CHAPTER 20: TIMED UP AND GO TEST (TUG)

Description

The Timed Up and Go Test (TUG) is a relatively quick outcome measure developed to test a person’s balance and fall risk. During assessment the subject is asked to rise from a seated position, walk 3 meters, turn around and sit back down while the clinician records the amount of time taken to complete the activity. The TUG is a widely used and simple measure of basic mobility and has shown to compare well with other measures of balance and function (Large, Gan, Basic, & Jennings, 2006). Based on the original Get up and Go Test by Mathias, et al. (1986) which was originally scored along an ordinal scale of 1 to 5 as well as the observer’s perception of fall risk, Podsiadlo and Richardson (1991) modified the test by timing the task rather than only scoring it qualitatively (Chaya & Vidhu, 2011). Scoring norms have been established for a number of age groups and the assessment can be completed in less than 5 minutes.

Psychometrics

A study of 51 people with neurocognitive disorders of the Alzheimer’s type by Ries, Ecternach, Nof, Gagnon, and Blodgett (2009) found test-retest reliability to very high at r = 0.99. Noren, Borgen, Bolin, and Stenstrim (2001) established similar results for inter-rater reliability using 3 raters at r = 0.99. TUG scores have also shown to correlate well with the Berg Balance Scale scores at 0.81 and Barthel Index at 0.78 (Podsiadlo & Richardson, 1991). An investigation of fall risk among elderly persons found that those unable to do the TUG due to nonphysical disability had the highest fall rate (11%), followed by those with physical disability (9%), while those able to do the Timed Up and Go had the lowest fall rate (6%) suggesting that physical impairment alone is not a good predictor for falls among the elderly (Large et al., 2006). Expanding on that research, Mirelman et al. (2014) found that persons with mild cognitive impairment had less walking consistency, smaller pitch range during transitions, lower angular velocity during turning and required more time to complete the turn-to-walk activities of the TUG. Meanwhile, several studies have established confidence intervals that can be used to note performance that is worse than average specifically if they exceed 9.0 seconds for 60 to 69 year olds, 10.2 seconds for 70- to 79-year-olds, and 12.7 seconds for individuals 80 to 99 year olds (Bohannon, 2006). While cutoff levels for the TUG at a score of 13.5 seconds or longer produced an overall correct prediction rate of 90% (Shumway-Cook, Brauer, & Woollacott, 2000).

Advantages

There is a significant amount of research to support its use in clinical practice. TUG is a relatively quick and simple outcome measure that requires a minimum amount of tools and set up (a tape measure, stop watch, tape for the floor mark, and a chair) and can be completed in less than 5 minutes. No special training is required and scoring is based on the amount of time needed to complete the activity.

Disadvantages

Although the TUG has been shown to be useful for evaluating functional mobility, the literature suggests that its predictive value and diagnostic accuracy for identifying future falls is not as straight forward, further validating results of research pertaining to other fall assessments that suggest that fall-risk falls are a complex issue that have many variables that are difficult to predict (Beauchet et al., 2011).

Administration

During assessment the subject is asked to (1) rise from a seated position, (2) walk 3 meters, and (3) return and sit back down. Timing begins just as the person attempts to rise from the chair and is stopped when the person is seated again after walking 3 meters. Regular footwear and customary walking aids should be used during the assessment.

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