Purpose

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)

Available versions

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

Items:

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:

1. Never done
2. Not done as an older adult
3. Do now
4. Do less
5. 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

Time:

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:

N/A

Equipment:

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
• References
• 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

Can be used with:

• 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:

• N/A

In what languages is the measure available?

Languages of the measure

• English
• Hebrew
• Spanish
• Korean
• Chinese
• Dutch

The ACS has been validated for use in the US, Israel, Australia, Hong Kong, Singapore, Puerto Rico and Korea (Erickkson et al., in press).

Summary

Psychometric Properties

Overview

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.

Reliability

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:
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).

Test-retest:
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).
, 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 (ICC=0.82).

Intra-rater:
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:
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.
has not yet been examined.

Validity

Content:
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).

Criterion:
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.

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.
of the ACS.

Construct:
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.

Responsiveness

No studies have examined the responsivenessThe ability of an instrument to detect clinically important change over time.
of the ACS.

References

• 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

Purpose

The Assessment of Life Habits (LIFE-H) was developed to assess the quality of social 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 of people with disabilities by estimating how a client accomplishes 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 and social roles (Fougeyrollas, Noreau, Bergeron, Cloutier, Dion & St-Michel, 1998).

In-Depth Review

Purpose of the measure

The Assessment of Life Habits (LIFE-H) was developed to assess the quality of social 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 of people with disabilities by estimating how a client accomplishes 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 and social roles (Fougeyrollas, Noreau, Bergeron, Cloutier, Dion & St-Michel, 1998).

Available versions

The LIFE-H, with 298 items, was developed by Fougeyrollas, Noreau, Bergeron, Cloutier, Dion and St-Michel, in 1997. In 1998, the number of items was cut down to 240 LIFE-H 3.0 (Fougeyrollas and Noreau, 1998).

The LIFE-H is also available in three shortened versions, the latest one being version 3.1. The LIFE-H 2.1 was developed by Fougeyrollas, Noreau, Bergeron, Cloutier, Dion and St-Michel, in 1997, and contains 58 items. The LIFE-H 3.0, developed by Fougeyrollas and Noreau in 1998 contains 69 items on its short form. The LIFE-H 3.1, developed by Fougeyrollas, Noreau and St-Michel in 2001, contains 77 items.

The International Network of Disability Creation Process (INDCP) encourages use of versions 3.0 and 3.1.

Features of the measure

Items:
The LIFE-H is a self-administered questionnaire. If the client has a low cognitive level the questionnaire can be answered by a proxy respondent (Poulin & Desrosiers, 2008). It evaluates the level 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 in 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.
and social roles by considering the degree of difficulty in carrying out life habits and the type of assistance required (Desrosiers, Noreau, Robichaud, Fougeyrollas, Rochette & Viscogliosi, 2004).

The LIFE-H assesses accomplishment of life habits and satisfaction with how they are accomplished. The accomplishment scale of the LIFE-H covers all 12 domains of life habits proposed by the Disability Creation Process (DCP) model. These 12 domains are similar to 7 of the 9 domains proposed by the International Classification of Functioning and Disabilities (ICF) of the World Health Organization (WHO, 1998). The first 6 domains are related to activities of daily living (ADL)Basic tasks that involve bodily issues (bathing, dressing, toileting, transferring, continence, eating and walking) that are done on a daily basis. including: nutrition, fitness, personal care, communication, housing, mobility. The remaining are related to social roles: responsibilities, interpersonal relationships, community life, education, employment and leisure (Fougeyrollas et al., 1998).

The versions of the LIFE-H cover all 12 domains with varying number of items under each domain as seen in Table 1.

For each item in the accomplishment scale the client is asked about perceived difficulty in performing a life habit and the type of assistance used to perform it. When a life habit is not realized because it is not part of the person’s daily life, it is considered as a non-applicable item. (Desrosiers et al., 2004; Desrosiers, Boubonnais, Noreau, Rochette, Bravo, & Bourget, 2005; Fougeyrollas et al., 1998; Poulin & Desrosiers, 2008).

The definitions of the difficulty level and the types of assistance are provided within the questionnaire and are as follows (Fougeyrollas et al., 1998):

In the satisfaction scale the client is asked to indicate the degree of satisfaction (on a five point scale from very satisfied to very dissatisfied) in accomplishing each item (Desrosiers et al., 2004; Desrosiers et al, 2005; Fougeyrollas et al., 1998; Poulin & Desrosiers, 2008).

Subscales:
Two sub-scales exist. The ADL sub-scale contains the following categories: nutrition, fitness, personal care, communication, housing, mobility. The Social Role sub-scale is represented by responsibilities, interpersonal relationships, community life, education, employment and leisure (Desrosiers et al., 2004; Desrosiers et al., 2005).

Scoring:
The LIFE-H has a continuous score ranging from 0 to 9. In the original version, a score of 0 implies an optimal level 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 9 indicates total handicap or total disruption in 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. However, in the three shortened versions (LIFE-H 2.1, 3.0, and 3.1) the scale was inverted and a score of 0 indicates total handicap or total disruption in 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 a score of 9 means an optimal level 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 (Fougeyrollas et al., 1998).

To calculate a single item score the answers related to the difficulty level and assistance are combined based on the grid below (Desrosiers et al., 2004; Desrosiers et al, 2005; Fougeyrollas et al., 1998; Poulin & Desrosiers, 2008):

The LIFE-H total score is obtained by summing the scores on each item and then dividing by the number of items (means). It is also possible to calculate the categories, ADL and Social Roles sub-scores by calculating the means of the sub-score of interest. (Desrosiers, Rochette, Noreau, Bravo, Hebert & Boutin, 2003; Fougeyrollas et al., 1998).

As the LIFE-H has a different number of items under each category, a normalized score can be calculated. The normalized score takes into account the number of items in each category and the number of non-applicable items, allowing a similar weight to each category sub-score (Noreau, Fougeyrollas & Vincent, 2002).

Normalized score = {SUM (Raw scores) x 10} / (Number of applicable items x 9)

The non-applicable items are not counted into the raw score. The satisfaction level on accomplishing an item is not considered in the scoring process. Rather, the answers related to satisfaction are used to document the quality of social 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 (Fougeyrollas et al., 1998).

Time:
The LIFE-H 3.0 (short form) takes approximately 20 to 40 minutes to complete. The administration time for the long form can vary from 20 to 120 minutes, according to the number of categories administered (Noreau et al., 2002). The time required to complete the other versions of the LIFE has not been reported.

Equipment:
Only a pencil and the test are needed.

Training:
None typically reported.

Alternative forms of the LIFE-H

LIFE-H 2.1, LIFE-H 3.0 (short and long version), and LIFE-H 3.1.

Client suitability

Can be used with:

• Clients with any type of disabilities, including children.
• Clients 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

Should not be used in:

• When administering the LIFE-H to clients with severe cognitive impairments the answers should be given by a proxy who knows the individual well.

In what languages is the measure available?

French, English, and Dutch (version 3.0).

Summary

Psychometric Properties

Overview

We conducted a literature search to identify all relevant publications on the psychometric properties of the LIFE-H. We identified sixteen studies in total, eleven included participants 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.

Floor/Ceiling Effects

Rochette, Desrosiers, Bravo, St-Cyr/Tribble & Bourget (2007b) observed, in 35 clients with mild 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, floor effects in the Nutrition, Mobility, Community Life, Education/Employment and Recreation categories of the LIFE-H when measuring 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 at 2 weeks post-stroke. At 6 months post-stroke, ceiling effects could be observed in all categories of the LIFE-H. The proportion of participants scoring the minimum and maximum scores was not reported.

Reliability

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:
Lemmens, van Engelen, Post, de Witte, Beurskens, and Wolters (2007) administered the LIFE-H, Dutch version 3.0 (short form), to 35 older adults with functional limitations due to 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. The consistency of the LIFE-H total score between two repeated measures showed an excellent Intraclass Correlation Coefficient (ICC)Intraclass correlation (ICC) is used to measure inter-rater reliability for two or more raters. It may also be used to assess test-retest reliability. ICC may be conceptualized as the ratio of between-groups variance to total variance. of 0.78. Consistency for the two subscales was also excellent (ICC = 0.80).

Poulin and Desrosiers, (2008) evaluated the consistency of the LIFE-H version 3.1, when completed by proxy versus patient respondents by comparing responses from 40 clients and their proxies. Clients and proxies were assessed separately by the same rater. Proxy interviews were conducted one week apart of the client’s assessment. Consistency between clients and proxies was excellent for the total score (ICC = 0.82) and the ADL sub-score (ICC = 0.87). Consistency for the Social Roles sub-score was adequate (ICC = 0.73).

Test-retest:
Noreau, Desrosiers, Robichaud, Fougeyrollas, Rochette, and Viscogliosi (2004) 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 LIFE-H, version 3.0 (short form), in 40 clients with functional limitations caused by many conditions, including 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. Participants were re-assessed within 5 to 10 days by the same rater and under the same conditions. 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).
assessed using an Intraclass Correlation Coefficient (ICC)Intraclass correlation (ICC) is used to measure inter-rater reliability for two or more raters. It may also be used to assess test-retest reliability. ICC may be conceptualized as the ratio of between-groups variance to total variance., was found to be excellent for the LIFE-H total score (ICC = 0.95), for the ADL sub-score (ICC = 0.96) and for the Social Roles sub-score (ICC = 0.76).

Lemmens et al., (2007) assessed 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 LIFE-H, Dutch version 3.0 (short form), in 35 older adults with functional limitations due to 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. Participants completed the LIFE-H questionnaire twice, the second time after a 2-week interval. 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 Intraclass 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 score (ICC = 0.80), for the ADL sub-score (ICC = 0.78) and for the Social Roles sub-score (ICC = 0.78).

Inter-rater:
Noreau et al., (2004) evaluated 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.
of the LIFE-H, version 3.0 (short form), in 44 older adults with functional limitations caused in part by 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. The LIFE-H was administered by 2 examiners within 3 to 5 days of each other. 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.
, as calculated using ICC, was excellent for the total score (ICC = 0.89) and ADL sub-score (ICC = 0.91) and adequate for the Social Roles sub-score (ICC = 0.64).

Validity

Content:
Fougeyrollas, Noreau, Bergeron, Cloutier, Dion and St-Michel (1998) sent the original copy of the LIFE-H to 12 experts including researchers, service providers and consumer representatives having occupational therapy, nursing, social work, psychology as a professional background. Following consultation, modifications related to clearness of items, definitions of the terms, and the rank of the accomplishment level were made and some items were eliminated. After this procedure the experts recognized the LIFE-H as being able to measure 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 handicap situations.

Criterion:
Concurrent:
No gold standardA measurement that is widely accepted as being the best available to measure a construct.
exists against which to compare the LIFE-H.

Predictive:
Rochette, Desrosiers, and Noreau (2001) examined the ability of age, gender, impairments and disabilities level (comprised of cognition, perception, depressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
, communication, sensorimotor and comorbidity) and environmental factorsAs defined by the International Classification of Functioning, Disability and Health, environmental factors make up the physical, social and attitudinal environment in which people live and conduct their lives.   More (comprised of perceived environmental barriers and facilitators), measured at discharge from a rehabilitation program, to predict handicap situations at 6 months post-stroke in 51 clients. Handicap situations were measured with the LIFE-H, version 2.1. Logistic regression revealed the best predictor of handicap situations at 6 months to be impairment and disabilities level (R2 = 38.3%) followed by age (R2 = 14.4%) and environmental barriers (R2 = 6.2%), respectively.

Desrosiers, Noreau, Rochette, Bravo and Boutin (2002) assessed, in 102 clients, whether age, length of stay in a rehabilitation program, motivation, communication problems, urinary and fecal incontinence, upper and lower extremity coordination, motor function impairment, lower and upper extremity disabilities, affect, visual perceptual performance, cognition, comorbidity and perceived social support, measured at discharge from a rehabilitation program, were able to predict handicap situations at 6 months after 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. Handicap situations were measured with the LIFE-H, version 2.1., motor function impairment with the Fugl-Meyer Assessment (Fugl-Meyer, Jääskö, Leyman, Olsson, & Steglind, 1975); lower extremity disabilities with walking speed, the Berg Balance Scale (Berg, Wood-Dauphinee, Williams & Maki, 1989) and the 2-Minute Walk Test (Kosak & Smith, 2005); upper extremity disabilities with the Upper Extremity Performance Evaluation Test for the Elderly (Test d’evaluation des membres superieurs des personnes agees – TEMPA) (Desrosiers, Hébert, Dutil, & Bravo, 1994); affect with the (Beck, Ward, Mendelson, Mock, & Erbraugh, 1961); visual perceptual performance with the Motor-Free Visual Perceptual test (Colarusso & Hammill, 1972); cognition with the Modified Mini-Mental State (Teng & Chui, 1987); comorbidity with the Comorbidity Index (Charlson, Pompei, Ales, Mock, & Erbraugh, 1987) and perceived social support with the Social Provisions Scale (Cutrona, 1986). Multiple regression analysis indicated that the Beck DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Inventory (R2 = 23.0%), lower extremity coordination (R2 = 31.0%), length of stay (R2 = 3.0%), the Berg Balance Scale (R2 = 9.0%), age (R2 = 1.0 %) and the Comorbidity Index (R2 = 1.0%) were the best predictors of handicap situations 6 months post-stroke.

Desrosiers, Malouin, Bourbonnais, Richards, Rochette & Bravo (2003) analyzed, in 102 clients 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, the ability of arm and leg impairments and disabilities, measured at discharge of a rehabilitation program, to predict 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 6 months later. 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 was measured with the LIFE-H, version 2.1., motor function and sensation with the Fugl-Meyer Assessment (Fugl-Meyer et al., 1975), arm coordination with the Finger to Nose test and leg coordination with a specific test developed by the same researcher team (Desrosiers, Hébert, Bravo, Dutil, 1995), arm disabilities with the Upper Extremity Performance Evaluation Test for the Elderly (Test d’evaluation des membres superieurs des personnes agees – TEMPA) (Desrosiers et al., 1994) and leg disabilities with the Berg Balance Scale (Berg et al., 1989), the 2-Minute Walk Test (Kosak & Smith, 2005) and walking speed. Balance (r = 0.67), walking endurance (r = 0.63), walking speed (r = 0.62), and leg coordination (r = 0.62) were found to be excellent predictors of the LIFE-H. Leg function (r = 0.58), arm disabilities (r = 0.48), arm coordination (r = 0.47), arm function (r = 0.43), and leg sensation (r = 0.31) were considered adequate predictors of the LIFE-H. Finally, arm sensation and the LIFE-H were poorly correlated, suggesting this variable is not able to predict the LIFE-H.

Desrosiers, Noreau, Rochette, Bourbonnais, Bravo and Bourget (2006) verified, in 66 clients, whether age, length of stay in a rehabilitation program, motivation, communication problems, urinary and fecal incontinence, upper and lower extremity coordination, motor function impairment, lower extremity disabilities, upper extremity disabilities, affect, visual perceptual performance, cognition, comorbidity, and perceived social support, measured at discharge from a rehabilitation program, were able to predict 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 at 2 and 4 years after 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. 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 was measured by the LIFE-H, version 2.1., motor function impairment with the Fugl-Meyer Assessment (Fugl-Meyer et al., 1975); lower extremity disabilities with walking speed, the Berg Balance Scale (Berg et al., 1989) and the 2-Minute Walk Test (Kosak & Smith, 2005); upper extremity disabilities with the Upper Extremity Performance Evaluation Test for the Elderly (Test d’evaluation des membres superieurs des personnes agees – TEMPA) (Desrosiers et al., 1994); affect with the Beck DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Inventory (Beck et al., 1961); visual perceptual performance with the Motor-Free Visual Perceptual test (Colarusso & Hammill, 1972); cognition with the Modified Mini-Mental State (Teng & Chui, 1987); comorbidity with the Comorbidity Index (Charlson et al., 1961) and perceived social support with the Social Provisions Scale (Cutrona, 1986). From a multiple regression analysis the best predictors for 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 at 2 and 4 years post-stroke are age (R2 = 11.0%), comorbidity (R2 = 18.0%), motor coordination (R2 = 15.0%), upper extremity disability (R2 = 6.0%) and affect (R2 = 3.0%).

Rochette, Bravo, Desrosiers, St-Cyr/Tribble and Bourget (2007a) estimated, in 88 clients 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 the ability of the Stress Appraisal Measure (Peacock & Wong, 1990) and the Revised Ways of Coping Questionnaire (Folkman & Lazarus, 1988) measured in the first 2 weeks post-stroke to predict the LIFE-H, version 3.0 (short form) 6 months post-stroke. Multiple linear regression analysis suggested that the Threat, Challenge, Centrality and Stressfulness’ subscales of the Stress Appraisal Measure were more likely to predict the LIFE-H scores. These four variables together were able to explain 25 % of variance on the LIFE-H scores provided by clients 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.

Poulin and Desrosiers (2008) examined, in 40 clients 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 and 40 proxies, whether age, gender, schooling, living environment, relationship of proxy, 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 type, side of motor impairmentLoss of strength and coordination, decrease in arm or leg movement
, previous 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, number of months since 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, self-perceived health, the Mini-Mental State Examination (Folstein, Folstein, & McHugh, 1975), the Chedoke McMaster 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 Assessment (Gowland, Van Hullenar, Moreland, Vanspall, Barreca, Ward et al., 1995) and the Geriatric DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Scale (Jongenelis, Pot, Eisses, Gerritsen, Derksen, Beekman et al., 2005) were able to predict disagreement on responses provided by clients and their proxies on the LIFE-H, version 3.1. All the variables were measured at one point in time among community-dwelling individuals who had been hospitalized due to 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 and their proxies. Severe lower extremity impairment and poorer cognitive performance were found to be the best predictors of disagreement on the LIFE-H total score (R2 = 40%). For the ADL sub-score, the variables able to predict disagreement on the LIFE-H were severity of lower extremity impairment, living environment and gender (R2 = 44%). For the Social Role sub-scores the best predictors of disagreement were severity of lower extremity impairment, cognitive functions and number of months since 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, explaining 32% of the variance.
Note: Although disagreement levels between clients’ responses and their proxies do not appear to be clinically significant, the predictors of disagreement should be considered when interpreting proxy responses.

Construct:
Desrosiers, Rochette, Noreau, Bravo, Hébert and Boutin (2003) evaluated 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 LIFE-H, version 2.1, by comparing it to the Functional Autonomy Measurement System (Systeme de mésure de l’autonomie fonctionelle – SMAF) (Hébert, Carries, & Bilodeau, 1988) and the Functional Independence Measure (FIM) (Keith, Granger, Hamilton, & Sherwin, 1987) at 2 weeks and at 6 months after discharge from 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 rehabilitation program. At the first point in time, 118 participants were available and at the second point in time 102. Correlations, 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.
coefficients, were found to be excellent between the SMAF and the LIFE-H total score (r1 = 0.85; r2 = 0.89), the LIFE-H ADL sub-score (r1 = 0.89; r2 = 0.91), and the LIFE-H Social Roles sub-score (r1 = 0.66; r2 = 0.77) and between the FIM and the LIFE-H total score (r1 = 0.79; r2 = 0.85), the LIFE-H ADL sub-score (r1 = 0.85; r2 = 0.88), and the LIFE-H Social Roles sub-score (r2 = 0.71). Correlations between the LIFE-H and the FIM at 2 weeks after discharge were adequate (r1 = 0.57).

Convergent:
Three studies have investigated 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 LIFE-H in older individuals with functional limitations but not necessarily individuals 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.

Desrosiers, Noreau, Robichaud, Fougeyrollas, Rochette and Viscogliosi (2004) measured 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 LIFE-H, version 3.0 (short form), by comparing it to the Functional Autonomy Measurement System (Système de mesure de l’autonomie fonctionelle – SMAF) (Hébert et al., 1988) in 87 elderly adults with functional limitations. Correlations were excellent between the SMAF and LIFE-H total score (r = 0.70) and the ADL sub-score (r = 0.76) and adequate between the SMAF and the LIFE-H Social Roles sub-score (r = 0.43).

Rochette, Desrosiers, Bravo, St-Cyr/Tribble and Bourget (2007c) analyzed 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.
by comparing changes of participation’s level on the LIFE-H version 3.0 (short form) to the Caregiver Strain Index (Robinson, 1983) and the Beck DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Inventory (Beck et al., 1961) in 54 spouses of individuals with a first ever 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. Correlations between the Caregiver Strain Index and the LIFE-H total score (r = 0.32) and the Social Roles sub-score (r = 0.39) were adequate. The Caregiver Strain Index and the LIFE-H ADL sub-score were poorly correlated (0.02). No correlations were found between the LIFE-H and the Beck DepressionIllness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood or a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
Inventory.

Lemmens et al., (2007) examined 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 LIFE-H, Dutch version 3.0 (short form), with the Impact on 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 Autonomy Questionnaire (IPA) (Cardol, Haan, Van den Bos, De Jong, & De Groot, 1999) and the London Handicap Scale (LHS) (Hardwood, Roger, Dickinson, & Ebrahim, 1994) in 63 older adults with functional limitations. Excellent correlations were found between the total score and the IPA (rho = 0.82) and the LHS (rho = 0.90).

Known groups:
Desrosiers, Bourbonnais, Noreau, Rochette, Bravo, and Bourget (2005) verified the ability of the LIFE-H, version 2.1, to discriminate between older 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 (n = 46) and healthy older individuals (n = 46). Known group validityThe degree to which an assessment measures what it is supposed to measure.
, as calculated using Student’s t-test, showed that scores of healthy subjects were significantly higher than the scores of the participants 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.

Responsiveness

Rochette et al., (2007b) examined the responsivenessThe ability of an instrument to detect clinically important change over time.
of the LIFE-H, version 3.0 (short form) in 35 clients with mild 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. 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 level was measured before 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 (T0), in a retrospective way, at 2 weeks (T1), 3 months (T2) and 6 months post (T3). At T1, effects sizes were large for the LIFE-H total score (1.21) as well as for the ADL and Social Roles sub-scores (1.15; 1.24). For the timeline T3-T1 and T3-T0, effects sizes were all moderate : LIFE-H total score (0.60; 0.62), ADL sub-score (0.64; 0.58), and the Social Roles sub-score (0.56; 0.70).

Rochette et al., (2007c) analyzed the responsivenessThe ability of an instrument to detect clinically important change over time.
of the LIFE-H, version 3.0 (short form) in 54 spouses of individuals with a first ever 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. 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 level was measured before 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 (T0), in a retrospective way, and at 2 weeks (T1) and 6 months (T2) post-stroke. At T1, effects sizes were moderate for the LIFE-H total score (0.53), small for the ADL sub-scores (0.0), and large for the Social Roles sub-score (0.90). At T2, the LIFE-H total score (0.38) and the ADL sub-score (0.13) demonstrated a small effect sizeEffect size (ES) is a name given to a family of indices that measure the magnitude of a treatment effect. Unlike significance tests, these indices are independent of sample size. The ES is generally measured in two ways: as the standardized difference between two means, or as the correlation between the independent variable classification and the individual scores on the dependent variable. This correlation is called the “effect size correlation”.
and the Social Roles sub-scores a moderate one (0.76). Changes in 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 were larger for personal relationships (T1 = 0.67; T2 = 0.83), employment (T1 = 0.68; T2 = 0.63) and recreation (T1 = 1.16; T2 = 0.93) showing moderate to large effect sizes.

References

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• WHO, 1998. The world health report executive summary. The world health organisation, 1998.

See the measure

How to obtain the LIFE-H

A copy of the LIFE-H can be ordered from the International Network on the Disability Creation Process (INDCP). The initial user’s rights fee is CAN$ 288.00 and enhances using the LIFE-H for a 3-year period. One assessment tool can be obtained for CAN$ 23.00 and additional information records forms for CAN$ 3.00 each. INDCP detains all rights on the reproduction and distribution on all the versions of the LIFE-H.

Students are not charged the initial user’s rights fee (CAN$ 288.00) and are allowed to reproduce the LIFE-H for their ongoing research project. However, to do so, students have to buy one copy of the assessment tool (CAN$ 23.00) and commit in not using it for purposes other than their current research project. At the end of the project, a copy of their master’s or doctorate thesis should be sent to the INDCP.

Further information on the LIFE-H can be obtained by emailing the International Network of Disability Creation Process (INDCP), at ripph@irdpq.qc.ca.

The following links allow you to download sample versions of both the General Short Form (LIFE- H 3.1), and General Long Form (LIFE- H 3.0). They are for viewing purposes only and may not be reproduced.

• LIFE-H short version (LIFE- H 3.1):
  http://www.ripph.qc.ca/documents/MHAVIE_ADULTE_ABREGE_AN_no-reproduction.pdf
• LIFE-H long version (LIFE- H 3.0):
  http://www.ripph.qc.ca/documents/MHAVIE_ADULTE_DETAILLE_AN_no-reproduction.pdf

Purpose

The SATIS-Stroke is a questionnaire that can be used to measure satisfaction with 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 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 among 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. The questions are tailored to assess the individual’s satisfaction with 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 their everyday 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.
.

In-Depth Review

Purpose of the measure

The SATIS-Stroke is a questionnaire that can be used to measure satisfaction with 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 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 among 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. The questions are tailored to assess the individual’s satisfaction with 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 their everyday activities. The SATIS-Stroke can be used with patients with chronic stroke regardless of their age, gender, social status, place of residence, delay since stroke and type of 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.

The SATIS-Stroke includes 36 items, covering the 9 ICF domains: learning and applying knowledge, general tasks and demands, communication, mobility, self-care, domestic life, interpersonal interactions and relationships, major life areas, and community, social and civic life. The 36 items are sorted and numbered in order of decreasing satisfactory level, meaning that the first item (moving outside your home in any circumstance) requires the highest satisfactory level in order to be performed, whereas the last item (listening to and watching television according to your needs) requires the lowest satisfactory level.

Available versions

There are no alternative versions.

Features of the measure

Items:
There are no actual items to the MTS.

Description of tasks:
The patient is asked to rate their perceived satisfaction in performing each of the following 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.
and life situations using a 4-point scale.

1. Moving outside your home in any circumstances
2. Climbing and going downstairs all stages in your home according to your needs
3. Using knife, fork and spoon in all circumstances
4. Having a sexual relationship with somebody
5. Using coins and banknotes in all circumstances
6. Participating in spoken exchange of information with your entourage
7. To supplement administrative documents in all circumstances
8. Washing your hair according to your needs
9. Taking a bath or your shower according to your needs
10. Undresssing to use the toilet and redressing in your home or outside of it
11. Entering and exiting home your home according to your needs
12. Participating in arts and culture (cinema, theatre, etc.)
13. Reaching objects in your near space
14. Dressing and undressing in all circumstances and according to your needs
15. Managing your income in all circumstances
16. Getting clothes out of the closet
17. Using storage spaces in your house
18. Participating in spousal relationships
19. Ensuring that your rights are respected
20. Carrying out your personal hygiene according to your needs
21. Asking for help in an emergency situation
22. Reading and understanding a document in all circumstances
23. Moving inside your home
24. Managing your pain in all circumstances
25. Using the telephone at home according to your needs
26. Maintaining emotional relationships
27. Expressing oneself to someone
28. Having urinary continence in your home and outside of it
29. Participating in food and drink preparation in all circumstances
30. Opening and closing doors in your home
31. Co-operating with your entourage
32. Being aware of what surrounds you
33. Participating in ceremonies (marriage, gathering family, etc)
34. Choosing appropriate clothes
35. Getting feelings across
36. Listening to and watching television according to your needs

Scoring and Score Interpretation:
The 36 items are sorted and numbered in order of decreasing satisfactory level, meaning that the first item requires the most amount of satisfaction in order to perform the task, whereas the last item requires the least amount of satisfaction in order to perform the task.

Perceived satisfaction is rated on a 4-point scale.

1. Very dissatisfied
2. Dissatisfied
3. Satisfied
4. Very Satisfied

Scores range from 0 to 105 with a higher score indicating greater perceived satisfaction with tasks.

Information on score interpretation is not yet available.

Time:
Not reported.

Training requirements:
No training requirements have been reported.

Subscales:
None reported.

Equipment:
None required.

Alternative forms of the SATIS-Stroke

There are no alternative forms of the SATIS-Stroke.

Client suitability

Can be used with:

• Patients with chronic 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 regardless of their age, gender, social status, place of residence, delay since 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 and type of 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 (Bouffioulx et al., 2008).

Should not be used with:

• Patients with cognitive deficits, as these patients were excluded from the original validation study (Bouffioulx et al., 2008).

In what languages is the measure available?

English, french.

Summary

Psychometric Properties

Overview

A literature search was conducted to identify all relevant publications on the psychometric properties of the SATIS-Stroke and revealed only the initial validation study. Results support preliminary validation of the psychometric properties, however further research is needed before the tool is ready for clinical use.

Floor/Ceiling Effects

Floor or ceiling effects of the SATIS-Stroke have not been examined.

Reliability

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:
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 SATIS-Stroke has not been examined.

Test-retest:
Bouffioulx, Arnould and Thonnard (2008) 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 SATIS-Stroke in 101 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. The SATIS-Stroke was administered two times, with an interval of 32 days between each administration. 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, as calculated using Intraclass 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 (ICC=0.98, p<0.001).

Intra-rater:
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 SATIS-Stroke has not been examined.

Inter-rater:
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.
of the SATIS-Stroke has not been examined.

Validity

Content:
Content validityRefers to the extent to which a measure represents all aspects of a given social concept. Example: A depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension.
of the SATIS-Stroke has not been examined.

Criterion:
Concurrent:
Bouffioulx, Arnould and Thonnard (2008) investigated 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.”
between the SATIS-Stroke and the Barthel Index. An excellent (r=0.74, p<0.05) 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 found between the two measures. Results from this study suggest that independence in activity and life situations is related to patient ratings of perceived satisfaction.

Predictive:
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.
of the SATIS-Stroke has not been examined.

Construct:
Convergent/Discriminant:
The convergent or discriminant of the SATIS-Stroke validityThe degree to which an assessment measures what it is supposed to measure.
has not been examined.

Known groups:
The known groups validityKnown groups validity is a form of construct validation in which the validity is determined by the degree to which an instrument can demonstate different scores for groups know to vary on the variables being measured.
of the SATIS-Stroke has not been examined.

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).
:
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."
or specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of the SATIS-Stroke has not been examined.

Responsiveness

Bouffioulx, Arnould, Vandervelde and Thonnard (2010) examined the responsivenessThe ability of an instrument to detect clinically important change over time.
of the SATIS-Stroke in 45 patients with acute, subacute or chronic 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. The SATIS-Stroke was administered at 1 week (acute), 3 months (subacute) and six months (chronic) following onset of 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. The patients were also asked to subjectively rate their perceptions of change in overall functional status at the three time points, which was then used to classify their status as ‘deteriorating’, ‘stable’ or ‘improved’. The SATIS-Stroke was found to have the greatest responsivenessThe ability of an instrument to detect clinically important change over time.
for detecting change in patients’s function from the acute to chronic phase, demonstrating a large effect sizeEffect size (ES) is a name given to a family of indices that measure the magnitude of a treatment effect. Unlike significance tests, these indices are independent of sample size. The ES is generally measured in two ways: as the standardized difference between two means, or as the correlation between the independent variable classification and the individual scores on the dependent variable. This correlation is called the “effect size correlation”.
(effect size=1.12, standardized response mean=0.62). The SATIS-Stroke was found to be less responsive from the acute to subacute phase (effect size=0.76, standardized response meanThe standardized response mean (SRM) is calculated by dividing the mean change by the standard deviation of the change scores.
0.59) and from the sub-acute to chronic phase (effect size=0.42, standardized response mean=0.27); however, it may be that less drastic changes in satisfaction may be occurring during these time periods. This study also reviewed the minimal clinically important difference but concluded that further investigate is necessary.

References

• Bouffioulx, E., Arnould, C. & Thonnard, J-L. (2008). SATIS-Stroke: A satisfaction measure of activities and participation in the actual environment experienced by patients with chronic stroke. Journal of Rehabilitation Medicine, 40, 836-843.
• Bouffioulx, E., Arnould, C. Vandervelde, L. & Thonnard, J-L. (2010). Changes in satisfaction with activities and participation between acute, post-acute and chronic stroke phases: A responsiveness study of the SATIS-Stroke questionnaire. Journal of Rehabilitation Medicine, 42, 944-948.

See the measure

How to obtain the SATIS-Stroke?

Information on the SATIS-Stroke can be obtained from the Bouffioulx, Arnould and Thonnard (2008) article.