Timed Up and Go Test (TUG)

Original Editor - David Csepe

Top Contributors - David Csepe, Siobhán Cullen, Kim Jackson, Wendy Walker and Laura Ritchie

Objective

To determine fall risk and measure the progress of balance, sit to stand and walking.

Intended Population

This test was initially designed for elderly persons, but is used for people with:

  • Parkinson's - This tool is validated for a population with Parkinson’s Disease.
  • Following a CVA
  • Following routine orthopaedic surgery i.e. TKR or THR
  • and others conditions

Method of Use

Materials Needed:

One chair with armrest

Stopwatch

Tape (to mark 3 meters)

Method:

  1. The patient starts in a seated position
  2. The patient stands up upon therapist’s command: walks 3 meters, turns around, walks back to the chair and sits down.
  3. The time stops when the patient is seated.
  4. The subject is allowed to use an assistive device. Be sure to document the assistive device used.

NOTE:

A practice trial should be completed before the timed trial

Cut-off time for high risk of falls:

Cut-off times to classify subjects as high risk for falling vary based on the study and participants.

If a patient took 14 seconds or longer he or she was classified as high-risk for falling.[1]

The TUG cut off scores can range from 8 – 11.5 seconds (in populations with Parkinson’s looking to identify disability) to 13.5 seconds (older community dwellers) or 15 secs (if already falling or with dual task). Optionally you can view this website: Shirley Ryan measurement database and references for clinimetrics


Example score sheet TUG score sheet

Evidence

Reliability

Intratester and intertester reliability (ICC) have been reported as high, in elderly populations, from .92-.99.[2]

However, reliability in community-dwelling populations has been found to be moderate (.56).[2]

In people with Alzheimers disease reliability is high (ICC = .985-.988).[3]

An ICC of 0.80 for subjects with Parkinson's was found[4] and excellent (0.95) ICC and excellent reliability in another study[5]. Test retest [6]and the interrator reliability are both high, the TUG can be used to assess differences in the Parkinson's and non-PD populations. [7]

Validity

Construct validity has been shown by correlating TUG scores with gait speed (Pearson r = .75), postural sway (Pearson r = -.48), step length (Pearson r = -.74), Barthel Index (Pearson r = -.79), and step frequency (Pearson r = -.59).[2]

Sensitivity and Specificity

The sensitivity and specificity have been reported to be 87%[1].

Moderate sensitivity in predicting falls in PD, so in isolation it might not be enough to predict falls in this population [8]

Minimally Detectable Change (MDC)

MDC is "the smallest amount of difference in individual scores that represents true change (beyond random measurement error)". [6]

The MDC was 4.09 seconds in patients with Alzheimers.

In patients with Parkinson's the MDC was 3.5 seconds[6]

One study aimed to calculate the minimal detectable change (MDC) for a range of measures used in amputee rehab. The MDC was presented in absolute values for:[9]

Benefits

  • Quick to conduct
  • Minimal equipment required
  • Highly reliable and valid
  • Provides useful outcomes related to reduced falls risk

Negatives

  • Unable to predict falls in the community[10]
  • Test re-test user error can be high
  • Turning is only assessed in the patient's preferred direction [5]

TUG Manual and TUG Cognitive

Previous studies have shown that people with Parkinson's can show gait changes like a decrease in walking speed, step length and pattern. These changes are due to a decrease in automaticity and attentional flexibility. People with Parkinson's are at a higher risk for falls because when performing dual tasks they "prioritize concurrent tasks over postural tasks". [8]

TUG Manual: Carrying a class of water in one hand while completing the TUG. Low sensitivity of 29% and moderate specificity 68%.[8]

TUG Cognitive: Counting backwards in threes from a random start point while completing the TUG. Sensitivity of 76.5% and specificity (73.7%). It had a moderate accuracy, so it is not recommended as a sole test for fall. The TUG Cognitive was shown to more discriminative than the TUG or TUG Manual. [8]

In a retrospective study of 36 participants with PD, participant who reported falls int he last 6 months were compared to participants who reported no falls. In this study the optimal cut off times to discriminate between fallers and non fallers with Parkinson's were as follows:[8]

TUG: 12 seconds

TUG Cognitive: 14.7 seconds

TUG Manual: 13.2 seconds

References

  1. 1.0 1.1 Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the timed up & go test. Phys Ther. 2000;80(9):896-903.
  2. 2.0 2.1 2.2 Steffen T, Hacker T, Mollinger L. Age- and gender-related test performance in community-dwelling elderly people: six-minute walk test, berg balance scale, timed up go test, and gait speeds. Phys Ther. 2002;82(2):128-137.
  3. Ries J, Echternach J, Nof L, Blodgett M. Test-retest reliability and minimal detectable change scores for the timed "up go" test, the six-minute walk test, and gait speed in people with alzheimer disease. Phys Ther. 2009;89(6):569-579.
  4. Huang S, Hsieh C, Wu R, Tai C, Lin C, Lu W. Minimal detectable change of the timed "up go" test and the dynamic gait index in people with parkinson disease. Phys Ther. 2011;91(1):114-121.
  5. 5.0 5.1 Haas B, Clarke E, Elver L, Gowman E, Mortimer E, Byrd E. The reliability and validity of the L-test in people with Parkinson’s disease. Physiotherapy. 2017 Dec 5.https://www.physiotherapyjournal.com/article/S0031-9406(17)30338-3/fulltext
  6. 6.0 6.1 6.2 Huang SL, Hsieh CL, Wu RM, Tai CH, Lin CH, Lu WS. Minimal detectable change of the timed “up & go” test and the dynamic gait index in people with Parkinson disease. Physical Therapy. 2011 Jan 1;91(1):114-21. https://www.ncbi.nlm.nih.gov/pubmed/20947672
  7. Morris S, Morris ME, Iansek R. Reliability of measurements obtained with the Timed “Up & Go” test in people with Parkinson disease. Physical therapy. 2001 Feb 1;81(2):810-8.
  8. 8.0 8.1 8.2 8.3 8.4 Vance RC, Healy DG, Galvin R, French HP. Dual tasking with the timed “up & go” test improves detection of risk of falls in people with Parkinson disease. Physical therapy. 2015 Jan 1;95(1):95-102. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.883.6123&rep=rep1&type=pdf
  9. Resnik L, Borgia M. Reliability of outcome measures for people with lower-limb amputations: distinguishing true change from statistical error. Physical therapy. 2011 Apr 1;91(4):555-65.
  10. Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC geriatrics. 2014 Dec;14(1):14.