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Rehab Measures: Timed Up and Go Dual Task; Timed Up and Go (Cognitive); Timed Up and Go (Motor); Timed Up and Go (Manual)

  Rehabilitation Measures Database

Title of Assessment

Timed Up and Go Dual Task; Timed Up and Go (Cognitive); Timed Up and Go (Motor); Timed Up and Go (Manual)

Link to instrument

Purpose

A dual-task dynamic measure for identifying individuals who are at risk for falls.

Acronym

TUG-DT (dual task), TUG-COG (cognitive), TUGman (manual task), TUGm (modified)

Instrument Reviewer(s)

Initially reviewed by Irene Ward, PT, DPT, NCS and the TBI EDGE taskforce of the Neurology Section of the APTA in 6/2012, Reviewed for the VestEDGE task force of the Vestibular section of the APTA by Elizabeth Dannenbaum MscPT in 2013; Updated with references from the PD population by Rosemary Gallagher, PT, DPT, GCS and the PD EDGE Taskforce of the Neurology Section of the APTA in 4/2013

Summary Date

29 01 2014

Description

  • Individuals are given verbal instructions to stand up from a chair, walk 3 meters as quickly and safely as possible, cross a line marked on the floor, turn around, walk back, and sit down.
  • In the TUG (Cognitive), individuals were asked to complete the test while counting backward by threes from a randomly selected number between 20 and 100.
  • In the TUG (Manual) it has been suggested that the client must walk holding a cup filled with water (Shumway-Cook et al ,2000, Hofheinz and Schusterschitz, 2010)
  • The test includes the time the individual takes to get out of the chair after he/she is told to "go".
  • Individuals are permitted to use the assistive device they typically use in the community, but without the assistance of another person.
  • Individuals are able to follow simple instructions.
  • .Maranhao-Filho et al (2011): TUG-Cog: Alternatively may recite alternating letters of the alphabet (a-c-e) aloud. TUG Manual: Same as TUG, but individual carries a full glass of water in one hand.
  • Lundin-Olsson et al (1998): TUG Manual: same as TUG, but individuals stand up, grasp a tumbler containing water placed on a table just beside the chair, carry the tumbler while walking, put it on the table and sit down

ICF Domain

Activity

Time to Administer

Less than 3 minutes

Number of Items

1 item

Equipment Required

  • Stop watch
  • Standard height chair with armrests
  • Measuring tape
  • Tape
  • Cone

Training Required

No training

Actual Cost

Cost of equipment

Populations Tested

  • Community Dwelling Elderly
  • Vestibular Disorders

Standard Error of
Measurement (SEM)

Not Established

Minimal Detectable
Change (MDC)

Not Established

Minimally Clinically
Important Difference (MCID)

Not Established

Cut-Off Scores

Community dwelling elderly:

(Shumway-Cook et al, 2000)

  • Elderly subjects who completed the TUG (Cognitive) in ³ 15 seconds were classified as fallers with an overall correct prediction rate of 87%.

Parkinsons Disease:

(Maranhao-Filho et al, 2011)

  • Difference between TUG manual and Tug is > 4.5 sec, this indicates an increased risk of falls Healthy adults

Normative Data

Community dwelling elderly:

(Hofheinz et al, 2010, n = 120 healthy older adults between the ages 60-87)

  • Mean time to perform TUG is 8.39(1.36) seconds
  • Mean time to perform TUG (Cognitive) is 9.82(2.39) seconds
  • Mean time to perform TUG (Manual) is 11.56(2.11) seconds
  • The performance times for the TUG and the TUG with dual task (cognitive and manual) do not differ significantly between men and women (P > 0.05). However, the mean values for different age groups (60-69, 70-79, 80-87 years old) differ significantly from each other. With increasing age, the time required to perform the different tests is longer.

(Shumway-Cook et al 2000)

  • Mean scores for Elderly without falls history: TUG 8.4 sec, TUG man 9.7 sec, TUGcog 9.7 sec

(Caixeta et al, 2012)

  • Elderly people (> 60 y.o.) with chronic peripheral vesitbular dysfunction and dizziness (n = 76): Mean TUG cog: 12.08 (SD 2.07)

Parkinson’s Disease:

(Campbell et al 2003, n = 19 older adults: 9 with PD and self-reported problems with mobility (6M/3F, 8 (89%)reporting falls past 6 months, mean age 74.3 + 7yrs, range 61-84) and 10 older adults without PD (4M/6F, 1 (10%) reporting falls past 6 months, mean age 76.4 + 7 yrs, range 68-86)

Time to complete (seconds) by group and task.(mean/SD):

Healthy Older

PD

Tug baseline

9.85 (1.44)

16.4 (3.8)

TUG low

10.77 (2.11)

16.5 (3.6)

TUG high

11.58 (2.63)

21.5 (7.9)

  • TUG low: low cognitive demand
  • TUG high: high cognitive demand

Test-retest Reliability

Community dwelling elderly:

(Hofheinz et al, 2010, n = 120 healthy older adults between the ages 60-87)

  • Excellent test-retest reliability (r T1-T2 = 0.98 and r T1-T3 = 0.98)

Interrater/Intrarater

  Reliability

Community dwelling elderly:

(Shumway-Cook et al, 2000)

  • Excellent interrater reliability (ICC = 0.99)

Community dwelling elderly:

(Hofheinz et al, 2010, n = 120 healthy older adults between the ages 60-87)

  • Excellent intrarater reliability (ICC = 0.94)

Internal Consistency

Not Established

Criterion Validity

(Predictive/Concurrent)

Concurrent validity:

Community dwelling elderly:

(Hofheinz et al, 2010, n = 120 healthy older adults between the ages 60-87)

  • Excellent correlation with Berg Balance Scale (r = -0.66)

(Caixeta et al, 2012, Vestibulopathic elderly (n = 76), without a control group)

  • TUG cog-Mini Mental State Exam; low yet significant correlation (Spearman's correlation coefficient: 0.36)
  • TUG cog-Clock Test: no correlation (Spearman's correlation coefficient: -0.2)

Parkinson's Disease:

Maranhao-Filho et al (2011)

  • Positive predictive Value of 71% for falls in older adults undergoing TUG-Cog versus 42% for those undergoing TUG simple

Predictive validity:

Community dwelling elderly:

(Shumway-Cook et al, 2000; n = 30; 15 fallers and 15 non-fallers; mean age of fallers= 86.2(6.4) years; mean age of non-fallers= 78.4 (5.8)

  • High specificity (93.3%) for predicting non-fallers
  • High sensitivity (80%) in positive prediction of falls

Construct Validity

(Convergent/Discriminant)

Not Established

Content Validity

Not Established

Face Validity

Not Established

Floor/Ceiling Effects

Not Established

Responsiveness

Not Established

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 Based on Parkinson Disease Hoehn and Yahr stage:

 

I

II

III

IV

V

PD EDGE

HR

HR

HR

HR

LS/UR

 

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

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

MS EDGE

HR

HR

HR

HR

HR

TBI EDGE

LS

LS

LS

LS

LS

 

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 EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

HR

HR

HR

NR

 

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)

MS EDGE

Yes

Yes

Yes

No

PD EDGE

Yes

Yes

Yes

Not reported

TBI EDGE

No

Yes

No

Not reported

 

Measure: Modified TUG w/ DTC

 

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)

VEDGE

LS

 

LS

 

Recommendations based on vestibular diagnosis

 

Peripheral

Central

Benign Paroxysmal Positional Vertigo (BPPV)

Other

VEDGE

LS

LS

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)

VEDGE

Yes

Yes

No

Yes

Considerations

  • Individuals are asked to perform subtraction. Language and educational levels should be considered when applying this test.
  • Shumway-Cook et al, 2000 found that the TUG, TUG (Manual) and TUG (Cognitive) were all comparable in determining the likelihood of falls in older adults. Therefore, the addition of a dual-task did not increase the sensitivity of the TUG in predicting the likelihood for falls in that study.
  •  The effect on the reliability of the TUG (Cognitive) has not been studied in individuals with cognitive impairments. However, Rockwood et al reports poor test-retest reliability of the TUG in individuals with cognitive impairments.
  • • In PD, changes in gait under dual task conditions are proportional to the complexity of the secondary task performed. (Campbell et al 2003)
  • TUG-Cog is simple to administer and interpret at the bedside. In the elderly, it greatly enhances measurement of the risk of falling. It should become part of the routine neurological examination.
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Bibliography

Caixeta, G. C. d. S., Doná, F., et al. (2012). "Cognitive processing and body balance in elderly subjects with vestibular dysfunction." Brazilian Journal of Otorhinolaryngology 78(2): 87-95.

Campbell, C. M., Rowse, J. L., et al. (2003). "The effect of cognitive demand on timed up and go performance in older adults with and without Parkinson disease." Journal of Neurologic Physical Therapy 27(1): 2-7.

Hofheinz, M. and Schusterschitz, C. (2010). "Dual task interference in estimating the risk of falls and measuring change: a comparative, psychometric study of four measurements." Clin Rehabil 24(9): 831-842. Find it on PubMed

Lundin-Olsson, L., Nyberg, L., et al. (1998). "Attention, frailty, and falls: the effect of a manual task on basic mobility." J Am Geriatr Soc 46(6): 758-761. Find it on PubMed

Maranhao-Filho, P. A., Maranhao, E. T., et al. (2011). "Rethinking the neurological examination II: dynamic balance assessment." Arq Neuropsiquiatr 69(6): 959-963. Find it on PubMed

Rockwood, K., Awalt, E., et al. (2000). "Feasibility and measurement properties of the functional reach and the timed up and go tests in the Canadian study of health and aging." Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 55(2): M70-73. Find it on PubMed

Shumway-Cook, A., Brauer, S., et al. (2000). "Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test." Phys Ther 80(9): 896-903. Find it on PubMed

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The contents of this database were developed under a grant from the Department of Education, NIDRR grant number H133B090024 (PI: Allen Heinemann, PhD).  However, the content does not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government.  
 
 

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