Activities Scale for Kids-Performance

Instrument Name: Activities Scale for Kids-Performance

Abbreviation: ASK-Performance

Points for Consideration:

Sound psychometrics; easy to administer; unclear responsiveness. Population dependent.

Description of Tool:

The Activities Scale for Kids-ASK is a PRO used to assess physical function in children. The tool has both a self-report measure (capability) as well as a performance measure. The ASK-performance is most commonly used in research studies and covers children ages 5 to 15 years.

The ASK(C) performance asks what the child 'did do' during the previous week.

The tool contains 30 items that can be used to derive a total score, as well as 7 subdomain scores: personal care, dressing, other skills, locomotion, play, standing skills, and transfers.

Children under 9 often need an adult to read the questions to them.

Other Related Tools (if applicable):

ASK-Capability

Minimum Qualification Required by COA Administrator: No degree requirement

Year: 1996

Objective of Development:

To measure physical disability in children with musculoskeletal disorders

Population of Development: Age range (therapeutic indication):

5-15 years (Musculoskeletal Pain, Cerebral Palsy, Scoliosis, Cystic Fibrosis)

Pediatric Population(s) in which COA has been used:

ASK: Immune system diseases; Musculoskeletal diseases; Congenital, Hereditary, and Neonatal Diseases and Abnormalities; Wounds and injuries; Nervous system diseases; Hemic and Lymphatic Diseases; Neoplasms; Cardiovascular diseases; Respiratory tract diseases; Skin and Connective Tissue Diseases

COA type: PRO

Number of Items 30

Mode of Administration: Self-administered

Data Collection Mode:

Time for Completion: 5 to 12 minutes

Response Scales: 5-point verbal rating scale: 0

Summary of Scoring:

Available Scores:
Global score ranging from 0 to 100

Weighting:
No

Score Interpretation:
Higher score = Better performance

Evidence of Literature Review: Yes

Evidence of Instrument Review: Yes

Evidence of Clinical or Expert Input: Yes

Evidence of concept elicitation in target patient population: Yes

Evidence of a Saturation Grid: None identified

Evidence for Selection of Data Collection Method: Yes

Recall/Observation Period: The last week

Evidence for Selection of Reponse Options: Yes

Evidence of cognitive interviewing of draft instrument in target patient population: Yes

Evidence of Preliminary Scoring of Items and Domains: Yes

Evidence related to respondent and administrator burden: Yes

Evidence of a Conceptual Framework: None identified

Evidence of an item-tracking matrix: None identified

Evidence related to item selection: Yes

Evidence of re-testing the final version: None identified

Internal consistency (Cronbach's alpha): Yes

Evidence of internal consistency:

Test-retest Reliability (ICC):

Young NL (2009)

Paper-version:
- Intraclass Correlation Coefficient (ICC): 0.987
- Was a definition of stability applied to identify stable patients: No
- Time frame or interval between the two administrations: Mean time: 23 days
- Population/Disease: Children with cerebral palsy, spina bifida, and cystic fibrosis; n=21, age range included in this range: 8.04-13.37 years)

Web-version:
- Intraclass Correlation Coefficient (ICC):
ASK-P: 0.989
ASK-P subdomains:
Personal care: 0.964
Dressing: 0.984
Other skills: 0.720
Play: 0.661
Locomotion: 0.967
Standing skills: 0.834
Transfers: 0.975
- Was a definition of stability applied to identify stable patients: No
- Time frame or interval between the two administrations: Mean time: 23 days
- Population/Disease: Children with cerebral palsy, spina bifida, and cystic fibrosis; n=18, age range included in this range: 8.04-13.37 years)

Lawitschka A (2020)
German ASKp

- Pearson correlation coefficient:
- Between T0 and T3, r= 0.659 (p<0.001); T0 and T6, r= 0.676 (p<0.001); T0 and T9, r= 0.453 (p<0.05); T0 and T12, r= 0.523 (p<0.05), T0 and T15, r= 0.494 (p<0.05), T0 and T18, r= 0.644 (p<0.01)
- Between T3 and T6, r= 0.935 (p<0.001); T3 and T9, r= 0.832 (p<0.001), T3 and T12, r= 0.934 (p<0.001), T3 and T15, r= 0.909 (p<0.001), T2 and T18, r= 0.900 (p<0.001)
- Between T6 and T9, r= 0.621 (p<0.01), T6 and T12, r= 0.832 (p<0.001), T6 and T18, r= 0.909 (p<0.001)
- Between T9 and T12, r= 0.806 (p<0.001), T9 and T19, r= 0.565 (p<0.05)
- Between T12 and T15, r= 0.739 (p<0.001), T13 and T18, r= 0.867 (p<0.001)
- Between T15 and T18, r= 0.964 (p<0.001)
- Was a definition of stability applied to identify stable patients: No
- Time frame or interval between the two administrations: 3, 6, 9, 12, 15 and 18 months
- Population/Disease: Patients with or without chronic graft-versus-host disease after allogenic hematopoietic stem cell transplant; n= 55, median age 12 (range 4-23 yeas), median age 12 (range 4-23 years)

Inter-rater/ inter-interviewer reliability (kappa):

Not reported

Evidence of test-retest or inter-rater reliability: Yes

Concurrent validity (convergent, divergent):

Pencharz (2001)
1- Correlation coefficient used: Pearson's correlation coefficient
- Measure: Child Health Questionnaire Parent Form physical function subscale (CHQ-PF-28) and Pediatric Outcomes Data Collection Instrument global function (PODCI)
- Results: Significant correlations were found between ASK-P, CHQ-PF-28 and PODCI: p Not stated
CHQ-PF-28 physical function subscale: 0.5
PODCI global function: 0.8
- Population/Disease: Children with fractures, spinal disorder, neuromuscular conditions, other musculoskeletal conditions; n=166, average age: 10.9± 2.6 years

Wright JG (2008)
2- Correlation coefficient used: Pearson's correlation coefficient
- Measure: Muscular Dystrophy Spine Questionnaire (MDSQ) and Pediatric Outcomes Data Collection Questionnaire (PODCQ)
- Results: Significant correlations were found between ASK-P, MDSQ and PODCQ:
MDSQ: 0.40, p<0.05
PODCQ: -0.66, p<0.001
- Population/Disease: Patients with muscular distrophy and scoliosis; n=26, age mean 15.2±2.90 years

Smith PL (2005)
3- Correlation coefficient used: Pearson's correlation coefficient
- Measure: Pediatric Outcomes Data Collection Questionnaire (PODCQ), Spina Bifida Hips Questionnaire (SBHQ)
- Results: Significant correlations were found between ASK-P, SBHQ, and PODCQ: p<0.01 for all results
SBHQ: 0.79
PODCQ: 0.81
- Population/Disease: Patients with spina bifida and dislocated hips; n=34 age mean 11.6 +/- 3.9 years

Known-group validity:

Pencharz (2001)

1- Measure/Groups of patients: Clinicians' global ratings
- A priori hypotheses: ASK-P scores would correlate with clinicians' and ratings
- Were hypotheses confirmed: Yes
- Results: Significant correlation was found between ASK-P score and clinicians' ratings: r=0.5, p Not stated
- Population/Disease: Children with fractures and spinal disorder; n ranged from 95 to 166, average age: 10.9± 2.6 years

2- Measure/Groups of patients: Clinicians' global ratings and ambulation level
- A priori hypotheses: ASK-P scores would discriminate patients' within each clinical criteria
- Were hypotheses confirmed: Yes
- Results: Significantly different ASK-P scores were found within each clinical criteria: F-test statistic, p<0.0001
Clinicians' global ratings: 25.2
Ambulation level: 70.6
- Population/Disease: Children with fractures and spinal disorder; n ranged from 95 to 166, average age: 10.9± 2.6 years

Young NL (2000)
KNown-groups validity:

3- Measure/Groups of patients: Disability levels measured by clinician's global ratings: mild (n=10), moderate (n=11), and severe (n=3)
- A priori hypotheses: Not detailed
- Were hypotheses confirmed: Not applicable
- Results: Significant differences were found between ASK-P scores for children of different disability levels: ANOVA, data Not shown, p<0.0001
- Population/Disease: Children with musculoskeletal disorder; n see above, mean age: 10.2± 3.33 years

Plint (2003)
4- Measure/Groups of patients: Disability levels: No disability (n=122), mild (n=10), moderate (n=11) and severe disability (n=3)
- A priori hypotheses: Not detailed
- Were hypotheses confirmed: Not applicable
- Results: Significant differences were found between "No disability "ASK-P score and the other groups: Mean (SD), p<0.005 for all results
No disability: 93.12 (6.45)
Mild disability: 85.86 (13.77)
Moderate disability: 52.66 (22.53)
Severe disability: 21.00 (10.23)
- Population/Disease: Children with or without musculoskeletal disorder; n see above, ahe range for children without musculosketal disorder 10.45 years (±2.99)

Lawitschka A (2020)
German ASKp
5- Measure/Groups of patients: Patients classified according their need of devices in two groups: Yes (n= 10) or No (n= 45)
- A priori hypotheses: Not detailed
- Were hypotheses confirmed: Not applicable
- Results: ANOVA
Patients who need devices had significantly (p<0.001) lower ASKp scores (Mean(SD)= 2.32(0.87) than patients who didn't need (Mean(SD)= 3.31(0.52), F= 22.298
- Population/Disease: Patients with or without chronic graft-versus-host disease after allogenic hematopoietic stem cell transplant; n= 55, median age 12 (range 4-23 years)

6- Measure/Groups of patients: Patients classified according the presence of endocrine comorbidity in two groups: Yes (n= 13) or No (n= 42)
- A priori hypotheses: Not detailed
- Were hypotheses confirmed: Not applicable
- Results: ANOVA
Patients who had endocrine comorbidity showed significantly (p<0.05) lower ASKp scores (Mean(SD)= 2.77(1.02) than patients who had Not (Mean(SD)= 3.24(0.54), F= 4.747
- Population/Disease: Patients with or without chronic graft-versus-host disease after allogenic hematopoietic stem cell transplant; n= 55, median age 12 (range 4-23 years)

7- Measure/Groups of patients: Patients classified according the presence of endocrine comorbidity in two groups: Yes (n= 13) or No (n= 42)
- A priori hypotheses: Not detailed
- Were hypotheses confirmed: Not applicable
- Results: ANOVA
Patients who had endocrine comorbidity showed significantly (p<0.05) lower ASKp scores (Mean(SD)= 2.77(1.02) than patients who had Not (Mean(SD)= 3.24(0.54), F= 4.747
- Population/Disease: Patients with or without chronic graft-versus-host disease after allogenic hematopoietic stem cell transplant; n= 55, median age 12 (range 4-23 years)

8- Measure/Groups of patients: Patients classified according the severity chronic graft-versus-host disease (cGVHD) of in two groups: No-cGVHD (n= 36) and Moderate/Severe cGVHD (n= 19)
- A priori hypotheses: Not detailed
- Were hypotheses confirmed: Not applicable
- Results: ANOVA
Patients with No-cGVHD showed significantly (p<0.05) higher ASKp scores (Mean(SD)= 3.26(0.53) than patients with moderate/severe cGVHD (Mean(SD)= 2.88(0.88), F= 4050
- Population/Disease: Patients with or without chronic graft-versus-host disease after allogenic hematopoietic stem cell transplant; n= 55, median age 12 (range 4-23 years)

9- Measure/Groups of patients: Patients classified according the presence of overlap (acute and chronic) cGVHD of in two groups: Yes (n= 9) and No (n= 46)
- A priori hypotheses: Not detailed
- Were hypotheses confirmed: Not applicable
- Results: ANOVA
Patients with overlap cGVHD showed significantly (p<0.05) lower ASKp scores (Mean(SD)= 2.54(0.074) than patients without (Mean(SD)= 3.23(0.64), F= 8.198
- Population/Disease: Patients with or without chronic graft-versus-host disease after allogenic hematopoietic stem cell transplant; n= 55, median age 12 (range 4-23 years)

10- Measure/Groups of patients: Correlation with cGVHD severity 10 point scale made by a clinician vs No-cGVHD
- A priori hypotheses: Not detailed
- Were hypotheses confirmed: Not applicable
- Results: Pearson correlation coefficient
Significant (p<0.01) correlation was found: r= -0.384
- Population/Disease: Patients with or without chronic graft-versus-host disease after allogenic hematopoietic stem cell transplant; n= 55, median age 12 (range 4-23 years)

11- Measure/Groups of patients: Patients classified according the joint involvement in two groups: Yes (n= 9) and No (n= 46)
- A priori hypotheses: Not detailed
- Were hypotheses confirmed: Not applicable
- Results:ANOVA
Patients with joint involvement showed significantly (p<0.05) lower ASKp scores (Mean(SD)= 2.81(0.59) than patients without (Mean(SD)= 3.23(0.69), F= 6.130
- Population/Disease: Patients with or without chronic graft-versus-host disease after allogenic hematopoietic stem cell transplant; n= 55, median age 12 (range 4-23 years)

12- Measure/Groups of patients: Patients classified according the presence of steroid side effects in two groups: Yes (n= 9) and No (n= 46)
- A priori hypotheses: Not detailed
- Were hypotheses confirmed: Not applicable
- Results: ANOVA
Patients with joint involvement showed significantly (p<0.001) lower ASKp scores (Mean(SD)= 2.28(1.14) than patients without (Mean(SD)= 3.28(0.53), F= 17.229
- Population/Disease: Patients with or without chronic graft-versus-host disease after allogenic hematopoietic stem cell transplant; n= 55, median age 12 (range 4-23 years)

13- Measure/Groups of patients: Patients classified according the presence of cGVHD-associated symptoms in two groups: Yes (n= 10) and No (n= 45)
- A priori hypotheses: Not detailed
- Were hypotheses confirmed: Not applicable
- Results: ANOVA
Patients withcGVHD-associated symptoms showed significantly (p<0.01) lower ASKp scores (Mean(SD)= 2.67(0.91) than patients without (Mean(SD)= 3.30(0.53), F= 10.044
- Population/Disease: Patients with or without chronic graft-versus-host disease after allogenic hematopoietic stem cell transplant; n= 55, median age 12 (range 4-23 years)

Evidence of Translatability Assessment: None identified

Evidence related to missing data: None identified

Evidence for Selection of Recall Period: Yes

Evidence of Administration Instructions and Training Provided: None identified

Evidence of concurrent validity: Yes

Evidence of known-groups validity: Yes

Evidence of ability to detect change over time: None identified

Ability to detect change (Responsiveness):

None identified

Evidence of responder thresholds: None identified

Young NL, Yoshida KK, Williams JI. The role of children in reporting their physical disability. Arch Phys Med Rehabil. 1995 Oct;76(10):913-8.
(PubMed Abstract: https://pubmed.ncbi.nlm.nih.gov/7487430/)

Young NL, Williams JI, Yoshida KK. The context of measuring disability: does it matter whether capability or performance is measured? J Clin Epidemiol. 1996 Oct;49(10):1097-101.
(PubMed Abstract: https://pubmed.ncbi.nlm.nih.gov/8826988/)

Young NL, Williams JI, Yoshida KK, Wright JG. Measurement properties of the activities scale for kids. J Clin Epidemiol. 2000 Feb;53(2):125-37.
(Full Text Article: https://pubmed.ncbi.nlm.nih.gov/10729684/)

Wai EK, Owen J, Fehlings D. Assessing physical disability in children with spina bifida and scoliosis. J Pediatr Orthop. 2000 Nov-Dec;20(6):765-70.
(PubMed Abstract: https://pubmed.ncbi.nlm.nih.gov/11097251/)

Plint AC, Gaboury I, Owen J, Young NL. Activities scale for kids: an analysis of Normals. J Pediatr Orthop. 2003 Nov-Dec;23(6):788-90. PMID: 14581784.
(PubMed Abstract: https://pubmed.ncbi.nlm.nih.gov/14581784/)

Young NL, Varni JW, Snider L. The Internet is valid and reliable for child-report: an example using the Activities Scale for Kids (ASK) and the Pediatric Quality of Life Inventory (PedsQL). J Clin Epidemiol. 2009 Mar;62(3):314-20.
(PubMed Abstract https://pubmed.ncbi.nlm.nih.gov/18834710/)

Smith PL, Owen JL, Fehlings D, Wright JG. Measuring physical function in children with spina bifida and dislocated hips: the Spina Bifida Hips Questionnaire. J Pediatr Orthop. 2005 (Pubmed abstract)

Pencharz J, Young NL, Owen JL, Wright JG. Comparison of three outcomes instruments in children. J Pediatr Orthop. 2001 Jul-Aug;21(4):425-32.
(https://pubmed.ncbi.nlm.nih.gov/11433150/)

Lawitschka A, Brunmair M, Bauer D. Psychometric properties of the Activities Scale for Kids-performance after allogeneic hematopoietic stem cell transplantation in adolescents and children : Results of a prospective study on behalf of the German-Austrian-Swiss GVHD Consortium. Wien Klin Wochenschr. 2021 Jan;133(1-2):41-51.
(https://pubmed.ncbi.nlm.nih.gov/32246210/)

Wright JG, Smith PL, Owen JL, Fehlings D. Assessing functional outcomes of children with muscular dystrophy and scoliosis: the Muscular Dystrophy Spine Questionnaire. J Pediatr Orthop. 2008 Dec;28(8):840-5.
(https://pubmed.ncbi.nlm.nih.gov/19034175/)

None identified

Yes

Original language:
English for Canada

Translations:
Portuguese for Portugal
Italian for Italy
Chinese for China

Italian for Italy:
Fabbri L, Neviani R, Festini F, Costi S. Transcultural validation of Activities Scale for Kids (ASK): translation and pilot test. Acta Biomed. 2016 May 26;87 Suppl 2:70-9. PMID: 27240035 (PubMed abstract)
Costi S, Bressi B, Cavuto S, Braglia L, Ferrari A, Pelosin E. Cross-cultural validation of Activities Scale for Kids: the performance of healthy Italian children. J Sports Med Phys Fitness. 2020 Jul;60(7):1014-1019 (PubMed abstract)
Costi S, Mecugni D, Beccani L, Alboresi S, Bressi B, Paltrinieri S, Ferrari A, Pelosin E. Construct Validity of the Activities Scale for Kids Performance in Children with Cerebral Palsy: Brief Report. Dev Neurorehabil. 2020 Oct;23(7):474-477 (Full text article)
Portuguese for Portugal:
Paixão D, Cavalheiro LM, Gonçalves RS, Ferreira PL. Portuguese cultural adaptation and validation of the Activities Scale for Kids (ASK). J Pediatr (Rio J). 2016 Jul-Aug;92(4):367-73 (PubMed abstract)

Dr. Nancy Young
Laurentian University
School of Rural and Northern Health
935 Ramsey Lake Road
Sudbury
ON
Canada
P3E 2C6
Phone: 705.675.1151 ext 4014
E-mail: nyoung@laurentian.ca

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*With the signature of a contract/agreement, please see the different conditions of use on the ASK© website (http://www.activitiesscaleforkids.com/)

ASK© website (http://www.activitiesscaleforkids.com/)

ASK© publications webpage (http://www.activitiesscaleforkids.com/?page_id=210)

List of items available in Young et al. 2000 (https://d1wqtxts1xzle7.cloudfront.net/48847124/s0895-4356_2899_2900113-420160914-6255-1k2yqa8.pdf?1473915123=&response-content-disposition=inline%3B+filename%3DMeasurement_properties_of_the_Activities.pdf&Expires=1613984775&Signature=Aphk1pHkbLzdWKjp7a00UQBSPG~zRP~mx~NXBG6GuBa9kx-cipQ9yQOEm4-Xolid70EuyxOr1tDWBH1EMaQIguony19oWfINlDFEQ-9AmlUDKshYDrGJ3Od2jOeXa3XOmO24Hg~0KGRO3LL5ZYCJ9S~EkcuqwD2BD8Z4BVpogRGqVgWO8SfgiVucSeS76zEcNoeM~F577JZwxNpWLGqNtWtN7fRBSLMIRhdHeTad44IRtNDKYhJHq9qF3OkBf45oiU02NfKDyEmBtakfNsopNygi-5x~i1PeYUEVj7jz2OJiLVkgdqH2G2Yaz4uJwm6-tN7a-i9eLemC0R0QgEsIBg__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA)