Activity Card Sort

Purpose

The ACS is used by occupational therapists to help clients describe their social, instrumental, and leisure activities.

Link to Instrument

Instrument Details

Acronym ACS

Area of Assessment

Activities of Daily Living
Life Participation
Occupational Performance

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$140.00

Cost Description

The Activity Card Sort, Second Eition is priced at $140 (as of February 2021) and can be purchased on AOTA's web site

Diagnosis/Conditions

Brain Injury Recovery
Cancer Rehabilitation
Multiple Sclerosis
Parkinson's Disease & Neurologic Rehabilitation
Spinal Cord Injury
Stroke Recovery

Stroke

Parkinson's Disease

Older Adults and Geriatric Care

Cancer

Designed to help patients describe their occupational histories.
Can be used to:
1) Identify lost activities
2) Set goals
3) Monitor rehabilitation
Composed of 89 photographs depicting the performance of various activities.
Three versions of the ACS are available:
1) Institutional
2) Recovering
3) Community Living
Information is used by clinicians to design patient-centered interventions.
Items include:
1) 20 instrumental activities
2) 35 low-physical-demand leisure activities
3) 17 high-physical-demand leisure activities
4) 17 social activities

Number of Items

89 photos and response forms

60 minutes

60 minutes or more

Required Training

Reading an Article/Manual

Adult

18 - 64

years

Elderly Adult

65 +

years

ICF Domain

Activity
Participation

Measurement Domain

Activities of Daily Living

Considerations

ACS versions currently available:

North American (US)
Israeli
Hong Kong
Australian
United Kingdom

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Test/Retest Reliability

Cancer Patients: (Lyons et al., 2010; n = 36; age = 54 (12); diagnosis: Multiple myeloma= 45%, Non-Hodgkin’s lymphoma = 28%, Leukemia = 19%, Hodgkin’s lymphoma = 8%)

Summary Statistics for the Proportion of Items for Which Participants Were Reliable in Their Designation of an Activity as Previously Done Versus Not Done Previously on the Activity Card Sort (Modified; N = 29)
Domain	Mean (SD)	Median	95% C.I.
Total score (80 activities)	71.9 (14.2)	72.5	66.5–77.3
Instrumental (20 activities)	81.6 (9.7)	85.0	77.9–85.3
Low-Physical-Demand-Leisure (28 activities)	67.4 (19.8)	71.4	59.8–74.9
High-Physical-Demand-Leisure (17 activities)	64.3 (23.8)	70.6	55.2–73.4
Social (15 activities)	76.1 (18.6)	80.0	69.0–83.2

Internal Consistency

Cancer Patients: (Lyons et al., 2010)

ACSm Internal Consistancy (at 1 and 18 Months)
Domain	Alpah at 1 month*	Alpha at 18 months*	Domain
Total score (80 activities)	.87 (Excellent)	.88 (Excellent)	Total score (80 activities)
Instrumental (20 activities)	.89 (Excellent)	.46 (Poor)	Instrumental (20 activities)
Low-Physical-Demand Leisure (28 activities)	.54 (Poor)	.80 (Excellent)	Low-Physical-Demand Leisure (28 activities)
High-Physical-Demand Leisure (17 activities)	.81 (Excellent)	.74 (Adequate)	High-Physical-Demand Leisure (17 activities)
*Cronbach's Alpha

Construct Validity

Cancer Patients: (Lyons et al., 2010)

Correlation of ACSm Total Score Pearson Correlation
Domains	r	Domains	r
Karnofsky Performance Scale	.42	Karnofsky Performance Scale	.42
Overall well-being (FACT–G)	.51	Overall well-being (FACT–G)	.51
Functional well-being (subscale of FACT–G)	.59	Functional well-being (subscale of FACT–G)	.59
ACSm = Activity Card Sort (modified) FACT–Cog = Functional Assessment of Cancer Therapy–General and Cognitive Scales Cognitive Function subscale FACT–G = Functional Assessment of Cancer Therapy–General Cognitive Scales

Test/Retest Reliability

Community Dwelling Adults: (Everard et al., 2000; n = 20; aged 65 to 87 years; time between assessments = 74 days)

Excellent: Instrumental activities of daily living (r = 0.95)
Excellent: Social (r = 0.83)
Excellent: Low-demand leisure activity (r = 0.91)
Excellent: High-demand leisure activity (r = 0.88)

Elderly Adults: (Albert et al., 2009; n = 375; mean age > 70 years; assessed at baseline and 12 months)

Adequate test Retest reliabilitiy (r = 0.74)

Criterion Validity (Predictive/Concurrent)

Community Dwelling Adults: (Everard et al., 2000; n = 20; aged 65 to 87 years)

Concurrent validity using the Activity Checklist
- Excellent: Instrumental (r = 0.90)
- Excellent: Social (r = 0.78)
- Excellent: Low-demand leisure (r = 0.82)
- Excellent: High-demand leisure activity (r = 0.72)

Older Adults: (Doney and Packer, 2008; n = 93, Mean age = 74.82 (8.64) years; Australian sample)

Adequate: ACS-Aus CAL scores (mean = 0.807, SD = 0.12) and AAP scores (mean = 38.080, SD = 7.49); r = 0.434

Construct Validity

Older Adults: (Doney and Packer, 2008)

Adequate convergent validity: ACS-Aus CAL scores and PWI scores (mean = 64.760, SD = 10.18) r = 0.354
Established discriminative validity: ACS-Aus CAL for a younger group (mean = 0.852, SD = 0.100) and an older gourp (mean = 0.760, SD = 0.120) which were found to be signigicantly different (independent t-test;p = 0.000)

Construct Validity

Idiopathic Parkinson Disease: (Duncan & Earhart, 2010; n = 62; Hoehn & Yahr Stages 1–4)

Correlations with other measures of mobility:
	BBS	FTSTS	6MWT	FOG-Q	DTWV	FWV
BBS	-	-0.16	0.79	-0.68	0.63	0.76
FTSTS		-	-0.30	-0.03	-0.27	-0.30
6MWT			-	-0.44	0.80	0.86
FOG-Q				-	-0.35	-0.38
DTWV					-	0.85
BBS = Berg Balance Scale FTSTS = The Five Times Sit to Stand test 6MWT = The Six Minute Walk Test DTWV = Dual task walking velocity FWV = Forward walking velocity

Criterion Validity (Predictive/Concurrent)

Chronic Stroke: (Hartman-Maei et al., 2007; n = 27; first event hemispheric stroke; mean age = 61.59 (7.38) years; Israeli sample, scores of teh test are reported before and after participants completed a community re-integration rehabilitation)

ACS Domain	Before: Mean (SD)	After: Mean (SD)	p
IADL	20.01 (15.60)	25.23 (15.70)	p = 0.000
Leisure social cultural	37.47 (24.41)	46.39 (19.66)	p = 0.000
Leisure Low physical	44.47 (22.72)	58.06 (22.87)	p = 0.000
Leisure High physical	8.26 (11.51)	15.39 (16.33)	p = 0.001
Total activity level	29.72 (14.99)	38.51 (14.91)	p = 0.000

Bibliography

Albert, S. M., Bear-Lehman, J., et al. (2009). "Lifestyle-adjusted function: variation beyond BADL and IADL competencies." Gerontologist 49(6): 767-777. Find it on PubMed

Doney, R. M. and Packer, T. L. (2008). "Measuring changes in activity participation of older Australians: validation of the Activity Card Sort-Australia." Australas J Ageing 27(1): 33-37. Find it on PubMed

Duncan, R. P. and Earhart, G. M. (2010). "Measuring participation in individuals with Parkinson disease: relationships with disease severity, quality of life, and mobility." Disabil Rehabil. Find it on PubMed

Everard, K. M., Lach, H. W., et al. (2000). "Relationship of activity and social support to the functional health of older adults." J Gerontol B Psychol Sci Soc Sci 55(4): S208-212. Find it on PubMed

Hartman-Maeir, A., Eliad, Y., et al. (2007). "Evaluation of a long-term community based rehabilitation program for adult stroke survivors." NeuroRehabilitation 22(4): 295-301. Find it on PubMed

Lyons, K. D., Li, Z., et al. (2010). "Consistency and construct validity of the Activity Card Sort (modified) in measuring activity resumption after stem cell transplantation." Am J Occup Ther 64(4): 562-569. Find it on PubMed

Purpose

Link to Instrument

Area of Assessment

Assessment Type

Administration Mode

Cost

Actual Cost

Cost Description

Diagnosis/Conditions

Number of Items

Required Training

ICF Domain

Measurement Domain

Considerations

Test/Retest Reliability

Internal Consistency

Construct Validity

Test/Retest Reliability

Criterion Validity (Predictive/Concurrent)

Construct Validity

Construct Validity

Criterion Validity (Predictive/Concurrent)

Bibliography

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