able to differentiate between clients with different levels of function (t=0.86; p=0.00).
Doney & Packer (2008) reported strong discriminative validityThe degree to which an assessment measures what it is supposed to measure.
of the ACS-Aus by comparing current Retained Activity Scores between a younger group of adults aged 60-75 years (n=48) and an older group of adults aged 76-95 years (n=45) living within a metropolitan area. A significant difference was found between the two groups (P=0.000) using independent t-test analysis. Power greater than 90% was revealed by post-hoc power analysis.
No studies have examined the responsivenessThe ability of an instrument to detect clinically important change over time.
Albert, S. M., Bear-Lehman, J., & Burkhardt, A. (2009). Lifestyle-adjusted function: Variation beyond BADL and IADL competencies. The Gerontologist, 49, 767-777.
Baum, C. M. (1995). The contribution of occupation to function in persons with Alzheimer's disease. Journal of Occupational Science, 2, 59-67.
Baum, C. & Edwards D. F. (2008). Activity Card Sort (2nd ed.). Bethesda, MD: American Occupational Therapy Association.
Baum, C. M., & Edwards, D. F. (2001). The Activity Card Sort. St Louis, MO: Washington University School of Medicine.
Baum, C. M., Perlmutter, M. & Edwards, D. (2000). Measuring function in Alzheimer's disease. Alzheimer's Care Quarterly, 1, 44-61.
Chan, V. W. K., Chung, J. C. C., & Packer, T. L. (2006). Validity and reliability of the Activity Card Sort – Hong Kong version. Occupational Therapy Journal of Research: Occupation, Participation and Health, 26, 152-158.
Doney, R. M., & Packer, T.L. (2008). Measuring change in activity participation of older Australians: validation of the Activity Card Sort – Australia. Australasian Journal on Ageing, 27, 33-37.
Edwards, D. F., Hahn, M., Baum, C., & Dromerick, A. W. (2006). The impact of mild stroke on meaningful activity and life satisfaction. Journal of Stroke and Cerebrovascular Diseases, 15, 151-157.
Edwards, D. F., Hahn, M., & Dromerick, A. (2006). Post stroke urinary loss, incontinence and life satisfaction: When does post-stroke urinary loss become incontinence? Neurourology and Urodynamics, 25, 39-45.
Eriksson, G. M., Chung, J. C. C., Beng, L. H., Hartman-Maeir, A., Yoo, E., Orellano, E. M., van Nes, F., de Jonge, D., & Baum, C. (in press). Occupations of older adults: A cross cultural description. Occupational Therapy Journal of Research.
Everard, K. M., Lach, H. W., Fisher, E. B., & Baum, M. C. (2000). Relationship of activity and social support to the functional health of older adults. Journal of Gerontology: Social Sciences, 55B, S208-S212.
Hartman-Maeir, A., Eliad, Y., Kizoni, R., Nahaloni, I., Kelberman, H., & Katz, N. (2007). Evaluation of a long-term community based rehabilitation program for adult stroke survivors. NeuroRehabilitation, 22, 295-301.
Hartman-Maeir, A., Soroker, N., Oman, S. D., & Katz, N. (2003). Awareness of disabilities in stroke rehabilitation – a clinical trial. Disability and Rehabilitation, 25, 35-44.
Hartman-Maeir, A., Soroker, N., Ring, H., Avni, N., & Katz, N. (2007). Activities, participation and satisfaction one-year post stroke. Disability and Rehabilitation, 29, 559-566.
Katz, N., Karpin, H., Lak, A., Furman, T., & Hartman-Maeir, A. (2003). Participation in occupational performance: reliability and validity of the Activity Card Sort. OTJR: Occupation, Participation and Health, 23, 10-17.
Law, M., Baum, C. & Dunn, W. (Eds.). (2005). Measuring Occupational Performance: Supporting Best Practice in Occupational Therapy (2nd edition). Thorofare, NJ: Slack Incorporated.
Lyons, K. D., Li, Z., Tosteson, T. D., Meehan, K., & Ahles, T. A. (2010). Consistency and construct validity of the Activity Card Sort (Modified) in measuring activity resumption after stem cell transplantation. American Journal of Occupational Therapy, 64, 562-569.
Orellano, E. (2008). Occupational participation of older Puerto Rican adults: reliability and validity of a Spanish version of the Activity Card Sort (PhD dissertation). Retrieved from ProQuest Dissertations database (Publication Number 3330659).
Packer, T. L., Boshoff, K., & DeJonge, D. (2008). Development of the Activity Card Sort – Australia. Australian Occupational Therapy Journal, 55, 199-206.
Sachs, D., & Josman, N. (2003). The Activity Card Sort: a factor analysis. OTJR: Occupation, Participation and Health, 23, 165-174.
Schreuer, N., Rimmerman, A., & Sachs, D. (2006). Adjustment to severe disability: constructing and examining a cognitive and occupational performance model. International Journal of Rehabilitation Research, 29, 201-207.
See the measure
How to obtain the assessment:
The assessment can be purchased online at the American Occupational Therapy Association online store: http://www.aota.org.
A spain version is available in the following article
The information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.
*The authors have no direct financial interest in any tools, tests or interventions presented in STROKE ENGINE.
Related Assessments
Assessment of Life Habits (LIFE-H)
Reintegration to Normal Living Index (RNLI)
SATIS-Stroke
Stroke Specific Quality of Life Scale (SS-QOL)
Toronto Bedside Swallowing Screening Test (TOR-BSST©)
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