Activities Scale for Kids- Performance Version

Posted on: March 16, 2015 | By: cabrahams2 | Filed under: Activities Scale for Kids: Performance Version-ASK

Descriptive Information:

  • Title: Activities Scale for Kids- Performance Version (ASKp)
  • Author: Nancy, L. Young, J. Ivan Williams, Karen K. Yoshida, James G. Wright
  • Source: The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
  • Costs: $150 CAD/year for clinicians, $250 CAD/year for non-funded academic research, $600 CAD/year for funded academic research, $900 CAD/year for funded multi-site academic research, free for student projects and teaching purposes
  • Purpose:  To measure physical function and disability in children with musculoskeletal disorders based on their perspective of what they have been doing at home, at school, and on the playground.
  • Type of Test: Child self-report questionnaire, which can be parent-reported if necessary.
    • “Can be used to assess a child’s status at a single point in time or to monitor changes associated with time or therapeutic interventions.”
  • Target Population and Ages: Children age 5-15 years old experiencing limitations in physical activity due to musculoskeletal disorders
  • Time Requirements: Completion time averages about 9 minutes (5-12 minute range)
  • Other version: ASK Capability, which measures what a child believes they “could do”. The two versions can be administered either alone or together.

Test Administration:

  • Administration:
    • Presented in the form of a 30-item questionnaire booklet, in which children determine and record the answers about what they “did do” in the last week.
      • There are 7 sub-domains represented within the ASKp:
        • Personal care (3 items)
        • Dressing (4 items)
        • Other skills (4 items)
        • Locomotion (7 items)
        • Play (2 items)
        • Transfers (5 items)
      • Each question is answered using a 5-point ordinal scale:
        • All of the time (4 points)
        • Most of the time (3 points)
        • Sometimes (2 points)
        • Once in awhile (1 point)
        • None of the time (0 points)
    • If children did not have a chance to do an activity they are asked to not pick a box and write a reason for not doing the activity.
    • Children under the age of 9 may require help from parent in order to read the questionnaire.
    • If has been found that child and parent-reported summary scores are very similar, indicating that parents may help or provide ratings for their child if necessary.
  • Scoring: Each answer has the ability to receive 0-4 points, with 4 points indicating the best function. Summary scores are calculated by dividing the sum of the child’s score on each item by the maximum score the child could have received, to obtain a score between 0-100%, with 100 being the best possible score. Activities that are not applicable or performed are not calculated into the summary score.
  • Type of information, resulting from testing: Summary scores are expressed as percentages ranging from 0-100%, with 100% indicating full physical function.
  • Environment for Testing: Should be completed at home in a quiet setting with adequate lighting and supervision.
  • Equipment and Materials Needed: The ASKp booklet and pencil
  • Examiner Qualifications: None; requires no special training
  • Standardization/normative data:
    • Mean ASKp summary scores by level of disability1,2:

      • Normal/ no musculoskeletal disabilities: 93.12% (SD 6.45)
      • Mild disabilities: 85.86% (SD 13.77)
      • Moderate disabilities 52.66% (+/- 22.53 SD)
      • Severe disabilities: 21% (+/- 10.23 SD)

Psychometric Properties:

  • Evidence of Validity1:
    • Construct validity:
      • Construct validity assessed and confirmed by:
        • Ability to detect gradations of disability as compared to the CHAQ (PCC 0.81)
        • Convergence with disability domains and divergence from non-disability domains as compared to HUI (Spearman’s correlation = 0.43 for similar constructs and -0.03 for dissimilar constructs)
        • Minimal ceiling effects (4%) and no floor effects (0%) found
    • Criterion validity:
      • Correlation of 0.81 (P < 0.0001) with parent-reported Childhood Health Assessment Questionnaire scores
      • A significant difference in scores according to clinicians’ global ratings of disability found between the mild, moderate, and severely disabled groups of children (P<0.0001)
      • Correlation of 0.92 (P<0.0001) with clinician-observation
  • Evidence of Reliability:
    • Test-retest reliability: excellent (ICC=0.97)
    • Inter-rater reliability: excellent (ICC= 0.99)
  • Discriminative: Has been shown to have high discriminatory ability
  • Responsiveness: Highly efficient at detecting clinically important change (~1.73 SD units)

Summary Comments:

  • Strengths: Minimal ceiling effects and no floor effects for children with musculoskeletal disorders, easy to score, significant feasibility in clinical setting, easy to understand, requires no special training or equipment, inexpensive
  • Weaknesses: Lack of a pain scale
  • Clinical Applications3:
    • “The ASK© is unique in that it reflects the children’s perspectives of disability, provides the option of examining performance and/or capability, and requires no special training or equipment. It is also completed by child self-report and may be administered by mail. These features are intended to enhance the feasibility of using the ASK© for a variety of research and clinical practice applications.”
    • “The quality of this measure enables clinicians and researchers to measure outcomes in a way that is relevant to patients…”

 

Adapted from:

  1. Young NL, Williams JI, Yoshida KK, et al. Measurement properties of the Activities Scale for Kids. J Clin Epidemiol. 2000;53:125–137.
  1. Plint AC, Gaboury I, Owen J, Young NL. Activies Scale for Kids: an analysis of normal. J Pediatr Orthop. 2003;23:788-790.
  1. ASK: Activities Scale for Kids. http://www.activitiesscaleforkids.com. Accessed March 14, 2015.

 

 

Below is an article summary of a research study that used the ASKp as a primary outcome measure:

 

Silkwood-Sherer DJ, Killian CB, Long TM, Martin KS. Hippotherapy— an intervention to habilitate balance deficits in children with movement disorders: a clinical trial. Phys Ther. 2012;92: 707–717.

The purposes of this study were to determine the effectiveness of hippotherapy on postural instability in children with mild to moderate balance deficits, as well as to determine if there is a correlation between changes in balance and function. The repeated-measures design study included a convenience sample of 16 children (9 boys and 7 girls), age 5-16 years old (mean= 10 years 4 months) with documented balance deficits. The inclusion criteria required each child have the ability to stand for 4 seconds independently without an assistive device and to follow instructions. Children were excluded if they had prior hippotherapy experience, an orthopedic or medical condition unrelated to primary diagnosis, had begun new treatment in the past month, or had allergies to horses. The primary outcome measures of the study included the Pediatric Balance Scale (PBS), a 14-item test to measure balance, and the Activities Scale for Kids- Performance (ASKp), a 30-item questionnaire that measures functional performance of daily life skills. Assessments were obtained before and after a 6-week hippotherapy intervention of two 45-minute sessions per week.  There were statistically significant increases in PBS and ASKp scores between baseline and post-intervention assessments. No significant correlation was found between change in PBS scores and ASKp scores from baseline assessments to post intervention assessments (P>0.05). However, a significant correlation was found between the post-intervention scores of the two tests (P=.003), suggesting there is some correlation between balance skills and the ability to perform functional activities.

Weaknesses of this study included a lack of control group and small sample size. The variety of diagnosis was both a strength and weakness as it showed that the benefits of hippotherapy is not diagnosis dependent, but made it difficult to generalize the results to a particular diagnosis. The findings of this study suggest that hippotherapy may be a helpful intervention approach to reduce balance deficits and improve functional performance in children with mild to moderate balance deficits.

 

2 responses to “Activities Scale for Kids- Performance Version”

  1. kriffanacht says:
    March 19, 2015 at 3:46 pm

    This outcome measure reminds me a lot of several of the extremity or spine specific measures we tend to use with adults with specific orthopedic problems in that it identifies/classifies children’s scores into categories of % disability. I like how it addresses several different categories which encompass various aspects of physical mobility, ADL’s and of course play. With this being a questionnaire where the parent or child reports their ability to perform specific skills I wonder if there is ever “over-reporting” of the child’s skills through the previous week? I also wonder if this outcome measure tends to be more useful with children whom tend to have certain specific orthopedic diagnosis more than others?

  2. cabrahams2 says:
    March 19, 2015 at 5:08 pm

    You make a good point and that is definitely something to consider when using the ASKp, as I am sure that there could be incidences of “over-reporting” (and even “under-reporting”). However, I feel this could be true for most outcomes that are self-report in nature. It is with hope that the child would truthfully and accurately report how often they were able to complete a skill over the previous week, but this may not always be the case. When researching the ASKp I did not see any mention of it being more beneficial for one orthopedic diagnosis over another.

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