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Reliability and Optimal Cut-Off Points of the Test for Upper Limb Apraxia (TULIA) for Spanish-Speaking Post-Stroke
Laura Sánchez-Bermejo1,2, Pedro Jesús Milla-Ortega1,3, José Manuel Pérez-Mármol1,2
1Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
Objective:
To evaluate the reliability, identify the optimal cut-off points, and determine the diagnostic accuracy of the TULIA Apraxia test in a sample of Spanish-speaking post-stroke patients.
Design:
Cross-sectional.
Setting:
Public primary care.
Participants:
201 post-stroke patients.
Main Measures:
Reliability was assessed using Cronbach's alpha. Cut-off points were identified for each TULIA Apraxia sub-test and stratified for age (≤65 years, > 65 years) using ROC curve analysis, area under the curve, and Youden index. Diagnostic accuracy was evaluated using sensitivity, specificity, and predictive values.
Results:
Cronbach's alpha of the sub-tests varied from 0.716 (95% CI 0.653-0.772) for pantomime intransitive to 0.824 (95% CI 0.784-0.858) for imitation non-symbolic. Cut-off points ranged from ≤25 to ≤35 points. For individuals aged ≤65 years, the cut-offs that best balanced sensitivity and specificity were ≤25 points for detecting alterations in imitation transitive and ≤33 points for pantomime non-symbolic. For individuals over 65 years, the imitation transitive cut-off (≤26 points) presented the most adjusted balance. The minimum positive predictive value was 0.667 (95% CI 0.542-0.777), indicating that the TULIA Apraxia tests correctly classified more than 67% of patients with apraxia. The minimum negative predictive value was 0.763 (95% CI 0.644-0.859), showing that the test accurately identified more than 76% of patients without apraxia.
Conclusions:
The TULIA Apraxia test is reliable in Spanish-speaking post-stroke patients. Optimal cut-off points, along with their respective sensitivity and specificity values, exhibit adequate test accuracy. Predictive values indicate that the test correctly identifies individuals with and without apraxia.
