Timed Up and Go Test (TUG)

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Tool Description

  • Timed walking test designed to measure gait performance and balance.
  • Originally developed as a clinical measure of balance in elderly individuals.
  • To date, the TUG has generally not been widely used in the SCI patient population.

ICF Domain:

Activity – subcategory: Mobility.

Number of Items:

n/a

Brief Instructions for Administration & Scoring

Administration:

  • The individual is instructed to stand up from an arm chair, walk 3 meters, return to the chair and sit down at their preferred walking speed.
  • Instructions to the patient: “When I say ‘go’ I want you to stand up and walk to the line, turn and then walk back to the chair and sit down again. Walk at your normal pace.”

Equipment:

  • A chair
  • A 3m walkway
  • A cone or line to demarcate 3 meter boundary
  • A stop watch.

Scoring:
Time for ‘Up and Go’ test:  _________sec.
Unstable on turning?  Y/N
Walking aid used?  Y/N  Type of aid: ______________

Note: the time recorded should be the time in seconds taken from the point the individual’s buttocks lifts off the seat to the time he/she sits down again.

Interpretability

MCID: not established
SEM = 3.9 seconds (Lam et al. 2008)
SRD = 10.8 seconds (Lam et al. 2008)

  • No cut-points or norms have been established for the SCI population
  • Published data is available for comparison (see Interpretability section of the Study Details sheet).

Languages:

n/a

Training Required:

No additional training required.

Availability:

For more detailed instructions, see the ‘How-to use’ page of this tool.

Clinical Considerations

  • This test is used to discriminate balance and ambulatory function between patients and evaluate change over time in a single patient.
  • The task is very functional and incorporates mobility, balance and lower extremity leg strength.
  • The distance walked in the TUG is only 3 meters and so it is not a test of walking endurance.
  • The test is simple and fairly easy to administer, however, it is not appropriate for many individuals with SCI.
  • Some proponents have advocated for use of a mean time from 3 successive trials due to potential learning effect.

Measurement Property Summary

# of studies reporting psychometric properties: 2

Reliability:

  • Intra-rater reliability is excellent (Pearson’s r=0.979) and inter-rater reliability is excellent (Pearson’s r=0.973).
  • Bland-Altman plot indicated that inter-rater reliability was better than intra-rater reliability and that repeatability of the test depends on patient’s walking performance.

[Van Hedel, Wirz & Dietz 2005]

Validity:

  • Correlation of the Timed Up and Go test is excellent with the:
    • 10 Meter Walk Test (Spearman’s r=-0.646)
    • 6 Minute Walk Test (Spearman’s r=0.88)
    • Berg Balance Scale (Spearman’s r=-0.815)
    • WISCI II (Spearman’s r=-0.76 - -0.799)
    • SCI-Functional Ambulation Inventory- mobility subscale (Spearman’s r=-0.724).

[Van Hedel et al. 2005, Lemay & Nadeau 2010]

Responsiveness:
No values for the responsiveness of the TUG has been reported.

Floor/ceiling effect:
No values were reported for the presence of floor/ceiling effects in the TUG for the SCI population.

Reviewer

Dr. William Miller, Christie Chan

Date Last Updated:

Feb 1, 2013

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Download Worksheet:

Worksheet Document

Video

Scoring

Time in seconds taken for the individual to stand up from an arm chair, walk 3 meters, return to the chair and sit down at their preferred walking speed is recorded.

Note: the time recorded should be the time in seconds taken from the point the individual’s buttocks lifts off the seat to the time he/she sits down again.

Equipment Needed

  • A chair
  • A 3m walkway
  • A cone or line to demarcate 3 meter boundary
  • A stop watch.

TUG:

Duffell LD, Brown GL, Mirbagheri MM. Interventions to Reduce Spasticity and Improve Function in People With Chronic Incomplete Spinal Cord Injury: Distinctions Revealed by Different Analytical Methods. Neurorehabil Neural Repair. 2015;29(6):566-76.
http://www.ncbi.nlm.nih.gov/pubmed/25398727

Lam T, Noonan VK, Eng JJ. A systematic review of functional ambulation outcome measures in spinal cord injury. Spinal Cord. 2008;46(4):246-54.
http://www.ncbi.nlm.nih.gov/pubmed/17923844

Lemay JF and Nadeau S. Standing balance assessment in ASIA D paraplegic and tetraplegic participants: concurrent validity of the Berg Balance Scale. Spinal Cord (2010) 48, 245–250; doi:10.1038/sc.2009.119
http://www.ncbi.nlm.nih.gov/pubmed/19773797

Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the “get-up and go” test. Arch Phys Med Rehabil. 1986;67:387-389.
http://europepmc.org/abstract/MED/3487300/reload=0;jsessionid=umsC4isWbVEl7GUxJDdv.4

Poncumhak P, Saengsuwan J, Amatachaya S. Ability of walking without a walking device in patients with spinal cord injury as determined using data from functional tests. J Spinal Cord Med. 2014;37(4):389-96.
http://www.ncbi.nlm.nih.gov/pubmed/24621030

Poncumhak P, Saengsuwan J, Kamruecha W, Amatachaya S. Reliability and validity of three functional tests in ambulatory patients with spinal cord injury. Spinal Cord. 2013;51(3):214-7.
http://www.ncbi.nlm.nih.gov/pubmed/23147127

Saensook W, Poncumhak P, Saengsuwan J, Mato L, Kamruecha W, Amatachaya S. Discriminative ability of the three functional tests in independent ambulatory patients with spinal cord injury who walked with and without ambulatory assistive devices. J Spinal Cord Med. 2014;37(2):212-7.
http://www.ncbi.nlm.nih.gov/pubmed/24090342

Shumway-cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. 2000;80(9):896-903.
http://www.ncbi.nlm.nih.gov/pubmed/10960937

Srisim K, Saengsuwan J, Amatachaya S. Functional assessments for predicting a risk of multiple falls in independent ambulatory patients with spinal cord injury. J Spinal Cord Med. 2015;38(4):439-45.
http://www.ncbi.nlm.nih.gov/pubmed/24621036

van Hedel HJA Wirz M, Dietz V. Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests. Arch Phys Med Rehabil 2005;86:190-196.
http://www.ncbi.nlm.nih.gov/pubmed/15706542

van Hedel HJ. Gait speed in relation to categories of functional ambulation after spinal cord injury. Neurorehabil Neural Repair. 2009;23(4):343-50.
http://www.ncbi.nlm.nih.gov/pubmed/19036717