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Rehab Measures: Timed Up and Go

Link to instrument

Timed Up and Go Instructions 

Title of Assessment

Timed Up and Go  

Acronym

TUG

Instrument Reviewer(s)

Initially reviewed by Jason Raad, MS, Jill Smiley, MPH and the Rehabilitation Measures Team in 2010; Updated with references for PD, elderly, TBI, SCI, and stroke populations by JulieAnn Webster, SPT and Michael Wetmore, SPT in 2011; Updated by Irene Ward, PT, DPT, NCS and the TBI EDGE task force of the Neurology Section of the APTA; Updated by Jennifer Kahn, PT, DPT, NCS, Candy Tefertiller, PT, DPT, ATP, NCS, and the SCI EDGE task force of the Neurology Section of the APTA.  Updated with references for Parkinson's Disease, Alzheimer's Disease, Osteoarthritis, and Vestibular Disorders by Kelly Rupkey, SPT, and Eileen Cekay, SPT in 4/2012. Updated by Elizabeth Dannenbaum, MscPT for the Vestibular EDGE task force of the Neurology section of the APTA. Updated with references by Rosemary Gallagher, PT, DPT, GCS and the PD Edge Taskforce of the Neurology Section of the APTA 2013.

Summary Date

11/16/2013 

Purpose

Assesses mobility, balance, walking ability, and fall risk in older adults

Description

  • The patient sits in the chair with his/her back against the chair back
  • On the command “go”, the patient rises from the chair, walks 3 meters at a comfortable and safe pace, turns, walks back to the chair and sits down
  • Timing begins at the instruction “go” and stops when the patient is seated
  • Scores range from 1 to 5 based on the observer's perception of the patient’s risk of falling (Mathias et al, 1986).  Podsiadlo & Richardson, 1991, quantified the test by recommending timing (sec) the time between the command to start, till the buttocks touch the chair
  • The patient should have one practice trial that is not included in the score (Podsiadlo & Richardson, 1991)
  • Patient must use the same assistive device each time he/she is tested to be able to compare scores
  • In the vestibular population it is suggested to test with both right and left turning (Whitney and Herdman, chapter 19 in Herdman, 2007pg293)

Area of Assessment

Balance Non-Vestibular; Functional Mobility; Gait; Vestibular 

Body Part

Not Applicable 

ICF Domain

Activity 

Domain

Motor 

Assessment Type

Observer 

Length of Test

05 Minutes or Less 

Time to Administer

< 3 minutes

Number of Items

Not applicable 

Equipment Required

Standard armchair (approximately 46 cm in height) and a stop watch

Training Required

No training

Type of training required

No Training 

Cost

Free 

Actual Cost

Free

Age Range

Elderly adult: 65+ 

Administration Mode

Paper/Pencil 

Diagnosis

Arthritis; Cerebral Palsy; Geriatrics; Multiple Sclerosis; Parkinson’s Disease; Spinal Cord Injury; Stroke; Vestibular Disorders 

Populations Tested

  • Acute Medical Patients (on wards)
  • Alzheimer's Disease
  • Arthritis (before and/or after joint arthroplasty
  • Cerebral Palsy
  • Community-dwelling Older Adults
  • Frail Elderly
  • Healthy Children age 3-9
  • Low Back Pain
  • Lower Extremity Amputations
  • Multiple Sclerosis
  • Osteoarthritis
  • Parkinson’s Disease
  • Rheumatoid Arthritis
  • Spinal Cord Injury
  • Stroke
  • Vestibular Disorders

Standard Error of Measurement (SEM)

Alzheimer’s Disease:

(Ries et al, 2009; n = 20 in mild to moderate AD group, n = 31 in moderately severe to severe AD group; mean age = 81.05 (9.48) years for mild to moderate AD group, mean age = 80.48 (8.43) years for moderately severe to severe AD group; FAST scale score = 4-5 in mild to moderate AD group, FAST scale score = 6-7 in moderately severe to severe AD group, Alzheimer’s Disease)

  • SEM = 2.48 seconds for all participants
  • SEM = 1.52 seconds for mild to moderate AD
  • SEM = 3.03 seconds for moderately severe to severe AD

Chronic Stroke:

(Flansbjer et al, 2005; n = 50; mean age = 58 (6.4) years; 6-46 months post-stroke; Swedish sample, Chronic Stroke)

  • SEM = 1.14 seconds

Parkinson Disease:

(Dal Bello-Haas et al, 2011; n = 24; mean age = 64.9 (8.0) years; mean time since diagnosis = 4.5 (4.3) years; H & Y Stage One = 13, Stage Two = 6, Stage Three = 5; mean MMSE scores = 27.4 (2.5) points, PD)

  • SEM = 1.75 seconds

SCI:

(In Lam 2007, calculated from, van Hedel 2005, n = 20, Acute SCI)

  • SEM = 3.9 seconds, calculated using intrarater reliability data using a Pearson correlation coefficient

Minimal Detectable Change (MDC)

Alzheimer’s Disease:

(Ries et al, 2009, Alzheimer’s Disease)

  • MDC90 = 4.09 seconds

 

Chronic Stroke:

(Flansbjer et al, 2005)

  • MDC (calculated from Flansbjer et al, 2005) = 2.9 seconds
  • Smallest Real Difference (SRD) = 23%

 

Parkinson's Disease:

(Dal Bello-Haas et al, 2011, PD)

  • MDC = 4.85 seconds

(Huang et al, 2011; n = 72; mean age = 67.5 (11.6) years; mean baseline TUG = 11.8 seconds; DGI = 21.6 points; Chinese language sample, PD)

  • MDC = 3.5 seconds

(Steffen & Seney, 2008; n = 37, mean age = 71 (12); mean H&Y score = 2 (range = 1–4); mean disease duration = 14 (6) years, PD)

  • MDC = 11 seconds

 

SCI:

(Lam et al, 2007; SCI meta analysis; AIS A, B, C, D; C2-L1; only subjects able to complete the walking test were included, calculated from van Hedel 2005, Acute SCI)

  • Smallest Real Difference= 10.8 seconds, found to detect significant clinical change in the TUG, Smallest Real Difference % = 30%

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

 
Cut-Off Scores indicating risk of falls by population
Population
Cut-Off score
Author
Community dwelling adults
> 13.5*
Shumway-Cook et al, 2000
Older stoke patients
> 14*
Andersson et al, 2006
Older adults already attending a falls clinic
> 15*
Whitney et al, 2005
Frail elderly
> 32.6*
Thomas et al, 2005
LE amputees
> 19*
Dite et al, 2007
Parkinson's Disease

> 11.5*

> 7.95*

Nocera et al, 2013

Dibble et al, 2006

Hip Osteoarthritis

> 10*

Arnold et al, 2007
Vestibular Disorders

> 11.1*

Whitney et al, 2004
* Time in seconds
 

Older People Residing in Residential Care Facilities:

(Nordin et al, 2006; n = 78 subjects with multiple impairments, dependent in ADL, and living in residential care facilities; mean age = 84.8 (5.7) years; mean MMSE score = 18.7 (5.6) points; mean Barthel Index score = 14.9 (3.0) points; TUG assessed by 20 PT's with three administrations per participant, Older People residing in Residential Care Facilities)

  • Due to variability in patient scores across administrations, a specific cut-off value may be of limited value for predicting falls in fail elderly adults living in residential care facilities.

Community-Dwelling Elderly People with a variety of medical conditions:

(Podsiadlo and Richardson, 1991)

TUG score (sec)
Functional Mobility Skill
< 20
independent for basic transfers
> 30
dependent on transfers, needed help to enter/ exit shower or tub, did not go out alone

Parkinson's Disease:

(Nocera J. et al, 2013) Using the Timed Up and Go in a Clinical Setting to Predict Falling in Parkinson’s Disease. Accepted Date 2/27/13.

Proposed cut off score for prediction of falls: 11.5 seconds (sensitivity = 0.66, specificity = 0.62)

Normative Data

Community-Dwelling Elderly People:

(Steffen at al, 2002; n = 96; mean age = 73 (8) years; participants had a mean of 1.8 (1.2) medical diagnoses including high blood pressure (n = 35), arthritis (n = 34), low back pain (n = 29), cancer and heart disease (n = 14), thyroid disease (n = 10) and diabetes (n = 9), Community Dwelling Elderly)

 

TUG Normative Data for Community-Dwelling Adults:

Age

Gender

n

Mean

SD

95% CI

60-69

Male

15

8

2

7-9

Female

22

8

2

7-9

70-79

Male

14

9

3

7-11

Female

22

9

2

8-10

80-89

Male

8

10

1

9-11

Female

15

11

3

9-12

 

Geriatric Rehabilitation:

(Brooks et al, 2006; n = 52 subjects, 35 females, 17 males, admitted to an inpatient geriatric rehabilitation program; mean age = 79.9 (7.7) years; mean stay in rehab = 1.4 (0.6) months, Geriatric Rehabilitation)

 

Normative Data for Geriatric Rehabilitation

Admission

Discharge

Mean (SD)

Range

Mean (SD)

Range

TUG Score

31.9 (20.9)

8.6 - 117

21.2 (10.3)

7.7 - 51.4

FIM

86.6 (13.8)

54 - 120

109.5 (12.2)

62 - 124

 

Parkinson’s Disease:

(Brusse et al, 2005; n = 25 community-dwelling older adults, 11 female, 14 male, with Parkinson's Disease; mean age = 76 (7) years; mean H & Y Stage Scale = 2, Parkinson's Disease)

Mean TUG Score

Mean (SD)

95% CI

TUG Score

14.8 (5.8)

12.3-17.3

 

(Dal Bello-Haas et al, 2011, Parkinson's Disease)

Score for Two Trials

Mean (SD)

Range

TUG Score Trial 1

10.6(3.7)

6.5-20.3

TUG Score Trial 2

10.3(2.5)

6.8-17.9

 

(Foreman et al, 2011; n = 36 people, 24 males, 12 females, with Parkinson's Disease; mean fallers age (n = 22) = 77.95 (11.41) years, mean non-fallers age (n = 14) = 66.64 (10.05) years, Parkinson's Disease)

TUG Score for Fallers and Non-Fallers

On Medication

Off Medication

Mean (SD)

95% CI

Mean (SD)

95% CI

TUG Score Fallers

12.21 (7.42)

8.92-15.50

15.5 (11.03)

10.55-20.59

Tug Score Non-fallers

7.94 (2.15)

6.70-9.19

8.13 (2.34)

6.77-9.48

*Only a significant difference between fallers and non-fallers during off medication

 

(Balash et al, 2005; n = 350 patients, 230 males, 120 females with Parkinson's Disease; mean age =  69.7 (10.6) years; mean onset of symptoms = 8.6 (6.2) years; fall history collected at previous week, previous month, and previous year, Parkinson's Disease)

Performance-based measures of balance and gait in PD Non-Fallers and Fallers

Characteristic

Non-Fallers

Fallers

p-value

Crude odds ratio

95% CI

Ability to stand tandem for 30 sec

67.2% (n=204)

37.8%(n=90)

<0.001

0.28

0.18-0.50

Mean duration of standing tandem (sec)

24.3 (8.9) (n=118)

17.2 (10.3) (n=31)

<0.001

0.93

0.90-0.97

Timed Up & Go Test (sec)

11.2 (5.2) (n=163)

16.8 (10.1) n=61

<0.001

1.11

1.06-1.16

Entries are mean +/- SD or % of subjects within a given group

 

(Schenkman et al., 2011; n = 339 males, mean age (y) 66.1 (9.34) range 37-92, time since onset (y): mean 6.0 (5.12) range 0-32,  H&Y stages 1-3, UPDRS total: mean 39.2 (9.56), UPDRS motor: mean 25.2 (9.56).  Subset of n = 136 performed TUG.)

H&Y STage

1-1.5

2

2.5

3

Linear Trend

Cohen f

Mean

8.40

9.21

11.18

10.89

F value:10.56

0.07

SD

1.15

2.06

3.78

3.59

P < 0.0015

Min

6.61

5.54

7.48

6.21

Q 1

8.21

7.86

9.30

8.48

Median

8.64

9.25

10.31

11.13

 

SCI:

(Lemay & Nadeau, 2010; n = 32 individuals with AIS D level SCI walking 10m independently with or without assistive walking devices; mean age = 47.9 (12.8); mean time post lesion 77.2 (44.3) days, Acute SCI)

  • Mean (SD) TUG score; 17.0 (18.7), range = 6.4 to 111.3
  • Mean (SD) TUG for Paraplegia; 19.7 (25.9), range = 6.4 to 111.3
  • Mean (SD) TUG for Tetraplegia; 14.6 (8.8), range = 6.5 to 36.7

Vestibular Hypofunction:

(Gill-Body et al, 2000)

  • Unilateral vestibular hypofunction 19.5 (5.72), range 12.67-39.0, n = 34, bilateral vestibular hypofunction 23.33 (11.66), range 12.74-52.01, n = 44.

Test-retest Reliability

Alzheimer’s Disease:

(Ries et al, 2009, Alzheimer's Disease)

  • Excellent test-retest reliability (ICC = 0.987)

 

Community-Dwelling Elderly People:

(Steffen et al, 2002, Community-Dwelling Elderly)

  • Excelent test-retest reliability (ICC = 0.97)

(Podsiadlo and Richardson, 1991; n = 22, individuals with a variety of medical conditions)

  • Good test-retest (ICC 0.99)

Elderly Adults:

(Rockwood et al, 2000; n = 2,305 elderly people, 874 males, 1431 females; mean age = 78.1 (69-104) years; Canadian sample, Elderly Adults)

  • Adequate test-retest reliability for all subjects (ICC = 0.56)

Adequate test-retest reliability for the cognitively unimpaired (ICC = 0.50)

  • Adequate test-retest reliability for the cognitively impaired (ICC = 0.56)

 

Osteoarthritis:

(Kennedy et al, 2005; n = 21; mean age=63.7 (10.7) years; patients with a diagnosis of OA who were scheduled to undergo primary, unilateral THA or TKA, Osteoarthritis)

  • Excellent test-retest reliability (ICC = 0.75)

 

Parkinson's Disease:

(Steffen & Seney, 2008, Parkinson's Disease)

  • Adequate test-retest reliability (ICC = 0.85)

(Huang et al, 2011; n = 72 participants recruited from special clinics for movement disorders at a university hospital; sex = 44 males and 28 females, mean age = 67.5 (11.6) years; Taiwanese sample, Parkinson's Disease)

  • Excellent test-retest reliability (ICC = 0.80)

 

Stroke:

(Flansbjer et al, 2005; 7 days between assessments, 16 to 18 months from stroke onset to initial assessment, Chronic Stroke)

  • Excellent test-retest reliability (ICC = 0.96)

 

Traumatic Brain Injury:

(Katz-Leurer et al, 2008; n = 24 children recruited from a rehabilitation hospital after sustaining a severe closed head injury and 24 matched controls with typical development; mean age for TBI = 8.7(3.5) years; mange age for control group = 8.5(3.0) years; Glasgow Coma Scale for at least 6 hours after admission was less than 8, TBI)

  • Excellent test-retest reliability (ICC = 0.86)

(Dal Bello-Haas et al, 2011, Parkinson's Disease)

  • Adequate test-retest reliability (ICC = 0.69)

Interrater/Intrarater Reliability

Community-Dwelling Elderly People with a variety of medical conditions:
(Podsiadlo and Richardson, 1991; n = 24)
  • Good between rater reliability (ICC 0.99)
Elderly adults:
(Siggeirsdottir et al, 2002; n = 31 elderly individuals living in a retirement home; median age = 82 (65-92) years; Icelandic sample, Elderly Adults)
  • Excellent Inter-rater reliability (mean difference between raters = 0.04 seconds)
Parkinson’s Disease:
(Morris al, 2001; n = 24 individuals, 12 with idiopathic Parkinson's Disease over the age of 50 and 12 age matched controls; mean age = 65.5 (10.5) years, Parkinson's Disease)
  • Excellent inter-rater reliability (r = 0.99)
(Bennie et al 2003: 20 PD, mean age 68(14.5) yrs: Adults in the following settings: neuro rehab, skilled nursing and acute care)
  • Excellent inter-rater reliability (ICC = 0.99)
  • Excellent intra-rater reliability (ICC = 0.98)

Older People Residing in Residential Care Facilities: (Nordin et al, 2006, Older People in Residential Care Facilities)

  • Excellent Intrarater Reliability (ICC = 0.92; 95% CI = 0.86 - 0.95)
  • Excellent Interrater Reliability (ICC = 0.91; 95% CI = 0.86 - 0.94)

Osteoarthritis:

(Wright et al, 2011; n = 91; mean age = 66.3 (9.4) years; duration of symptoms ranging from < 1-10 years, Hip Osteoarthritis)

  • Excellent interrater Reliability (ICC = 0.87; 95% CI = 0.74 - 0.94)

SCI:

(van Hedel et al, 2005; mean age = 54 (20) years; AIS A = 5%, B = 4%, C = 9% and D = 81%, n = 22 for intrarater, n = 20 for interrater, Acute SCI)

  • Excellent intrarater reliability (r = 0.979) n = 22, mean difference between raters 3.3seconds + 7.0 seconds.
  • Excellent interrater reliability (r = 0.973) n = 20, mean difference did not differ from 0, -0.3seconds + 7.5 seconds
  • Further analysis using Bland-Altman plots. For subjects who performed the TUG within 40seconds, repeatability of testing was good. Differences increased when average time needed to perform test increased

Internal Consistency

Not Established

Criterion Validity (Predictive/Concurrent)

Bilateral Vestibular Hypofunction

(Brown et al, 2001)

  • TUG levels indicates falls risk (tug ≥ 13.5 sec) post rehabilitation (n = 6/9)

Elderly Adults:

(Podsiadlo & Richardson 1991; n = 60 patients referred to a geriatric day hospital; mean age = 79.5 years)

  • Excellent correlation between the TUG and Berg Balance (r = -0.81)
  • Excellent correlation between the TUG and gait speed (r = -0.61)
  • Excellent correlation between the TUG and Barthel Index of ADL (r = -0.78)

(Wrisley and Kumar, 2010; n = 35)

  • Excellent correlation between the TUG and Functional Gait Assessment (r = -0.84, p < 0.001)

(Bhatt T et al, 2011)

  • The TUG test was able to predict fall risk (slip outcomes): Sensitivity 56%, Specificity 60%

Osteoarthritis:

(Sabirli et al, 2012; n = 89; mean age = 62.9 (9.51) years; disease duration = 7.08 (6.52) years; mean radiological stage = 3.22 (0.69), Osteoarthritis)

  • Excellent correlation between the TUG and Kellengren-Lawrence radiological stages (r = 0.628)

Parkinson's:

(Bennie et al 2003: 20 PD, mean age 68(14.5) yrs: Adults in the following settings: neuro rehab, skilled nursing and acute care. Found significant correlation between the TUG and BBS (r = -0.47, p = 0.04) and also TUG combined with FR significantly correlated with BBS: (r = 0.56, p = 0.044))

Parkinson’s Disease Predictive Validity:

Mak: (Mak & Pang, 2009; n = 48 HC, mean age 65.6(7.6)yrs, 21F; 71 PD, (38 non-fallers, mean age 62.3(7.1) yrs, mean disease duration: 7.4(4.3) yrs; 33 fallers, mean age 64.2(8.5) yrs, mean disease duration: 7.9(4.8) yrs).
Increased TUG time (> 16 sec) significantly associates with increased fall risk (OR 3.86, CI 1.05,14.27, P = 0.043)

Kerr: (Kerr et al 2010, n= 101 mean H7Y 2.1(0.8) 53 non-fallers, 48 fallers, mean age 66.4(8.2), 67.3% male, mean disease duration = 6.1(4.4) yrs.

Predicted Fall Risk: Sensitivity: 0.69, specificity: 0.62, Accuracy: 0.63, Area under the curve: 0.65
Balash: (Balash et al, 2005; n = 350 patients, 230 males, 120 females with Parkinson's Disease; mean age = 69.7 (10.6) years; mean onset of symptoms = 8.6 (6.2) years; fall history collected at previous week, previous month, and previous year)

Predicted Fall Risk: Increased TUG time (fallers mean 16.8 + 10.1 sec, nonfallers 11.2 + 5.2 sec) increased risk for falls: adjusted OR = 1.18, 95% CI: 1.03-1.63

Stroke:

(Flansbjer et al, 2005, Chronic Stroke)

  • Excellent correlation between the TUG and CGS (r = -0.86)
  • Excellent correlation between the TUG and FGS (r = -0.91)
  • Excellent correlation between the TUG and SCas (r = 0.86)
  • Excellent correlation between the TUG and SCde (r = 0.90)
  • Excellent correlation between the TUG and 6MW (r = 0.92)

Unilateral Hypofunction:

(Gill-Body KM, et al 2000)

  • Weak to moderate correlations exist between TUG scores and Dizziness Handicap Inventory (r = 0.59) in subjects with unilateral vestibular hypofunction, yet no correlation in subjects with unilateral vestibular hypofunction

Vestibular Disorders:

(Meretta et al, 2006; n = 59 peripheral diagnostic subcategory, n = 40 central diagnostic subcategory, n = 18 mixed diagnostic subcategory; mean age = 62.7 (16.7) years, Vestibular Disorders)

  • Adequate correlation between the TUG and FTSST at baseline measurement (r = 0.53)
  • Adequate correlation between the TUG and FTSST at final measurement (r = 0.59)
  • Adequate correlation between the TUG and FTSST change scores (r = 0.43)

Vestibulopathic Elderly:

(Whitney SL et al, 2004)

  • TUG (> 11.1 sec) is sensitive (80%) and specific (56%) in falls prediction.

(Caixeta GC et al., 2012)

  • Low yet significant negative correlation(r = -0.312) between the TUG and MMSE (mini mental state exam)

Construct Validity (Convergent/Discriminant)

Discriminant Validity:

Geriatric Rehabilitation:

(Brooks et al, 2006)

  • Adequate correlations between the TUG and Functional reach (r = -0.36*)
  • Excellent correlations between the TUG and 2MWT (r = -0.68*)

* TUG Correlations are expected to be negative, lower scores equal better outcome

 

Convergent Validity:

 

Community-Dwelling Older Adults:

(Lin et al, 2004; n = 1200; mean = 73.4 years; Taiwanese sample, Community-Dwelling Older Adults)

  • Adequate: TUG and the Tinetti Balance (r = -0.55)
  • Adequate: TUG and the Tinetti Gait (r = -0.53)
  • Adequate: TUG and walking speed (r = 0.66)
  • Adequate: TUG and ADL scale (r = -0.45)

Osteoarthritis:

(Maley et al, 2005; n = 54; mean age = 68.3 (8.7) years; physician-diagnosed medial-compartment knee OA, Osteoarthritis)

  • Excellent correlation between TUG and STR (Stair Climbing Task) (r = 0.88)

(Boonstra et al, 2008; n = 28 16-months post-operative unilateral TKA, n = 31 gender, age and BMI-matched controls; mean age: not given, Osteoarthritis)

  • Adequate correlation between TUG and Visual Analog Scale (VAS) for pain (r = 0.58)

 (Sabirli et at, 2012, Osteoarthritis)

  • Excellent correlation between TUG and KOOS pain subgroup score (r = -0.66)
  • Adequate correlation between TUG and KOOS symptoms subgroup score (r = -0.521)
  • Adequate correlation between TUG and KOOS ADL subgroup score (r = -0.531)
  • Excellent correlation between TUG and KOOS sport subgroup score (r = -0.694)
  • Adequate correlation between TUG and KOOS quality of life subgroup score (r = -0.561)

Parkinson's Disease:

(Brusse et al, 2005, Parkinson’s Disease)

Convergent Validity Evidence - Moderate to good correlation with the following measures:
Measure
r
BBS
-0.78** (Excellent)
FGS
-0.69** (Excellent)
CGS
-0.67** (Excellent)
**Significant at p < 0.001

SCI:

(van Hedel et al, 2005; mean age = 54 (20) years; AIS A = 5%, B = 4%, C = 9% and D = 81%, Acute SCI)

  • Validity was investigated for the 10MWT, TUG, and 6MWT via correlations with the WISCI II and amongst each other. The authors completed an analysis of overall WISCI II scores as well as sub groups, dividing the WISCI II, based on walking ability.
    • Overall correlations (n = 67)
      • Excellent WISCI II vs TUG (r = -0.76)
      • Excellent TUG vs 10MWT (r = 0.89)
      • Excellent TUG vs. 6MWT (r = -0.88)
    • WISCI II score of 0 to 10 (n = 13 to 20)
      • Poor, WISCI II vs TUG (r = 0.16)
      • Excellent TUG vs 10MWT (r = 0.92)
      • Excellent TUG vs. 6MWT (r = -0.70)
    • WISCI II score of 11 to 20 (n = 47)
      • Excellent, WISCI II vs TUG (r = -0.65)
      • Excellent TUG vs. 10MWT (r = 0.79)
      • Excellent TUG vs. 6MWT (r = -0.78)
    • WISCI II (0-8, 10, 11, 14, 17 ), dependent walkers (n = 15)
      • Poor, WISCI II vs. TUG (r = -0.22)
      • Excellent TUG vs. 10MWT (r = 0.88)
      • Excellent TUG vs. 6MWT (r = -0.74)
    • WISCI II (9, 12, 13, 15, 16, 18-20), independent walkers (n = 45)
      • Excellent, WISCI II vs. TUG (r = -0.66)
      • Excellent TUG vs. 10MWT (r = 0.86)
      • Excellent TUG vs. 6MWT (r = -0.88)

Stroke:

(Knorr et al, 2010; n = 44 community-dwelling persons after stroke; sex = 24 males and 20 females; mean age = 62.6 (12.6) years; mean time post-stroke = 98.6 (52.6) days, Stroke)

  • Excellent associations between TUG and CB&M (ρ = -0.75, p < 0.001)
  • Excellent associations between TUG and BBS (ρ = -0.70, p < 0.001)

Overall, improved validity of TUG with WISCI II in individuals who are less impaired, higher walking ability, and do not require assistance. Strong relationships maintained among TUG, 10MWT, and 6MWT. TUG should be used with caution in people with poorer walking ability.

(van Hedel 2008 (n = 6-127), Acute, Subacute, Chronic SCI)

  • Excellent correlation of TUG and 10M; however, relationship changes over time.

 

Time Since Injury
N
Spearman Rho
R2 (adjusted value)
2 weeks
6
0.81*
0.96
1 month
74
0.87**
0.57
3 months
136
0.95**
0.75
6 months
131
0.96**
0.76
12 months
127
0.92**
0.72
*p < 0.05; **p < 0.001

(Lemay & Nadeau, 2010; n = 32; AIS D level; mean age = 47.9 (12.8); mean time post lesion 77.2 (44.3) days), Acute SCI)

 

Convergent validity Excellent correlation of TUG with the following measures:

Measure

TUG

Berg Balance Scale

-0.815

SCI-FAI parameter

-0.761

SCI-FAI assistive devices

-0.802

SCI-FAI mobility

-0.724

2MWT

-0.623

WISCI II

-0.799

10MWT

-0.646

All significant at p < 0.01

Community-Dwelling Older Adults with vestibular disorders:

(Marchetti et al, 2011)

  • TUG has a moderate-strong correlation with ABC ( p = -0.4, n = 98)

Content Validity

The TUG was developed as an extension of the "Get Up and Go" (GUG) measure originally developed by Mathias et al, 1986.
 
 

Face Validity

Not Established

Floor/Ceiling Effects

Elderly Adults:
(Rockwood et al, 2000, Elderly Adults)
  • Poor Floor Effects (29.3%)

Older Acute Patients:

(de Morton et al, 2008; literature review included 178 studies, Older Acute Patients)

  • Poor floor effects (25%)

Responsiveness

Community-Dwelling Older Adults:

(Lin et al, 2004; in terms of Effect Sizes (ES), Community-Dwelling Older Adults)

  • Moderate effect for ADL decline (ES = 0.42)
  • Small effect for falls (ES = 0.12)
  • Small effect for ADL improvements (ES = 0.05)

Osteoarthritis:

(French et al, 2010; n = 39 knee OA patients undergoing physical therapy; mean age: 65.3 (6.9) years, Osteoarthritis)

  • Small effect for response to physical therapy (ES = 0.33)

Professional Association Recommendations

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (VEDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

(Vestibular > 6 weeks post)

SCI EDGE

HR

HR

R

StrokEDGE

HR

HR

HR

VEDGE

LS

 

LS

 

Recommendations Based on Parkinson Disease Hoehn and Yahr stage:

 

I

II

III

IV

V

PD EDGE

HR

HR

HR

NR

NR

 

 

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

StrokEDGE

HR

HR

HR

HR

HR

TBI EDGE

LS

LS

LS

LS

LS

 

Recommendations based on SCI AIS Classification:

 

AIS A/B

AIS C/D

SCI EDGE

LS

HR

 

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

LS

LS

NR

NR

 

Recommendations based on vestibular diagnosis

 

Peripheral

Central

Benign Paroxysmal Positional Vertigo (BPPV)

Other

VEDGE

R

R

LS

LS

 

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

PD EDGE

Yes

Yes

Yes

Not reported

SCI EDGE

Yes

Yes

Yes

Not reported

StrokEDGE

Yes

Yes

Yes

Not reported

TBI EDGE

No

Yes

No

Not reported

VEDGE

Yes

Yes

Yes

Yes

Considerations

  • The TUG may demonstrate less reliability among patients suffering from cognitive impairment
  • Chairs with armrests and a seating height of 44-47 cm should be used (Siggeirsdottir et al, 2002)
  • Results suggest using age-related normative data for adults between the ages of 60 and 90 years.
    (Steffen et al, 2002)
  • Intrarater reliability may be affected by subject performance when completing multiple assessments indicating patients quickly become familiar with this test resulting in the first test affecting the second test (vanHedel et al, 2005).
  • TUG was designed to be tested with people walking at a comfortable speed, yet at times is tested with the walking at a “quick yet safe speed”. Clinically it is important that the chair is free standing, and not placed against a wall.
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Year published

1991 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 10/30/2010 11:36 AM  by Dawood Ali 
Last modified at 8/28/2014 4:11 PM  by Jason Raad