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. 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. 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