The Dutch Activity Card Sort institutional version was reproducible, but biased against women

PURPOSE: To examine the reproducibility of the institutional version of the Dutch Activity Card Sort (ACS-NL) and the possible presence of gender bias. METHODS: Older rehabilitation inpatients (N = 52) were included. Intra- and inter-rater agreement for the ACS-NL total and subscale scores was examined by intraclass correlations (ICC), and agreement of individual items by the κ coefficient (k). Gender bias was examined by the proportion of men and women selecting an ACS item. RESULTS: ICC for inter-rater agreement of the ACS total score ranged between 0.78 and 0.87, ICC for intra-rater agreement ranged between 0.79 and 0.89. Median inter-rater κ for ACS-NL items was 0.72 (interquartile scores; 0.62-0.80). The inter-rater agreement (k = 0.43) and intra-rater agreement (k = 0.39) for the five most important activities was lower. Twenty ACS activities favoured men and seven activities favoured women. As a result, men scored systematically higher on the ACS-NL than women. Logistic regression analysis correcting for activity engagement level confirmed our findings. CONCLUSIONS: The reproducibility of the ACS-NL was high. The ACS-NL institutional version score may be biased in favour of men.