Timed Up and Go Test (TUG)

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Objective[edit | edit source]

Nursing Home.jpg

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[1].
  • 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.[2]

Intended Population[edit | edit source]

Materials Needed[edit | edit source]

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

Method[edit | edit source]

  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[edit | edit source]

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[3].

Cut-off time for high risk of falls[edit | edit source]

An older adult who takes ≥12 seconds to complete the TUG is at risk for falling.[3]

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[4]

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[edit | edit source]

Hip Osteoarthritis:

Total Knee Arthroplasty:

Total Hip Replacement:

Alzheimer's Disease:

Parkinson's Disease:

  • High test-retest reliability in patients with Parkinson's Disease (ICC= 0.80).[9] Furthermore, a later study found excellent test-retest reliability (r=0.97).[10]
  • TUG can be used to assess differences in the Parkinson's and non Parkinson's populations. [11]
  • A strong correlation between longer times to complete the TUG and falls in patients with Parkinson's Disease. Furthermore, a modified version of the TUG (TUG-Cognitive) appeared to show the most promising results in predicting falls in patients with Parkinson's Disease. [12]
  • In patients with Parkinson's the MDC was 3.5 seconds[13]

Elderly population:

  • Intratester and intertester reliability (ICC) have been reported as high, in elderly populations, from (0.92-0.99).[14]
  • Reliability in community-dwelling populations has been found to be moderate (0.56).[14]
  • Correlation between TUG scores and 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).[14]
  • TUG has a reported sensitivity and specificity of 87% in the elderly population. [15]

Benefits[edit | edit source]

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

Negatives[edit | edit source]

  • Unable to predict falls in the community[16]
  • Test re-test user error can be high
  • Turning is only assessed in the patient's preferred direction [10]

TUG Manual and TUG Cognitive[edit | edit source]

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". [12]

  • TUG Manual: Carrying a class of water in one hand while completing the TUG. Low sensitivity of 29% and moderate specificity 68%.[12]
  • 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. [12]

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:[12]

  • 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[17].

References[edit | edit source]

  1. ↑ Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Physical therapy. 2000 Sep 1;80(9):896-903.Available from:https://academic.oup.com/ptj/article/80/9/896/2842520 (last accessed 16.10.2020)
  2. ↑ Ascencio EJ, Cieza-Gómez GD, Carrillo-Larco RM, Ortiz PJ. Timed up and go test predicts mortality in older adults in Peru: a population-based cohort study. BMC geriatrics. 2022 Dec;22(1):1-3.
  3. ↑ 3.0 3.1 CDC govt. TUG Available from:https://www.cdc.gov/steadi/pdf/TUG_Test-print.pdf (last accessed 16.10.2020)
  4. ↑ SR ability lab TUG Available from:https://www.sralab.org/rehabilitation-measures/timed-and-go (last accessed 16.10.2020)
  5. ↑ Wright AA, Cook CE, Baxter GD, Dockerty JD, Abbott JH. A comparison of 3 methodological approaches to defining major clinically important improvement of 4 performance measures in patients with hip osteoarthritis. The Journal of Orthopaedic and Sports Physical Therapy/Journal of Orthopaedic and Sports Physical Therapy [Internet]. 2011 May 1;41(5):319–27.
  6. ↑ Yuksel E, Kalkan S, Cekmece S, Unver B, Karatosun V. Assessing minimal detectable changes and Test-Retest reliability of the Timed up and Go Test and the 2-Minute Walk test in patients with total knee arthroplasty. The Journal of Arthroplasty/The Journal of Arthroplasty [Internet]. 2017 Feb 1;32(2):426–30.
  7. ↑ Yuksel E, Unver B, Kalkan S, Karatosun V. Reliability and minimal detectable change of the 2-minute walk test and Timed Up and Go test in patients with total hip arthroplasty. Hip International/Hip International [Internet]. 2020 Jan 13;31(1):43–9.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ 10.0 10.1 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
  11. ↑ 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.
  12. ↑ 12.0 12.1 12.2 12.3 12.4 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 [Internet]. 2015 Jan 1;95(1):95–102.
  13. ↑ 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
  14. ↑ 14.0 14.1 14.2 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.
  15. ↑ 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.
  16. ↑ 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.
  17. ↑ Almajid R, Tucker C, Wright WG, Vasudevan E, Keshner E. Visual dependence affects the motor behavior of older adults during the Timed Up and Go (TUG) test. Archives of gerontology and geriatrics. 2020 Mar 1;87:104004.
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