Assessing limb apraxia after ischemic stroke: validation of the Chinese version of the diagnostic instrument for limb apraxia-short version (DILA-S) classic subtests

This study aimed to translate and validate the Chinese version of the Diagnostic Instrument for Limb Apraxia-Short Version (DILA-S) classic subtests in Chinese patients after ischemic stroke.
The DILA-S was translated and adapted for use in Mandarin-speaking Chinese patients. Internal consistency, test-retest reliability, dimensionality, convergent validity, divergent validity, and concurrent validity were tested.
A total of 112 ischemic stroke patients were included. The internal consistency (Cronbach’s alpha 0.85 ~ 0.92) and test-retest reliability (ICC 0.88 ~ 0.93) were found satisfactory. Exploratory factor analysis obtained two factors for the imitation subtests and the execution scale of the pantomime of tool use. Convergent validity was supported by strong correlations (ρ > 0.7) between the scores of the DILA-S subtests and the LOTCA motor praxis subscale. Divergent validity was acceptable for weak to moderate correlations (ρ ranged from −0.25~ −0.41) between the scores of the DILA-S subtests and the NIHSS. Concurrent validity was supported by strong correlations (ρ > 0.7) between the scores of the DILA-S subtests and the MoCA, as well as strong correlations (ρ > 0.6 < 0.7) between the scores of the DILA-S subtests and the BI.
The Chinese version of the DILA-S classic subtests demonstrated satisfactory psychometric properties for assessing limb apraxia in Chinese patients after ischemic stroke.

本研究旨在针对缺血性脑卒中后中国患者，翻译并验证肢体失用症诊断简版量表（Diagnostic Instrument for Limb Apraxia-Short Version, DILA-S）经典子量表的中文版。
该量表已完成汉化适配，适用于汉语普通话使用者群体的卒中患者。本研究对其内部一致性、重测信度、维度结构、聚合效度、区分效度与同时效度进行了检验。
本研究共纳入112例缺血性脑卒中患者。结果显示，该量表的内部一致性（Cronbach’s α系数为0.85~0.92）与重测信度（组内相关系数ICC为0.88~0.93）均表现良好。
探索性因素分析结果显示，该量表可提取出两个维度，分别对应模仿子测验与工具使用手势模仿执行量表。
聚合效度方面，DILA-S各子量表得分与洛文斯顿认知评定量表（Loewenstein Occupational Therapy Cognitive Assessment, LOTCA）运动失用子量表得分呈强相关（ρ>0.7），验证了该量表的聚合效度。
区分效度方面，DILA-S各子量表得分与美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）得分呈弱至中度相关（ρ范围为-0.25~-0.41），符合区分效度的要求。
同时效度方面，DILA-S各子量表得分与蒙特利尔认知评估量表（Montreal Cognitive Assessment, MoCA）得分呈强相关（ρ>0.7），与巴氏指数（Barthel Index, BI）得分亦呈强相关（ρ>0.6且<0.7），验证了该量表的同时效度。
综上，肢体失用症诊断简版量表经典子量表的中文版具备良好的心理测量学特性，可用于评估中国缺血性脑卒中患者的肢体失用症状。