Timed Up and Go Test (TUG)

Original Editor - David Csepe

Top Contributors - David Csepe, Kim Jackson, Siobhán Cullen, Admin, Lucinda hampton, Tarina van der Stockt, Abbey Wright, Laura Ritchie, Wendy Walker, Scott Buxton, Sheik Abdul Khadir, WikiSysop, Shaimaa Eldib, Lauren Lopez, Stacy Schiurring, Evan Thomas, Naomi O'Reilly, Kai A. Sigel, Karen Wilson, 127.0.0.1, Vidya Acharya and Tony Lowe

Objective

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

• Simple screening test that is a sensitive and specific measure of probability for falls among older adults.
• A recent study published in 2022 found that the TUG test is a strong mortality predictor, displacing other established risk factors such as chronic diseases in geriatric populations of low and middle income countries.

Intended Population

• This test was initially designed for elderly persons, but is used for in other populations eg Parkinson's - This tool is validated for a population with Parkinson’s Disease; Multiple Sclerosis; Hip fracture; Alzheimers; CVA; TKR or THR; Huntington Disease
• It is one of the 4 tests used in the The Balance Outcome Measure for Elder Rehabilitation (BOOMER)

Materials Needed

• One chair with armrest
• Stopwatch
• Tape (to mark 3 meters)

Method

1. Patients wear their regular footwear and can use a walking aid, if needed.
2. The patient starts in a seated position
3. The patient stands up upon therapist’s command: walks 3 meters, turns around, walks back to the chair and sits down.
4. The time stops when the patient is seated.
5. Be sure to document the assistive device used.

Note: A practice trial should be completed before the timed trial

Observations

Observe the patient’s postural stability, gait, stride length, and sway.

• Note all that apply: Slow tentative pace; Loss of balance; Short strides; Little or no arm swing; Steadying self on walls; Shuffling; En bloc turning; Not using assistive device properly.
• These changes may signify neurological problems that require further evaluation.

Cut-off time for high risk of falls

An older adult who takes ≥12 seconds to complete the TUG is at risk for falling.

Cut of scores indicating risk of falls by Population (in seconds)

• Community dwelling adults - 13.5
• Older stroke patients - 14
• Frail elderly - 32.6
• LE amputees - 19
• PD - 11.5
• Hip OA - 10 -
• Vestibular disorders - 11.1

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

Example score sheet TUG score sheet

Evidence

Reliability

• Intratester and intertester reliability (ICC) have been reported as high, in elderly populations, from .92-.99.
• Reliability in community-dwelling populations has been found to be moderate (.56).
• In people with Alzheimers disease reliability is high (ICC = .985-.988).
• An ICC of 0.80 for subjects with Parkinson's was found and excellent (0.95) ICC and excellent reliability in another study. Test retest and the interrator reliability are both high, the TUG can be used to assess differences in the Parkinson's and non Parkinson's populations.

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).

Sensitivity and Specificity

• The sensitivity and specificity have been reported to be 87%.
• Moderate sensitivity in predicting falls in PD, so in isolation it might not be enough to predict falls in this population

Minimally Detectable Change (MDC)

• MDC is "the smallest amount of difference in individual scores that represents true change (beyond random measurement error)".
• The MDC was 4.09 seconds in patients with Alzheimers.
• In patients with Parkinson's the MDC was 3.5 seconds

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
• Test re-test user error can be high
• Turning is only assessed in the patient's preferred direction

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".

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

In a retrospective study of 36 participants with PD, participant who reported falls in the 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:

• TUG: 12 seconds
• TUG Cognitive: 14.7 seconds
• TUG Manual: 13.2 seconds

A cross-sectional quantitative study investigating the effects of age-related visual dependence on motor performances (turning cadence; gait speed) under increased attention demands by adding a motor task and visual stimulus to the Timed Up and Go (TUG) test sub-components demonstrated significant performance differences in the TUG test tasks due to age and visual dependence.