Activity Card Sort (ACS)

Evidence Reviewed as of before: 06-04-2011
Author(s): Annabel McDermott
Editor(s): Nicol Korner-Bitensky, PhD OT
Expert Reviewer: Professor Carolyn Baum

Purpose

The Activity Card Sort (ACS) is an interview-based tool used to measure an individual’s participation in instrumental, leisure and social activities. The ACS can be used to gain information regarding a client’s activity patterns in order to support development of routines and participation 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 activities 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 activities for a broader population of older adults in a variety of settings. It can be used to monitor change in activity participation over time as a means of comparing premorbid engagement in activities with current activity participation (Baum, Perlmutter & Edwards, 2000; Hartman-Maeir, Soroker, Ring, Avni & Katz, 2007). The ACS is useful for initial assessment, goal setting and intervention planning 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 participation due to a chronic health condition, a stroke or aging.

The ACS does not provide information regarding factors such as:

  • Length of time spent engaged in activities
  • Frequency of participation
  • Social interactions during activity participation
  • 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 participation. The original version of the ACS consisted of photographs of adults performing a variety of social, instrumental and leisure activities. The Activity Card Sort, 2nd Edition (Baum & Edwards, 2001, 2008) consists of 89 activities 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 activities from the list and explore factors that are limiting the individual’s engagement in those activities, as a means of facilitating goal setting and intervention planning (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 activities by the sum total of previous activities:

Current activities / Previous activities = Retained Activity Score

The Retained Activity Score ranges from 0-100 and therefore reflects the percentage of activities 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 activities, while a score of 0 indicates that the individual has not re-engaged in any premorbid activities, nor introduced any new activities into his/her daily life (Lyons, Li, Tosteson, Meehan & Ahles, 2010).

The amount of activities 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 reliability
  • 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 activities. 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 participation 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 activities from the original version were removed and eight culturally-relevant activities were added. The activities are organized within the four domains of IADLS (21 pictures), social-cultural activities (21 pictures), low-physical leisure activities (27 pictures) and high-physical leisure activities (19 pictures).

Packer et al. (2008) developed a version of the ACS to suit an Australian population. The ACS-Australia includes 82 activities, 12 of which are unique to the Australian version. Activities are organized according to three domains of household (12 activities), social/educational (24 activities) and leisure (46 activities).

Chan et al. (2006) developed a version of the ACS to suit a Hong Kong population, which resulted in a final list of 65 activities 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 activities 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

What does the tool measure?

Activity participation

What types of clients can the tool be used for?

Older individuals who have experienced change in their activity participation as a result of onset of illness

Is this a screening or assessment tool?

Assessment tool
The ACS can also be used for goal setting and monitoring activity participation as a measure of function/well-being over time.

Time to administer

20 – 30 minutes

Versions

ACS Community Version (US)
ACS Institutional Version (US)
ACS Recovery Version (US)
Activity Checklist (US)
ACS (Israeli version)
ACS – Australia
ACS – Hong Kong
ACS – Korean
ACS – Puerto Rican
ACS – Singapore
ACS – The Netherlands

Other Languages

Hebrew, Spanish, Korean, Chinese and Dutch

Measurement Properties

Reliability

Internal consistency
– Two studies examined the Pearson’s correlation.
– One study reported excellent Cronbach’s alpha.
– One study reported adequate to excellent Cronbach’s alpha.

Intra-rater
– No studies have examined the intra-rater reliability of the ACS.

Inter-rater
– No studies have examined the inter-rater reliability of the ACS.

Test-retest
– One study indicated excellent one-week test-retest reliability of the ACS US version.
– One study reported excellent test-retest reliability of the ACS (checklist version).
– One study reported excellent two-week test-retest reliability of the ACS-HK using the ICC.
– One study reported excellent test-retest reliability of the PR-ACS using the ICC.

Validity

Content
– The ACS US version was developed in consultation with two groups of older adults living in the United States.
– Subsequent versions of the ACS were developed based on the ACS US version and/or culturally-relevant activity lists, questionnaires or time-use surveys. All versions were reviewed by expert panels of healthy older adults and some versions were also reviewed by specialist health professionals.

Criterion
Predictive Validity
– No studies have reported on the predictive validity of the ACS.

Concurrent Validity
– One study reported excellent concurrent validity between the ACS US version and the ACS (checklist version).
– One study reported adequate concurrent validity between the ACS (Israeli version) and the Occupational Questionnaire.
– One study reported adequate concurrent validity between the ACS-Aus and the Adelaide Activities Profile.

Construct
– One study reported satisfactory validity of the original ACS to measure previous activity engagement in a sample of individuals with Alzheimer’s disease.

Known Groups
– Two studies regarding the ACS (Israeli version) have reported satisfactory to excellent validity to differentiate among groups according to age, illness and carer roles, and satisfactory validity to identify differences between groups of young and older adults.
– One study reported excellent validity of the ACS-HK to discriminate between clients presenting with different functional abilities.
– One study reported satisfactory validity of the PR-ACS to discriminate between clients presenting with different levels of function.
– One study reported satisfactory discriminative validity of the ACS-Aus.

Convergent/Discriminant Validity
– Two studies investigated convergent validity of the ACS US version. A significant association was reported with the Reintegration to Normal Living Index (RNLI). Significant correlations were reported with SF-12 factors.
– One study reported adequate correlations between the ACS-Aus and the Personal Well-being Index (PWI).
– One study reported excellent correlations between the ACS-HK and the Comprehensive Quality of Life scale (ComQoL).
– One study reported excellent convergent validity between the PR-ACS and the Puerto Rican version of the RAND 36-Short Form Health Survey.

Floor/Ceiling Effects

N/A

Sensitivity / Specificity

No studies have explored the sensitivity/specificity of the ACS.

Does the tool detect change in patients?

Yes – the ACS detects change in an individual’s participation in activities

Acceptability

Law et al. (2005) reported that the ACS US version is non-threatening and easy to understand. Katz et al. (2003) reported that the ACS (Israeli version) is user-friendly.

Feasibility

Law et al. (2005) reported that the ACS US version can be modified to suit the target audience. Katz et al. (2003) reported that the ACS (Israeli version) is suitable for individuals with language difficulties.

How to obtain the tool?

The ACS can be purchased from the AOTA online store: http://www.aota.org.

Psychometric Properties

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 Consistency

Katz et al. (2003) examined the internal consistency 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 consistency of the ACS (Israeli version), as calculated using Cronbach’s Coefficient Alpha was excellent for Instrumental Activities of Daily Living (α=0.82) and social-cultural activities (α=0.80) but poor for low-physical leisure activities (α=0.66) and high-physical leisure activities (α=0.61). Internal consistency of both low and high physical leisure activities 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 activities and 17 high-physical-demand activities).

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 correlation was calculated for five student group factors of instrumental activities 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 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 consistency of the ACS-HK in a group of 60 elderly individuals (mean age 74 years) who had experienced a stroke a minimum of 6 months prior. Internal consistency, calculated using Cronbach’s alpha, was excellent (α= 0.89).

Orellano (2008) examined internal consistency of the PR-ACS in a group of healthy older adults (n=106) and a group of adults with Multiple Sclerosis (n=40). Internal consistency, 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).

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

Inter-rater
Inter-rater reliability has not yet been examined.

Test-retest

One-week test-retest reliability 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 reliability.

Everard et al. (2000) examined the test-retest reliability of the ACS (checklist version) on a sample of 20 community-dwelling older adults. Excellent test-retest reliability 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 reliability of the ACS-HK in two groups of elderly individuals who had experienced a stroke a minimum of 6 months prior (less active group, n=30; more active group, n=30). Two-week test-retest reliability, as calculated using the intra-class correlation coefficient was excellent for the total group (ICC=0.98). Individual group analysis also revealed excellent test-retest reliability for both groups (less active group ICC=0.91; more active group ICC=0.96).

Orellano (2008) examined test-retest reliability 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 reliability, as calculated using the intra-class correlation coefficient was excellent (ICC=0.82).

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 activities, increasing the number of activities 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 activities 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 activities 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 activities, 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 activities 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 activities and perceived importance of activities (Erikkson et al., in press). The resultant activities 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 activities from the US and Israeli versions and information from time diaries regarding common daily activities (Packer et al. 2008).

The ACS – Korea was developed using information from a literature review and a time-use survey. The resultant list of activities was evaluated and refined by a panel of experts (Erikkson et al., in press).

Criterion

Predictive
No studies have reported on the predictive validity of the ACS.

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 validity 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 validity 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 validity (r=0.54), as calculated using Pearson correlation coefficient.

Doney & Packer (2008) assessed the concurrent validity of the ACS-Aus in 93 metropolitan-based adults aged 60 to 95 years. As there is no gold standard for comparison, the authors assessed the direction, strength and significance of the correlation between the Current (retained) Activity Level scores of the ACS-Aus and the Adelaide Activities Profile. A significant, adequate correlation (r=0.434, P=0.000) was found using Pearson-product moment analysis.

Construct

Baum (1995) examined the validity 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.

Known Group Validity
Sachs and Josman (2003) reported satisfactory discriminative validity of the ACS (Israeli version), to identify differences between groups of young and older adults.

Katz et al. (2003) examined the construct validity 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 activities, low-physical activities, high-physical activities and totals), indicating excellent construct validity to differentiate among groups according to age, illness and carer roles. Post hoc (Scheffe) tests showed significant differences between most groups. Specific to the stroke group, post hoc analysis indicated scores were not significantly different on social-cultural, low-physical or high-physical leisure activities compared to caregivers, and on high-physical leisure activities compared to individuals with multiple sclerosis.

Chan et al. (2006) examined the construct validity of the ACS-HK in two groups of elderly individuals who had experienced a stroke 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 validity 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 validity 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.

Convergent/Discriminant Validity
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 activities (p=0.006), social activities (p=0.0001) and high demand leisure activities (p=0.0001). A significant positive association was seen between mental health and maintenance of low-demand leisure activities (p=0.0001) only. A significant negative association was found between physical health and maintenance of low-demand leisure activities (p=0.015).

Edwards et al. (2006) examined the relationship between life satisfaction and participation using the Reintegration to Normal Living Index (RNLI) and ACS (percentage of retained pre-stroke activities) with a sample of patients with stroke (n=219). An association was seen between life satisfaction and participation in meaningful activity (β=0.14, p=0.001).

Doney & Packer (2008) assessed the convergent validity of the ACS-Aus by comparison with the Personal Well-being Index (PWI) in 93 metropolitan-based adults aged 60 to 95 years. Convergent validity between the ACS-Aus current activity level scores and the PWI total score was calculated using Pearson correlation coefficient and was found to be adequate (r=0.354, P=0.01), indicating a positive relationship between participation and well-being. The authors noted that this correlation was likely weakened by a potential ceiling effect 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 validity 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 stroke a minimum of 6 months prior. Convergent validity as calculated by Pearson’s 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 validity 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 validity, as calculated by Pearson’s correlation coefficients, was excellent (r=0.66, p=0.00).

Responsiveness

No studies have examined the responsiveness 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: OccupationParticipation and Health, 23, 10-17.
  • Law, M., Baum, C. & Dunn, W. (Eds.). (2005). Measuring Occupational Performance: Supporting Best Practice in Occupational Therapy (2nd edition). Thorofare, NJ: Slack Incorporated.
  • Lyons, K. D., Li, Z., Tosteson, T. D., Meehan, K., & Ahles, T. A. (2010). Consistency and construct validity of the Activity Card Sort (Modified) in measuring activity resumption after stem cell transplantation. American Journal of Occupational Therapy, 64, 562-569.
  • Orellano, E. (2008). Occupational participation of older Puerto Rican adults: reliability and validity of a Spanish version of the Activity Card Sort (PhD dissertation). Retrieved from ProQuest Dissertations database (Publication Number 3330659).
  • Packer, T. L., Boshoff, K., & DeJonge, D. (2008). Development of the Activity Card Sort – Australia. Australian Occupational Therapy Journal, 55, 199-206.
  • Sachs, D., & Josman, N. (2003). The Activity Card Sort: a factor analysis. OTJR: Occupation, Participation and Health, 23, 165-174.
  • Schreuer, N., Rimmerman, A., & Sachs, D. (2006). Adjustment to severe disability: constructing and examining a cognitive and occupational performance model. International Journal of Rehabilitation Research, 29, 201-207.

See The Measure

How to obtain the assessment:

The assessment can be purchased online at the American Occupational Therapy Association online store: http://www.aota.org.

A spain version is available in the following article

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