Timed Up and Go Test (TUG)

Original Editor - David Csepe

Top Contributors - David Csepe, Siobhán Cullen, Wendy Walker, Laura Ritchie and Scott Buxton

Objective

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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 Parkinsons, Multiple Sclerosis, hip fracture, Alzheimer, CVA, Huntington Disease and others.

Method of Use

Materials Needed: one chair with armrest, stopwatch, tape (to mark 3 meters).

The patient starts in a seated position.

The patient stands up upon therapist’s command walks 3 meters, turns around, walks back to the chair and sits down.

The time stops when the patient is seated.

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. By using regression analysis Shumway-Cook used 14 seconds as the cut-off.[1] Thus, if a subject took 14 seconds or longer he or she was classified as high-risk for falling.[1]


Example score sheet TUG score sheet

[2]

Evidence

Reliability

Intratester and intertester reliability have been reported as high in elderly populations, from .92-.99.[3] However, reliability in community-dwelling populations has been found to be moderate (.56).[3] In people with Alzheimers disease reliability is high (ICC = .985-.988).[4] A study by Huang et al[5] reported an ICC of 0.80 for subjects with Parkinson's Disease.

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).[3]

Sensitivity and Specificity

The sensitivity and specificity have been reported to be 87% each in a study by Shumway-Cook et al in 2000.

Minimally Detectable Change

The MDC was 4.09 seconds in patients with Alzheimers. In patients with Parkinson's the MDC was 3.5 seconds.

A study published in 2011 by Resnik et al[6] 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:

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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. Physiotutors. The Timed Up and Go Test (TUG) | Fall Risk Assessment. Available from: https://www.youtube.com/watch?v=grrYoBucNPE
  3. 3.0 3.1 3.2 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.
  4. 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.
  5. 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.
  6. Resnik, L. and Borgia, M., (2011). Reliability of outcome measures for people with lower-limbfckLRamputations: distinguishing true change from statistical error. Physical Therapy, 91(4), pp. 555-565.