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Timed Up and Go (TUG)

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General Description

Purpose
The original purpose of the TUG was to test basic mobility skills of frail elderly persons. The test has been used in other populations, including people with arthritis, stroke, and vertigo1.

Content
Measurement of the time in seconds for a person to rise from sitting from a standard arm chair, walk 3 meters, turn, walk back to the chair, and sit down. The person wears regular footwear and customary walking aid.

Developer/Contact Information
The TUG was adapted by Podsiadlo and Richardson2 from the Get Up and Go Test of Mathias et al3.

Versions
The original Get Up and Go Test3 used an ordinal scoring system based on the observer's assessment of a person's risk of falling. The TUG2 uses time in seconds.

Number of Items in Scale
Not applicable.

Subscales
Not applicable.

Populations
The TUG was developed in frail elderly adults 60-90 years of age referred to a geriatric hospital, and it targets community dwelling frail elders.

Other Uses
The TUG has been used in other conditions, including arthritis, stroke, and vertigo1. The TUG was not useful with cognitively impaired frail elderly people because 35.5% of the group were physically unable to perform the test4.

WHO ICF Components

Changing and maintaining body position (d410-d429) and walking (d450).

Administration

Method
Easily administered physical performance test with single tester.

Training
None required.

Time to Administer / Complete
15 minutes or less.

Equipment Needed
Arm chair with a seat height of approximately 46 centimeters and arm height of 65 centimeters; 3 meter walkway; stopwatch or wrist watch with a second hand.

Availability / Cost
Readily available and inexpensive.

PDF of TUG
Click here for a PDF of the TUG.

Scoring

Responses
Scale. Not applicable. Score range. Not applicable.

Interpretation of Scores
A cut-off score of ≥ 13.5 seconds was shown to predict falls in community-dwelling frail elders, but this score is not verified in other studies4. Scores of ≥ 30 seconds correspond with functional dependence in people with pathology2. Standardized cut-off scores to predict risk of falling have not yet been established.

Method of Scoring
Time in seconds.

Time to Score
Same as time of test.

Training to Score
None required.

Training to Interpret
None required.

Norms Available
No formal normal values are available. Healthy adults over 79 years old took 7-10 seconds2; frail elderly subjects took 10-240 seconds to perform, with 45 out of 57 subjects performing the test in less than 40 seconds2; all healthy community dwelling subjects 65-84 years of age performed the test in < 20="" seconds="" without="" an="" assistive="">5. In a meta-analysis of 21 studies reporting TUG times in healthy older adults, the mean times progressively increased with age with 8.1 seconds (95% confidence interval = 7.1-9.0) among 60 to 69 year olds, 9.2 seconds (95% CI = 8.2-10.2) among 70-79 year olds, and 11.3 seconds (95% CI = 10.0-12.7) among 80-99 year olds6.

Psychometric Information

Reliability
Inter-rater reliability is high with a same day, three-rater intra-class correlation coefficient (ICC) of 0.992. The ICC was 0.97 in another study of inter-rater reliability among 3 physiotherapists7. The inter-rater reliability was an ICC of 0.99 for a physical therapist, physician, and patient attendant on consecutive visits, and the consecutive intra-rater reliability was an ICC of 0.99. In another study of intra-session, test-retest reliability, the ICC (model 2, 1) was 0.978. Intra-rater reliability over longer periods (up to 132 days) is not as high with a reliability of 0.749. Test-retest (2-7 days) standard error of measurement has been measured as 1 second7.

Validity
Criterion. Moderate to high correlations have been observed with scores on Berg Balance Scale2, 10, gait speed2, 11, 12, stair climbing13, and the Barthel Index of Activities of Daily Living Scale2, 7. TUG scores of greater than 10 seconds were predictive of near-falls in older adults with hip osteoarthritis (Odds ratio 3.1, 95% confidence intervals 1.0-9.9)14

Construct. Validity has been determined by examining differences in scores for patients who were independent and dependent in basic transfers. All subjects who completed the TUG in < 20="" seconds="" were="" independent="" in="" transfers.="" subjects="" requiring="" ≥="" 30="" seconds="" were="">2. The TUG scores for community-dwelling subjects (65 - 95 years old) with a history of falling were slower than for people with no history of falling14, 15. Using logistic regression, sensitivity of the TUG to predict falls using a cut-off score of ≥ 13.5 seconds was 0.80 with a specificity of 1.004. TUG scores correlate with mobility and strength complaints15, 16. The TUG is capable of discriminating people at risk of falling from healthy elderly subjects and young control subjects17. In elderly Mexican-American women, those with the best and worst performance on the TUG were more likely to fall than those with moderate performance18.

Responsiveness/sensitivity to change
TUG scores changed following a quadriceps and hamstrings strengthening program for patients with rheumatoid arthritis compared with subjects who received no strengthening19. A small effect size (ES = 0.33, SRM = 0.35) was reported for persons with knee osteoarthritis who had received physical therapy (French)21. The timed test would be more sensitive to change than ordinal measures. Minimum clinically important differences (MCID) or clinically meaningful change of the TUG was established by comparing baseline and 9 weeks scores of 65 people with osteoarthritis who were undergoing physical therapy. A reduction in time greater than or equal to 0.8, 1.4 and 1.2 seconds on the TUG was determined to be the MCID22.

Comments and Critique

Performance on the TUG is related to multiple factors. A history of arthritis increases the risk of falling as measured by balance tests such as the TUG19. As a test of balance, the TUG may be most useful for patients with rheumatoid arthritis in functional class IV7. Scores differed based on type of footwear worn. They were longest with dress shoes and shortest with walking shoes23. Cognitively impaired subjects took longer to perform the TUG than unimpaired subjects4. Chair type (standard arm chair, armless chair and easy chair) does not affect speeds1. There is a tendency for TUG times to increase with age8. Including a cognitive or manual task concurrent with the TUG increased the times. Sensitivity for predicting falls was 0.80 and specificity was 0.934. The use of an assistive device increased the TUG times4. A cane increased the time the least, followed by a rolling walker and then a pick up walker5. Female candidates for hip or knee arthroplasty took 2.2 times longer than healthy controls; male candidates took 1.9 times as long24. The TUG measures limited aspects of balance (rising, walking, turning, and sitting).

References

  1. Eekhoof JAH, DeBock GH, Schaapveld K, Springer MP. Short report: functional mobility assessment at home. Timed up and go test using three different chairs. Can Fam Physician 2001; 47:1205-7.
  2. Podsiadlo D, Richardson S. The Timed Up & Go: A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39:142-8.
  3. Mathias S, Nayak USL, Isaacs B. Balance in the elderly patient: The "Get-up and Go" test. Arch Phys Med Rehabil 1986; 67:387-89.
  4. Rockwood K, Awalt E, Carver D, MacKnight C. Feasibility and measurement properties of the functional reacn and the timed up and go tests in the Canadian study of health and aging. J Gerontol A Biol Med Sci 2000; 55A:M70-3.
  5. Medley A, Thompson M. The effect of assistive devices on the performance of community dwelling elderly on the timed up and go test. Issues Aging 1997; 20:3-7.
  6. Bohannon RW. Reference values for the timed up and go test: a descriptive meta-analysis. J Geriatr Phys Ther 2006; 29:64-8.
  7. Nore'n AM, Bogren U, Bolin J, Stenstrom C. Balance assessment in patients with peripheral arthritis: Applicability and reliability of some clinical assessments. Physiother Res Int 2001; 6:193-204.
  8. Steffen TM, Hacker TA, 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; 82:128-37.
  9. Jette AM, Jette DU, Ng J, Plotkink DJ, Back MA. The Musculoskeletal Impairment Study Group. Are performance-based measures sufficiently reliable for use in multicenter-trials? J Gerontol A Biol Med Sci 1999; 54:M3-6.
  10. Bennie S, Bruner K, Dizon A, Fritz H, Goodman B, Peterson S. Measurements of balance: comparison of the Timed "Up and Go" test and Functional Reach test with the Berg Balance Scale. J Phys Ther Sci 2003; 15:93-7.
  11. Freter SH, Fruchter N. Relationship between timed 'up and go' and gait time in an elderly orthopaedic rehabilitation population. Clin Rehabil 2000; 14:96-101.
  12. vanHedel HJ, Wirz M, V D. Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests. Arch Phys Med Rehabil 2005; 86:190-6.
  13. Hughes C, Osman C, Woods AK. Functional Reach, and Times Up and Go tests in older adults. Issues Aging 1998; 21:18-22.
  14. Arnold C, Faulkner RA. The history of falls and the associadtion of the timed up and go test to falls and near-falls in older adults with hip osteoarthritis. BMC Geriatr 2007;7.
  15. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community dwelling older adults using the timed up and go test. Phys Ther 2000; 80:896-903.
  16. Gunter KB, White KN, Hayes WC, Snow CM. Functional mobility discriminates nonfallers from one-time and frequent fallers. J Gerontol A Biol Med Sci 2000; 55:M672-6.
  17. DiFabio RP, Seay R. Use of the "fast evaluation of mobility, balance, and fear" in elderly community dwellers: validity and reliability. Phys Ther 1997; 77:904-17.
  18. Wall JC, Bell C, Campbell S, Davis J. The timed getup-and-go test revisited: measurement of the component tasks. J Rehabil Res Dev 2000; 37:109-13.
  19. Schwartz AV, Villa ML, Prill M, et al. Falls in older Mexican-American women. J Am Geriatr Soc 1999;47:1371-8.
  20. McMeeken J, Stillman B, Story I, Kent P. The effects of knee extensor and flexor muscle training on the timed-up-and-go test in individuals with rheumatoid arthritis. Physiother Res Int 1999; 4:55-67.
  21. French HP, Fitzpatrick M, FitzGerald O. Responsiveness of physical function outcomes following physiotherapy intervention for osteoarthritis of the knee: an outcome comparison study. Physiother 2011; 97:302-08.
  22. 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. J Orthop Sports Phys Ther 2011; 41:319-27.
  23. Arnadottir SA, Mercer VS. Effects of footwear on measurements of balance and gait in women between the ages of 65 and 93 years. Phys Ther 2000; 80:17-27.
  24. Kennedy D, Stratfod PW, Pagura SM, Walsh M, Woodhouse LJ. Comparison of gender and group differences in self-report and physical performance measures in total hip and knee arthroplasty candidates. J Arthroplasty 2002; 17:70-7.