Background: Upper limb apraxia (ULA) is a neurological syndrome characterized by the inability to perform purposeful movements. ULA could impact individuals’ perceptions, including perceived self-efficacy. The aim of this study is to investigate whether ULA is related to general self-efficacy and self-efficacy for managing symptoms in post-stroke patients. Methods: A cross-sectional study was conducted involving 82 post-stroke patients. Regression analyses were implemented using a stepwise model including seven dimensions of ULA: imitation (non-symbolic, intransitive, and transitive), pantomime (non-symbolic, intransitive, and transitive), and dimension of apraxic performance in activities of daily living. These dimensions were independent variables, while general self-efficacy and symptom management self-efficacy dimensions were dependent variables. Results: The findings revealed that intransitive imitation accounted for 14% of the variance in general self-efficacy and 10% of self-efficacy for managing emotional symptoms. Transitive imitation explained 10% of the variance in self-efficacy for managing global symptoms and 5% for social–home integration symptoms. The combination of intransitive imitation, non-symbolic pantomime, and alterations in activities of daily living performance associated with ULA explained 24% of the variance in cognitive self-efficacy. Conclusions: Hence, ULA dimensions seem to be related to the levels of general perceived self-efficacy and self-efficacy for managing symptoms among post-stroke patients.

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.

Importance: Poststroke, patients often experience decreased role participation, partially because of cognitive impairment. However, the potential relationship between upper limb apraxia (ULA), a cognitive dysfunction, and role participation remains unclear. Objective: To evaluate whether ULA is related to role participation among patients with mild to moderate stroke. Design: Cross-sectional study. Setting: Randomly selected Spanish public primary care centers. Participants: One hundred fifty-three patients with mild to moderate poststroke. Outcomes and Measures: Role participation was assessed with the Role Checklist; ULA, with the TULIA Apraxia test and the ADL Observations scale. ULA construct included the components of nonsymbolic imitation, intransitive imitation, transitive imitation, nonsymbolic pantomime, intransitive pantomime, transitive pantomime, and praxis function in daily life activities. Regression analyses were conducted to assess the potential relationship between ULA and role participation. Results: Transitive pantomime explained 20.5% of the variance of the current level of role participation, R2 = .205, F(3, 152) = 12.795, p < .001. Nonsymbolic imitation and transitive imitation explained 15.8% of the variance in changes in role participation after stroke, R2 = .158, F(4, 152) = 6.957, p < .001. Intransitive pantomime accounted for 17.8% of the variance in expectations for future role participation, R2 = .178, F(3, 152) = 10.776, p < .001. Nonsymbolic imitation and intransitive pantomime explained 16.2% of the variance of the assigned value to role participation, R2 = .162, F(4, 152) = 7.170, p < .01. Conclusions and Relevance: ULA is related to role participation after mild to moderate stroke. These findings serve as the foundation for designing and developing novel clinical interventions in occupational therapy. Plain-Language Summary: After a stroke, patients often experience difficulties participating in roles that provide a sense of purpose in daily activities. This decrease in participation is partly because of cognitive factors. Upper limb apraxia (ULA) is a cognitive sequela of stroke that hinders the ability to perform deliberate and essential movements. ULA can affect daily life by posing challenges in the execution of daily tasks and activities, which can affect a person’s independence, participation, and community reintegration. Because ULA is a cognitive dysfunction that affects intentional movements, this study investigated the potential relationship between ULA and role participation. Based on the evaluation of 153 patients with mild to moderate poststroke, the results revealed that ULA is associated with role participation after a stroke. These findings serve as the foundation for occupational therapists to design and develop novel clinical interventions.

Objective: To cross-cultural adapt the ADL Observation Scale and evaluate its psychometric properties in a sample of Spanish-speaking patients with stroke. Methods: A validation study that included cross-cultural adaptation, structural validity assessment, reliability, and diagnostic accuracy analysis. The study followed COSMIN and STARD criteria. Translation and cross-cultural adaptation of the ADL Observation Scale followed a backward translation process. Structural validity was assessed with confirmatory factor analysis, and internal consistency was analyzed using Cronbach’s alpha and McDonald’s omega coefficient. Cut-off points were estimated using ROC analysis, and diagnostic accuracy was evaluated using sensitivity, specificity, and positive and negative predictive values. Internal consistency, cut-off points, and diagnostic accuracy were calculated for two different age groups (≥65 years; > 65 years). Results: The Spanish version of the ADL Observation Scale was obtained after cross-cultural adaptation. The psychometric properties were tested in a sample of 180 patients with stroke. Structural validity showed a four-factor structure of the scale (RMSEA = 0.078; CFI = 0.952; TLI = 0.934). Internal consistency for each factor indicated Omega values between 0.641, 95% CI [0.495, 0.753], and 0.915, 95% CI [0.882, 0.936]. Cut-off points, also calculated for each factor, ranged from ≥1 to ≥4 points. Sensitivity, specificity, and positive and negative predictive values showed high values, indicating the scale’s discriminatory capacity for correctly classifying patients with praxis deficits. Conclusion: The ADL Observation Scale has a four-factor structure, and it is a reliable instrument for evaluating the levels of praxis function in daily living among Spanish-speaking patients with stroke. The scale also has adequate diagnostic accuracy in detecting patients with praxis deficits.

Background: The Role Checklist is broadly used to assess perceived role participation. Although stroke survivors often experience decreased participation, its reliability has not been evaluated for Spanish-speaking individuals with stroke. Objective: To evaluate the psychometric properties of the Role Checklist in Spanish-speaking individuals with stroke. Design: Validation study. Setting: Randomly selected public primary care centres. Participants: 179 participants with stroke. Outcome measures: Internal consistency was analysed using Cronbach’s alpha and item-total correlations. Test–retest and inter-rater reliability were evaluated with the intraclass correlation coefficient (ICC). Measurement precision was examined by calculating the SE of measurement (SEM) and the minimum detectable change (MDC) 95% CI. Floor and ceiling effects were assessed by calculating the proportion of participants who achieved the minimum and maximum possible scores. Results: The ‘role participation’ subscale showed a Cronbach’s alpha of 0.73 (95% CI 0.57 to 0.74) and the ‘assigned value’ subscale of 0.45 (95% CI 0.33 to 0.57). All item-total correlations for the items within the ‘assigned value’ subscale were significant. Test–retest analysis showed ICC values >0.84, and inter-rater reliability showed ICC values >0.99 for role participation and assigned value. The SEM estimates were 1.43 for the role participation subscale and 0.88 for the value attributed to the total number of roles subscale. MDC ₉₅ values were 3.96 and 2.43 for these subscales, respectively. No floor or ceiling effects were observed. Conclusion: The Role Checklist exhibited acceptable internal consistency, temporal stability and interobserver reliability.