Timed Up and Go

The Timed Up and Go Test (TUG) assesses mobility, balance, walking ability, and fall risk in older adults.

Link to Instrument

Acronym TUG

Area of Assessment

Balance – Non-vestibular
Functional Mobility
Gait
Vestibular

Assessment Type

Administration Mode

Paper & Pencil

Cost

Diagnosis/Conditions

Populations

Key Descriptions

Equipment Required

Time to Administer

Less than 3 minutes

Required Training

No Training

Age Ranges

Instrument Reviewers

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.

ICF Domain

Measurement Domain

Professional Association Recommendation

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 (SCI EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

Abbreviations:

LS / UR

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

Recommendations for use based on acuity level of the patient:

Acute

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

(Vestibular > 6 weeks post)

SCI EDGE

StrokEDGE

Vestibular EDGE

Recommendations Based on Parkinson Disease Hoehn and Yahr stage:

I

II

III

IV

V

PD EDGE

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

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

StrokEDGE

TBI EDGE

Recommendations based on SCI AIS Classification:

AIS A/B

AIS C/D

SCI EDGE

Recommendations for use based on ambulatory status after brain injury:

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

Recommendations based on vestibular diagnosis

Peripheral

Central

Benign Paroxysmal Positional Vertigo (BPPV)

Other

Vestibular EDGE

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

SCI EDGE

StrokEDGE

TBI EDGE

Vestibular EDGE

Considerations

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Non-Specific Patient Population

Cut-Off Scores

Cut-Off Scores indicating risk of falls by population

Population

Cut-Off score

Author

Community dwelling adults

Shumway-Cook et al, 2000

Older stoke patients

Andersson et al, 2006

Older adults already attending a falls clinic

Whitney et al, 2005

Frail elderly

Thomas et al, 2005

LE amputees

Dite et al, 2007

Parkinson's Disease

Nocera et al, 2013

Dibble et al, 2006

Hip Osteoarthritis

Arnold et al, 2007

Vestibular Disorders

Whitney et al, 2004

* Time in seconds

Content Validity

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

Alzheimer's Disease and Progressive Dementia

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)

Minimal Detectable Change (MDC)

Alzheimer’s Disease:

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

Test/Retest Reliability

Alzheimer’s Disease:

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

Stroke

Standard Error of Measurement (SEM)

Chronic Stroke:

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

Minimal Detectable Change (MDC)

Chronic Stroke:

(Flansbjer et al, 2005)

Test/Retest Reliability

Stroke:

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

Criterion Validity (Predictive/Concurrent)

Stroke:

(Flansbjer et al, 2005, Chronic Stroke)

Construct Validity

Convergent Validity:

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)

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)

Time Since Injury

N

Spearman Rho

R2 (adjusted value)

2 weeks

1 month

3 months

6 months

12 months

(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:

Berg Balance Scale

SCI-FAI assistive devices

All significant at p < 0.01

Parkinson's Disease

Standard Error of Measurement (SEM)

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)

Minimal Detectable Change (MDC)

Parkinson's Disease:

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

(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)

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

Normative Data

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

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

Score for Two Trials

Mean (SD)

Range

TUG Score Trial 1

TUG Score Trial 2

(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

Tug Score Non-fallers

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

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

Crude odds ratio

Ability to stand tandem for 30 sec

Mean duration of standing tandem (sec)

Timed Up & Go Test (sec)

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.)

Test/Retest Reliability

Parkinson's Disease:

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

(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)

Interrater/Intrarater Reliability

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)

(Bennie et al 2003: 20 PD, mean age 68(14.5) yrs: Adults in the following settings: neuro rehab, skilled nursing and acute care)

Criterion Validity (Predictive/Concurrent)

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

Construct Validity

Convergent Validity:

Parkinson's Disease:

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

Convergent Validity Evidence - Moderate to good correlation with the following measures:

-0.78** (Excellent)

-0.69** (Excellent)

-0.67** (Excellent)

**Significant at p < 0.001

Spinal Injuries

Standard Error of Measurement (SEM)

SCI:

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

Minimal Detectable Change (MDC)

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)

Normative Data

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

Interrater/Intrarater Reliability

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)

Construct Validity

Convergent Validity:

SCI:

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