Reliability and Optimal Cut-Off Points of the Test for Upper Limb Apraxia (TULIA) for Spanish Speaking Post-Stroke Patients Sánchez Bermejo, Laura Milla Ortega, Pedro Jesús Pérez Mármol, José Manuel Apraxia Stroke Psychometrics This work was supported by Fundación Progreso y Salud. Consejería de Salud y Consumo. Junta de Andalucía. FPS 2020 - “Proyectos de I+i en Atención Primaria, Hospitales Comarcales y Centros Hospitalarios de Alta Resolución del Sistema Sanitario Público de Andalucía (CHARES)”. Reference number: AP-0325-2022. 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. 2026-01-08T12:02:23Z 2026-01-08T12:02:23Z 2025-02-28 journal article Published version: Sánchez-Bermejo L, Milla-Ortega PJ, Pérez-Mármol JM. Reliability and Optimal Cut-Off Points of the Test for Upper Limb Apraxia (TULIA) for Spanish-Speaking Post-Stroke Patients. Clin Rehabil. 2025 Feb;39(2):202-213. doi: 10.1177/02692155241305250. 0269-2155 1477-0873 https://hdl.handle.net/10481/109326 10.1177/02692155241305250 eng http://creativecommons.org/licenses/by-nc-nd/4.0/ open access Attribution-NonCommercial-NoDerivatives 4.0 Internacional Sage Journals