Timed Up and Go

Last Updated

November 06, 2013

Timed Up and Go Infographic

Printer-Friendly Timed Up and Go Infographic

Purpose

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

Link to Instrument

Instrument Details

Acronym TUG

Area of Assessment

Balance – Non-vestibular
Functional Mobility
Gait
Vestibular

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

Arthritis + Joint Conditions
Cerebral Palsy
Multiple Sclerosis
Parkinson's Disease & Movement Disorders
Spinal Cord Injury
Stroke Recovery
Vestibular Disorders

Vestibular Disorders

Stroke

Spinal Injuries

Parkinson's Disease

Osteoarthritis

Older Adults and Geriatric Care

Alzheimer's Disease and Progressive Dementia

Brain Injury

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.
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, 2007, p. 293).

Standard armchair (approximately 46 cm in height)
Stopwatch

Less than 3 minutes

Required Training

No Training

Elderly Adult

65 +

years

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

Activity

Measurement Domain

Motor

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.

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
Vestibular EDGE	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

TBI EDGE

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
Vestibular EDGE	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
Vestibular EDGE	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.

Do you see an error or have a suggestion for this instrument summary? Please email us!

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

Content Validity

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

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

Minimal Detectable Change (MDC)

Alzheimer’s Disease:

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

MDC90 = 4.09 seconds

Test/Retest Reliability

Alzheimer’s Disease:

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

Excellent test-retest reliability (ICC = 0.987)

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)

SEM = 1.14 seconds

Minimal Detectable Change (MDC)

Chronic Stroke:

(Flansbjer et al, 2005)

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

Test/Retest Reliability

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)

Criterion Validity (Predictive/Concurrent)

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)

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)

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

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)

SEM = 1.75 seconds

Minimal Detectable Change (MDC)

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

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	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

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

Test/Retest Reliability

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)

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)

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)

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:
Measure	r
BBS	-0.78 (Excellent)**
FGS	-0.69 (Excellent)**
CGS	-0.67 (Excellent)**
**Significant at p < 0.001

Standard Error of Measurement (SEM)

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)

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%

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)

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

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)

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)

Cut-Off Scores

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

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

Test/Retest Reliability

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)

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)

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)

Criterion Validity (Predictive/Concurrent)

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%

Construct Validity

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)

Community-Dwelling Older Adults with vestibular disorders:

(Marchetti et al, 2011)

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

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)

Normative Data

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.

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)

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 Validity:

Community-Dwelling Older Adults with vestibular disorders:

(Marchetti et al, 2011)

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

Test/Retest Reliability

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)

Interrater/Intrarater Reliability

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)

Construct Validity

Convergent Validity:

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)

Responsiveness

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)

Test/Retest Reliability

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)

Bibliography

Abu Hilal, M., Di Fabio, F., et al. (2013). "Implementation of enhanced recovery programme after pancreatoduodenectomy: A single-centre UK pilot study." Pancreatology 13(1): 58-62. Find it on PubMed

Andersson, A. G., Kamwendo, K., et al. (2006). "How to identify potential fallers in a stroke unit: validity indexes of 4 test methods." J Rehabil Med 38(3): 186-191. Find it on PubMed

Balash, Y., Peretz, C., et al. (2005). "Falls in outpatients with Parkinson's disease: frequency, impact and identifying factors." J Neurol 252(11): 1310-1315. Find it on PubMed

Bennie, S., Bruner, K., et al. (2003). "Measurements of balance: comparison of the Timed" Up and Go" test and Functional Reach test with the Berg Balance Scale." Journal of Physical Therapy Science 15(2): 93-97.

Bhatt, T., Espy, D., et al. (2011). "Dynamic gait stability, clinical correlates, and prognosis of falls among community-dwelling older adults." Archives of physical medicine and rehabilitation 92(5): 799-805.

Brooks, D., Davis, A. M., et al. (2006). "Validity of 3 physical performance measures in inpatient geriatric rehabilitation." Arch Phys Med Rehabil 87(1): 105-110. Find it on PubMed

Brown, K. E., Whitney, S. L., et al. (2001). "Physical therapy outcomes for persons with bilateral vestibular loss." Laryngoscope 111(10): 1812-1817. Find it on PubMed

Brusse, K. J., Zimdars, S., et al. (2005). "Testing functional performance in people with Parkinson disease." Phys Ther 85(2): 134-141. Find it on PubMed

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.

Dal Bello-Haas, V., Klassen, L., et al. (2011). "Psychometric Properties of Activity, Self-Efficacy, and Quality-of-Life Measures in Individuals with Parkinson Disease." Physiother Can 63(1): 47-57. Find it on PubMed

de Morton, N. A., Berlowitz, D. J., et al. (2008). "A systematic review of mobility instruments and their measurement properties for older acute medical patients." Health Qual Life Outcomes 6: 44. Find it on PubMed

Dibble, L. E. and Lange, M. (2006). "Predicting falls in individuals with Parkinson disease: a reconsideration of clinical balance measures." J Neurol Phys Ther 30(2): 60-67. Find it on PubMed

Dite, W., Connor, H. J., et al. (2007). "Clinical identification of multiple fall risk early after unilateral transtibial amputation." Archives of Physical Medicine and Rehabilitation 88(1): 109-114. Find it on PubMed

Flansbjer, U. B., Holmback, A. M., et al. (2005). "Reliability of gait performance tests in men and women with hemiparesis after stroke." J Rehabil Med 37(2): 75-82. Find it on PubMed

Foreman, K. B., Addison, O., et al. (2011). "Testing balance and fall risk in persons with Parkinson disease, an argument for ecologically valid testing." Parkinsonism Relat Disord 17(3): 166-171. Find it on PubMed

Gill-Body, K. M., Beninato, M., et al. (2000). "Relationship among balance impairments, functional performance, and disability in people with peripheral vestibular hypofunction." Physical Therapy 80(8): 748-758.

Huang, S. L., Hsieh, C. L., et al. (2011). "Minimal detectable change of the timed "up & go" test and the dynamic gait index in people with Parkinson disease." Physical Therapy 91(1): 114-121. Find it on PubMed

Katz-Leurer, M., Rotem, H., et al. (2008). "Functional balance tests for children with traumatic brain injury: within-session reliability." Pediatr Phys Ther 20(3): 254-258. Find it on PubMed

Kerr, G., Worringham, C., et al. (2010). "Predictors of future falls in Parkinson disease." Neurology 75(2): 116-124.

Knorr, S., Brouwer, B., et al. (2010). "Validity of the Community Balance and Mobility Scale in community-dwelling persons after stroke." Archives of Physical Medicine and Rehabilitation 91(6): 890-896. Find it on PubMed

Lam, T., Noonan, V. K., et al. (2008). "A systematic review of functional ambulation outcome measures in spinal cord injury." Spinal Cord 46(4): 246-254. Find it on PubMed

Lemay, J. F. and Nadeau, S. (2010). "Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale." Spinal Cord 48(3): 245-250. Find it on PubMed

Lin, M. R., Hwang, H. F., et al. (2004). "Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and Tinetti balance measures in community-dwelling older people." Journal of the American Geriatrics Society 52(8): 1343-1348. Find it on PubMed

Mak, M. K. and Pang, M. Y. (2009). "Balance confidence and functional mobility are independently associated with falls in people with Parkinson’s disease." Journal of neurology 256(5): 742-749.

Marchetti, G. F., Whitney, S. L., et al. (2011). "Factors associated with balance confidence in older adults with health conditions affecting the balance and vestibular system." Archives of physical medicine and rehabilitation 92(11): 1884-1891.

Mathias, S., Nayak, U., et al. (1986). "Balance in elderly patients: the" get-up and go" test." Archives of physical medicine and rehabilitation 67(6): 387. Find it on PubMed

Morris, S., Morris, M. E., et al. (2001). "Reliability of measurements obtained with the Timed "Up & Go" test in people with Parkinson disease." Physical Therapy 81(2): 810-818. Find it on PubMed

Nemmers, T. M. and Miller, J. W. (2008). "Factors influencing balance in healthy community-dwelling women age 60 and older." J Geriatr Phys Ther 31(3): 93-100. Find it on PubMed

Ng, S. S. and Hui-Chan, C. W. (2005). "The timed up & go test: its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke." Archives of Physical Medicine and Rehabilitation 86(8): 1641-1647. Find it on PubMed

Nocera, J., Stegemöller, E. L., et al. (2013). "Using the Timed Up and Go Test in a Clinical Setting to Predict Falling in Parkinson’s Disease." Archives of physical medicine and rehabilitation.

Nordin, E., Rosendahl, E., et al. (2006). "Timed "Up & Go" test: reliability in older people dependent in activities of daily living--focus on cognitive state." Phys Ther 86(16649889): 646-655.

Podsiadlo, D. and Richardson, S. (1991). "The timed "Up & Go": a test of basic functional mobility for frail elderly persons." J Am Geriatr Soc 39(2): 142-148. 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

Schenkman, M., Cutson, T. M., et al. (2002). "Application of the continuous scale physical functional performance test to people with Parkinson disease." Journal of Neurologic Physical Therapy 26(3): 130.

Schenkman, M., Ellis, T., et al. (2011). "Profile of functional limitations and task performance among people with early-and middle-stage Parkinson disease." Physical therapy 91(9): 1339-1354.

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

Siggeirsdottir, K., Jonsson, B. Y., et al. (2002). "The timed 'Up & Go' is dependent on chair type." Clinical Rehabilitation 16(6): 609-616. Find it on PubMed

Steffen, T. and Seney, M. (2008). "Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism." Physical Therapy 88(6): 733-746. Find it on PubMed

Steffen, T. M., Hacker, T. A., et al. (2002). "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." Physical Therapy 82(2): 128-137. Find it on PubMed

Tanji, H., Gruber‐Baldini, A. L., et al. (2008). "A comparative study of physical performance measures in Parkinson's disease." Movement Disorders 23(13): 1897-1905.

Thomas, J. I. and Lane, J. V. (2005). "A pilot study to explore the predictive validity of 4 measures of falls risk in frail elderly patients." Arch Phys Med Rehabil 86: 1636-1640. Find it on PubMed

van Hedel, H. J., Wirz, M., et al. (2005). "Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests." Archives of Physical Medicine and Rehabilitation 86(2): 190-196. Find it on PubMed

van Hedel, H. J., Wirz, M., et al. (2005). "Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests." Arch Phys Med Rehabil 86(2): 190-196. Find it on PubMed

Whitney, J. C., Lord, S. R., et al. (2005). "Streamlining assessment and intervention in a falls clinic using the Timed Up and Go Test and Physiological Profile Assessments." Age Ageing 34(6): 567-571. Find it on PubMed

Whitney, S. L., Marchetti, G. F., et al. (2004). "The sensitivity and specificity of the Timed "Up & Go" and the Dynamic Gait Index for self-reported falls in persons with vestibular disorders." J Vestib Res 14(15598995): 397-409.

Wrisley, D. M. and Kumar, N. A. (2010). "Functional gait assessment: concurrent, discriminative, and predictive validity in community-dwelling older adults." Physical Therapy 90(5): 761-773. Find it on PubMed

Information Provided by Shirley Ryan AbilityLab

The Rehabilitation Measures Database (RMD) is a service provided by the Shirley Ryan AbilityLab, the nation’s #1 rehabilitation hospital and leader in translational medicine. Learn more about the conditions we treat, the continuing education courses and credits provided and about career opportunities.

Last Updated

Atomized Content

Purpose

Link to Instrument

Area of Assessment

Assessment Type

Administration Mode

Cost

Diagnosis/Conditions

Required Training

Instrument Reviewers

ICF Domain

Measurement Domain

Professional Association Recommendation

Considerations

Cut-Off Scores

Content Validity

Standard Error of Measurement (SEM)

Minimal Detectable Change (MDC)

Test/Retest Reliability

Standard Error of Measurement (SEM)

Minimal Detectable Change (MDC)

Test/Retest Reliability

Criterion Validity (Predictive/Concurrent)

Construct Validity

Standard Error of Measurement (SEM)

Minimal Detectable Change (MDC)

Normative Data

Test/Retest Reliability

Interrater/Intrarater Reliability

Criterion Validity (Predictive/Concurrent)

Construct Validity

Standard Error of Measurement (SEM)

Minimal Detectable Change (MDC)

Normative Data

Interrater/Intrarater Reliability

Construct Validity

Cut-Off Scores

Normative Data

Test/Retest Reliability

Interrater/Intrarater Reliability

Criterion Validity (Predictive/Concurrent)

Construct Validity

Floor/Ceiling Effects

Responsiveness

Normative Data

Criterion Validity (Predictive/Concurrent)

Construct Validity

Test/Retest Reliability

Interrater/Intrarater Reliability

Construct Validity

Responsiveness

Test/Retest Reliability

Bibliography

Information Provided by Shirley Ryan AbilityLab

Home Safety Self-Assessmen...

NIH Toolbox for Assessment...

Home and Community Environ...