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TIMED UP & GO TEST (TUG)

Type of test: Timed performance measure. The TUG is a test of general mobility.1

Time to administer: 1 practice trial and 2 recorded trials, with each trial usually taking less than 1 minute.

Clinical Comments: The multi-part directions can be complex for some persons, thus a practice trial is

always recommended.

Purpose/population for which tool was developed: The TUG was developed as a mobility test for geriatric clients.

The test contains the balance and gait maneuvers used in everyday life. The first authors to devise the instrument

used a 1 to 5 scale based on observer’s perception of the patient’s risk of falling.2 The second set of authors

1 did the

same test but timed it instead of using the 1-5 scale

Dual task use of TUG: Some authors have suggested using the TUG test along with challenging the client with a

dual task called the TUGO (obstacle).The obstacle can be a box (width 120cm, depth 20 cm) the height which varies

(0,5, 17 cm) placed 5 cm away from chair client steps over it in both directions.3

When appropriate to use: The TUG is most appropriate for use with the frail elderly who have diagnoses such as

CVA, Parkinson’s disease, rheumatoid arthritis, osteoarthritis, multiple sclerosis, hip fracture, cerebellar

degeneration, and general de-conditioning. The individual must be able to follow directions and must be able to

independently rise from a chair, walk at least 6 meters, and turn around, with or without an assistive device.

Scaling: The score for the TUG is in seconds (ratio scale). A lower score represents better (faster) performance.

Equipment needed:

Stopwatch, measuring to 100ths

Tape markers, 3 meters apart

Standard height chair (approx 46 cm / 18 inches), with arms and backrest

Directions: Measure in seconds, the time taken by an individual to stand up from a standard arm chair

(approximate seat height of 46cm / 18 inches), walk a distance of 3 meters, turn, walk back to the chair, and sit

down again. The subject should wear regular footwear and use his/her customary walking aid. No physical

assistance is given, but guarding for safety is appropriate. The client starts with his back against the chair, toes

behind the first tape marker, arms resting on the chair’s arms and the walking aid at hand. The client is instructed

that, on the word “go” he/she is to get up and walk at a comfortable and safe pace to a tape line on the floor 3 meters

away*, turn, return to the chair, and sit down again with the back touching the backrest. The person has a practice

trial then 2 timed trials that are averaged.

*Data collected in Table 1: a small plastic cone was placed on the 3-meter mark and subjects were instructed to walk around the cone

The tester may want to document the quality of the transition phases: rising from chair, initiating walking, turning

and descent into chair. Footwear and floor conditions (linoleum vs. carpet) make a difference in outcomes.4

Factors affecting performance: Ankle plantar-flexor and subtalar invertor muscle force accounted for 48% of the

variance in TUG scores 5 in a group of 39 people reporting no fall history. In a study of people with LE amputation,

age at amputation explained only 10% of the variance in the TUG scores and 1-leg balance explained 32% of the

variance.6 Self-efficacy explained 45% of the variance in TUG scores of older adults with knee OA (n=54).

7

Reliability:

Summary: Intra and interrater reliability are high (.92-.99) for adults with the exception of Botolfsen (2008)

study and lower on children (.85-.86)

Reference N = Sample description Reliability statistic

Intrarater reliability: same rater within one session (or one day)

Hughes, 19988 20 Community dwelling older adults ICC = .92

Katz-Leurer, 20089

Pediatric Physical Therapy

24

24

traumatic brain injury children (mean

age 9)

ICC(1,1)=0.86(CI .71-.94) SEM

0.60


Journal typical developed children (mean age

= 9)

ICC(1,1)=0.85(CI .74-.92) SEM

0.23

Botolfsen, 200810

28 older people with impaired mobility ICC(1,1)==0.68

Yeung, 200811

24 Patients on an inpatient orthopedic

rehabilitation ward 1 day

ICC(2,2)=.80 (CI .56-.91) SEM 10.2

sec, MDC(90) 24sec

Interrater Reliability

Podsiadlo, 1991 1 60 Community dwelling older adults ICC =.99

Shumway-Cook, 1997 12

30 Community dwelling older adults ICC = .98

Noren, 200113

19 Dx/o RA or other peripheral arthritis,

median age = 55

Agreement = R = .97

Test-retest reliability on the TUG are generally high .85 in people with PD to .99 in community dwelling

elderly, & children with CP. MDCs was lowest 3 for people with Alzheimers and highest 15 for adults for

people in nursing homes.

Test-retest reliability: same rater over time (e.g., 2 days; 1 week)

author n= population time frame correlation coefficient MDC

Podsiadlo,

19911

60 Community

dwelling older adults

ICC = .99

Rockwood,

200014

1115 Community

dwelling older

adults, cognitively

impaired &

unimpaired

ICC=.56

Gan, 200815

26 Children with

Cerebral Palsy

7-10 days

Initial mean

25.9(30.4)

ICC=.99 ( CI 0.98-0.99) MDC=8.2

Manor, 2007 20 adults with

peripheral

neuropathy

7 days 1 trial ICC(1,1) = 0.93 (

CI 0.86-0.96)

2 trials ICC(1,1) = 0.00

(0.98-0.99)

4 trials ICC(1,1) = 0.99

(0.99-0.99)

6 trials ICC(1,1) = 0.97

(0.94-0.99)

Steffen, 200816

37 Clients with

Parkinson’s disease

7-10 days

initial TUG mean

15(10)

ICC (2,1) = .85

MDC=11

Nilsagard,

200717

43 multiple sclerosis,

in Sweden

1 week ICC(2,1) =0.91( CI 0.83-

0.95)

Ries,200918

51 Alzheimers disease

tests separated by 30-

60 minute rest period

Initial Mean

mild to moderate

AD19.95(9.81)

moderately severe to

severe AD

28.1(17.49

ICC=.985-.988

MDC(90) =4.09

MDC (95)= 3.3

MDC(95)=6.8

Nordin, 200619

78 older adults with

arthritis in nursing

homes

5-7 days

30(17.4)

ICC= .92

(1,1) and (3,1)

MDC=15

seconds

Campbell,

200320

9 males with

parkinsons disease

within 7 days ICC=.72 MDC=4.83

seconds

Noren, 200113

22 adults with arthritis 2-7 days r=.97 unable to

calculate


Podsiadlo,

19911

22 older adults with

CVA,PD,RA, OA,

general

deconditioning,,

postsurg, hip fx

up to 5 weeks ICC=.99 unable to

calculate

Validity: TUG is correlated to gait speed around .70 in most studies. Many other tests are correlated with the

TUG but most at correlations .3-.5 There appears to be no gold standard to compare the mobility test TUG

with.

Construct / Concurrent Validity: It is difficult to always differentiate between these 2 types of validity. Evaluating this

property requires a “gold standard” measure with which to compare the tests results. Such a “gold standard” is often

not available.

Population N = Support for validity

s/p TKR and THR 78 The TUG is correlated with gait speed (r =.745 at admission, r = .816 at

discharge) unless gait speeds were faster than .5m/s or TUG scores faster than

30 s. The authors conclude that, in some elderly populations with orthopedic

problems, measuring both TUG and gait speed may not be necessary.21

Hip Fx 20 TUG correlated with FIM (r = -.47 at admission) and with self-paced walking (r

= -.68)22

Lower Limb

Amputation

84 TUG correlated with Frenchay Activities Index (r =-.486),23

Pre-total knee

arthroplasty

59 TUG correlated with: Voorips Questionnaire of physical activity (r = -.31). 24

clients with hip and

knee joint replacements

200 TUG scores correlate preoperatively with WOMAC (.29) and SF-36 physical

functioning (-.28) SF-36 role-physical (-0.21) at 12 week followup

WOMAC(0.43) p<0.0001 and SF-36 physical functioning (r=0-.39,) and SF-36

role-physical (r=0-.33)25

clients with lower limb

amputation

13 TUG correlates with 6 minute walk test (-.76)26

clients with hip

osteoarthritis

118 TUG correlates with WOMAC pain (.25), WOMAC function (.28) and SF-36

PF (-.34)It also helps predict the WOMAC function score when used in

regression.27

Older Adults in

residential care with

Mild Cognitive Imp.

17 TUG correlated with full turn test (r = .66), sit-to-stand test (r = .36), forward

reach (r = .57), one-legged stand (r= .31).28

Community dwelling

elderly

48 TUG correlated with: tandem balance (-.37); sit-to-stand (.37); grip strength (-

.40); bimanual dexterity (.46).29

30 TUG correlated with: composite score for Timed Movement Battery: self-

selected time (.89); maximum movement time (.79).30

20 TUG correlated with: Functional Stair Test (r = .59)8

60 TUG correlated with: Berg Balance scale (r = -.72), Gait Speed (r = -.55),

Barthel Index (r = -.51)1

81 TUG correlated with the four square step test (r = .88) and Functional Reach (r

= -.47).31

35 TUG correlated with: 4 of the 6 subscales of the Fast Evaluation of Mobility,

Balance and Fear Test (r = -.38 to .60).32

Frail Elderly 30 The TUG is correlated with all subscales of the SF-36: (r = -.36 to -.66).33

Home dwelling clients

with Parkinson’s

Disease

122 TUG scores correlate with UPDRS scores (.51-.58), H & Y scale (.45), and gait

speed (.21). When TUG was used in regression they were not shown to be

independent risk factors for falling.34

Older adults with

balance impairment

167 TUG correlated with: Maximal stepping task (r = -.68); rapid step test (r = .35);

tandem stance time (r = -.49); uni-pedal stance time (r = -.56); tandem walk (r =

.56); 6MW (r = -.75); POMA (r = -.65); EPESE physical function test (r = .50);

ABC (r = -.61).35


40 TUG is correlated with: gait speed (r =-.75), postural sway path (r=.50), step

frequency (r=-.59), step length (r=-.74)2

30 TUG scores were significantly higher (p < .0001) for elderly persons who had

difficulty in turning than for elderly persons who did not have difficulty

turning.36

Clients with

Huntington’s disease

30 TUG scores correlate with UHDRSfor measures of gait speed(0.72)for velocity

(0.67) for stride length (0.42) for cadence dynamic balance (0.33) for double

support, and (.63) for support base in meters, , falls and gait patterning (0.16)

for falls, CoV stride length (0.45) step time (0.54), CoV step time (0.66) and

measures of functional limitations HD-ADL (0.4) and total functional capacity

(-0.68)37

Older adults, fallers and

non fallers

21 TUG correlates with accelerometry (.62), with Berg (-.77)38

Patients with

Parkinson’s Disease

65 TUG correlated with Dizziness Handicap Index (-.42) and Barthel Index (.39)39


with Parkinson’s

Disease

122 TUG scores correlate with UPDRS scores (.51-.58), H & Y scale (.45), and gait

speed (.21). When TUG was used in regression they were not shown to be

independent risk factors for falling.34

Residents of long term

care facility

38 Higher levels of depression were associated with slower TUG scores (.30)40

Community dwelling

Post-menopausal

women in Australia

104 TUG (OR = 1.69, CI=.04-2.73) & speed of sound (SOS) calcaneal quantitative

ultrasound measurements helped predict falls risk.41

Older people in the

community

344 TUG correlated with Fall Risk for Older People-Community (FROP-Com )

(.63)42

Patients with type 2

diabetes

747 TUG (a measure of impaired mobility) was predicted by typed 2 diabetes,

female gender and BMI but not coronary stenoses or age,43

healthy older men 44 The study looked at the effect of graded doses of testosterone on physical

function and muscle performance TUG did not correlate with testosterone dose

or concentrations or changes in muscle strength or power.44

clients with multiple

sclerosis in Sweden

43 TUG correlated with 30 m timed walk test (.85) and with 10 m timed walk test

(.83).17

clients with acute stroke

(5 days post) in county

hospital in Sweden

Group1

30 in

2000 &

group 2

30 2004

TUG correlates with falls efficacy scale (FES) (-.70)/(-.55) and BBS (-.68)/ (-

.72) in group 1 & 2 respectively,45

postmenopausal women

with osteoporosis

53 mean

age 55

(43-73)

TUG and age (.42)46

adult survivors of

childhood acute

lymphoblastic leukemia

75 TUG was positively correlated with BMI (0.34)47

women with breast

cancer treated with

taxane chemotherapy

40 TUG correlated with COP (center of pressure), eyes open /head back (.55), eyes

closed/head straight(.50) and eyes closed/head back (.47)48

older adults in geriatric

unit of tertiary care

hospital

50 TUG correlated with L test( L test measure walking speed and resembles the

TUG except the path has 4 turns and is 20 meters) (.96),49

People with balance

deficits secondary to a

Vestibular disorder

32 TUG correlated with Four Square Step Test (FSST) (.69).50

community dwelling

older adults

67 TUG correlated with Ambulatory Self Confidence Questionaire (ASCQ)

(-.46) 51

elderly women 22 TUG correlated with height of subjects r=0.43 not age, body mass or BMI.3


PD 79 TUG correlated to OARS,(.37-.58) UPDRS total (.67), UPDRS ADL (.52),

UPDRS motor (.66), and HY stage (.71)52

elderly people in Europe 59 Correlation between the TUG and the GMF subscales(Gross Motor Function

Assessment Scale); dependence (0.68), pain (.37) and insecurity (0.55)at

baseline and was about the same at 3 weeks and end of rehab.53

D/c ambulatory OP

rehabilitation patients

215 No correlation between TUG and phase angle (derived from resistance and

reactance measurements obtained from bioelectric impedance analysis)54

children

Children with cerebral

palsy

26 The TUG and BBS (-0.88), FRT(-0.77)15

children in a

rehabilitation hospital,

traumatic brain injury,

cerebral palsy and

typically developed

60

N=15CP

N= 15

TBI

N=30TD

TUG correlates with step length and time with TBI children using preferred leg

step length NS/.88, non preferred leg NS/.62 time preferred leg NS/.67, timed

non preferred leg NS/.43Children with typically development (TD) and CP did

not have any significant correlation on these variables.55

children in a

rehabilitation hospital,

traumatic brain injury

and typically developed

48 Step length and TUG correlates (.53) among children post TBI only (n=24)It

was not correlated to step time or correlated in typically development children9

Predictive Validity

Summary: TUG cut off scores of 12-14 seconds are often used to predict falling. Not all studies were able to predict

falls using TUG.

Population N= Results

Community dwelling

older adults

167 TUG scores, adjusted for age & gender, were significant predictors of fall risk

(odds ratio = 1.70; p <.05) 35

older people with

history of falls

78 TUG scores were predictive of falls for single fallers n=17, 21.02(6,35) vs

controls 17,07(2.76) p=0.025 and in multiple fallers n=22, 42.11(23.18) vs

controls 17.34(3.6) p<0.00156

clients with


24 TUG scores predictive value for fallers for people with HD if ≥14 seconds.

Fallers (> or = 2 falls over 12 mos) TUG scores 15.6(7.7 to 52.6) non-fallers

12.6(7.7 to 16.6)57


with Parkinson’s

disease

122 TUG scores were not predictive of falling at least once in the last 3 mos based

on logistic regression. Although the mean scores were different fallers (n=43),

15.1(9,0) vs non fallers (n=79) 11.9(5.8)34

Clients with suspected

normal pressure

hydrocephalus

87 Initial TUG scores were not different for responders and non responders to

cerebral spinal fluid drainage. They were different post-drainage 29.91 (52%) to

57.28 (11%) seconds respectively58

community living

elderly adults France

2368 Women and men had an increased risk of failure (>12 sec) on TUG, older

participants with higher BMI, lower clock test scores, poorer health score, and

women’s use of psychotropic drugs also predicted scoring less than 12 on the

TUG using logistic regression. The MMSE did not predict scoring on the TUG

using a cutoff of 1259

clients on an inpatient

orthopedic

rehabilitation ward

142 TUG scores did not predict of length of stay11

medical clients 147 Initial TUG scores predicted length of stay in hospital using regression analysis.

TUG score was associated with increased adjusted hazard ratio for an adverse

event in 6 months.60

healthy volunteers 100 There was no significant difference in TUG between fallers n=11and non fallers

n=71, 9.4(3.4) and 7.98(2.3) respectively61

clients with ALS 31 TUG correlated with risk of falling 10% in the next 6 mos using a cutoff of 14

sec62

Community dwelling

Post-menopausal

104 TUG (OR = 1.69, CI=.04-2.73) & speed of sound (SOS) calcaneal quantitative

ultrasound measurements helped predict falls risk.41


women in Australia

elderly clients after

intravenous sedation

with midazolam

18 TUG correlated with dynamic balance test(CDP)(0.70)63

older adults 55 TUG was not correlated with disability components. It was correlated with

LLFDI(late life functional and disability Instrument) (-0.52)64

clients with hip fracture 196 Regression showed that poor TUG scores can be predicted with lower pre-

fracture function, increased age, having an intertrochanteric fracture,

performing TUG with a walker, and performing TUG in the later postoperative

period65

Discriminate Validity:

Population N= support for validity

clients with


30 TUG discriminates between Huntington’s disease severity stages:

HD stage 1 9.29(2.06), HD stage 2 11.07(2.4), HD stage 3 17.00(9.72)37

clients with Parkinson’s

disease

79 TUG discriminated between H&Y 2 versus 2.5/3(graphs presented not #)52

Sensitivity/specificity:

Therapists need to use cutoff scores based on patient population they treat. The sensitivity/specificity on the

TUG is variable with little consensus amongst researchers.

Population N= Cutoff Score and Description Results

Identifying

independence

in basic

mobility

60 Scores < 20 sec (n=17 of 60): all subjects were independent in basic

transfers (chair & toilet); most were able to go outside alone and climb

stairs; and many were independent for tub or shower transfers.1

< 20 sec = more

independent with

basic mobility

Identifying

older persons

who fall

30 Cutoff score of ≥13.5 sec. (community dwelling older adults)66

sensitivity = 80%;

specificity =100 %

81 Cutoff score of > 13 sec: (community dwelling elderly)31

sensitivity =89%;

specificity = 67%

278 Cutoff score of >16 sec (longitudinal study of community dwelling

older adults, non-fallers)67

sensitivity = 54%

specificity = 74%

180 Cutoff score of ≥ 20 sec (community dwelling elderly)68

sensitivity = 10%;

specificity = 95%

Identifying

increased

dependency

in basic

mobility

60 Scores > 30 sec (n =26 of 60): subjects tended to show increased

dependency in that many needed assistance with transfers; most

needed help in/out of tub or shower; and almost all were unable or

needed help with climbing stairs. 1

> 30 sec = more

dependent with basic

mobility

Clients with

Parkinsons

disease

120 Mak, 200969

TUG time of ≥16 seconds was independently associated with increased

risk of falling (1 fall in past 12 mos) OR=3.86, CI: 1.05. 14.2

TUG cutoff score of 13.569

TUG cutoff score of 20.1

Sensitivity 87%

specificity 36%

Sensitivity 59%

Specificity 10%

clients with

vestibular

disorders

32 Whitney, 200970

TUG>11.1 seconds gaze stability test (GST) cutoff value <63 for

yaw70

TUG>11.1 seconds GST cutoff value <65 for pitch

Sensitivity 100%

specificity 89%

LR =9.1

Sensitivity 100%

Specificity 82%

LR=5.6


post

menopausal

women in

Australia

104 Tan, 200841

The study looks at comparison of physical performance measurements

by osteoporotic fracture risk group

non osteoporotic group n=55

osteoporotic group n=49

TUG score

7.8(1.2)seconds

TUG score 8.4(1.4)

seconds

frail persons

living in

residential

care facilities

in Sweden

183 Nordin, 200871

(1 fall in 6 mos)

TUG cut-off 12 seconds

Sensitivity 98

specificity 13

TUG cutoff 15 seconds

sensitivity 96

specificity 32


sensitivity 79

specificity 32


sensitivity 62

specificity 62


sensitivity 49(

specificit72


sensitivity36

specificity86

TUG cutoff 40 seconds sensitivity26

specificity89

older

community

dwelling

women with

vertebral

fractures

104 Morris, 200772

predicting fallers (2+ falls)

TUG cutoff score 10 seconds

sensitivity 94.9%

specificity 10.6%


sensitivity 71.8%

specificity 42.6%


sensitivity 51.3%

specificity 63.8%

TUG cutoff score 25 seconds sensitivity 38.5%

specificity 76.6%


specificity 85.1%

TUG cutoff score 40seconds sensitivity 20.5%

specificity 93.6%


specificity 97.9%

clients with

unilateral

transtibial

amputation

40 Dite, 200773

predictive for falls (more than 1 fall in 6 mos)

TUG ≥ 19 seconds

sensitivity 85%

specificity 74%

older adults 974 Thrane, 200774

1 or more falls in 12 mos

TUG cutoff scores > 12 seconds n= (women/men) 239/114

sensitivity.44 /37%

specificity58/79%

TUG cutoff score > 13 seconds n=183/84

sensitivity 35/30%

specificity69/80%

TUG cutoff score >14 seconds n=142/190

sensitivity 26/20%

specificity75/90%

TUG cutoff score >15 seconds n=102/44 sensitivity 20/18%

specificity83/94%

TUG cutoff score >16 seconds n=86/27

sensitivity17/11%

specificty86/97%

TUG cutoff scores >17 seconds n=66/23 sensitivity 14/11%

specificity 90/98%


older men

and women

with hip pain

from

osteoarthritis

106 Arnold, 200775

(one fall in past 12 mos)

TUG >10 sec n=77

sensitivity faller 73%

specificity faller

35%

sensitivity near-faller

081%

specificity near-faller

36%

TUG >11 seconds n=56


specificity faller

55%

sensitivity near faller

68%

specificity near –faller

51%



specificity faller

70%


55%

specificity near- faller

70%



specificity faller

74%


45%

specificity near-faller

77%


sensitivity faller

27%

specificity faller

77%

sensitivity near-

faller36%

specificity near faller

79%

clients with

hip fracture

surgery

59 Kristensen, 200776

TUG as predictor of falls within 6 months after surgery

cutoff point > or = 20 seconds

sensitivity 95%

specificity10%

cutoff point > or= 24 seconds sensitivity 95%

specificity 35%

cutoff point > or = 30 seconds sensitivity 84%

specificity55%

cutoff point> or = 34 seconds sensitivity 74%

specificity 35%

NOTE: Clinicians need to choose a cut-off score based on the specific purpose for which the test is used

Responsiveness / sensitivity to change:

Summary: TUG is a responsive instrument to use to measure functional mobility in persons with musculoskeletal

disorders, and is frequently used to assess patients in rehabilitation. Higher scores in seconds indicate more

difficulty with the task and are often used as predictor for falls, although no particular score is a gold standard for

this.


Population

descriptor

N Reference, sample size,

intervention

Responsive

Yes / No

Data supporting

responsiveness

Community

dwelling

elderly

35 Gras, 2004 77

Rx 1: HEP hip strength/stretch

exercises

Rx 2: HEP ankle strength/stretch

exercises

Intensity: 5 days/wk, 3x/wk, x8

wks

no Mean scores (SD):

Rx 1:

Initial: 11.0(3.2) s

End: 10.3 (3.1) s NS

Rx 2:

Initial: 10.9 (3.4) s

End: 10.0 (2.0) s NS

99

Hakim, 2004

78

Rx 1 (n=29): Tai Chi exercise with

trained instructor

Rx 2 (n=29): Structured exercise

program

Control (n=41): no regular exercise

Intensity: 1-2x/wk for > 1 year

yes Mean scores (SD):

Rx 1 (Tai Chi): 8 (1.8)s

Rx 2: 9.5 (1.9)s

Control: 13 (7.7)s

Rx 1 (Tai Chi) >control

(p=.001), but Rx 1 = Rx 2

(NS)

45 Nitz, 2004 79

Rx: (n=24): functional balance

exercises + fall prevention

education

Control (n=21): open & closed

chain UE/LE ROM exercise + fall

prevention education

(see reference for excellent write-

up of interventions)

Intensity: 1 hr/session, 1x/wk, x10

wks


Rx:

Initial: 10.7(.6)s

End: 9.4(.5)s (p=.01)

Control

Initial: 10.4 (.7)s

End: 9.4(.5) (p=.018)

No significant diff between

groups

22 Robinson, 2004 80

Rx: (N=10 fallers, N=7 non-

fallers): falls prevention program

addressing strength, balance,

flexibility and education

Control (N=5): no intervention

Intensity: 50 min, 2x/wk, x 6 wks

plus daily by subjects at their home

not sensitive

to

intervention

Mean scores(SD):

Fallers:

Pre: 11.5 s

Post: 12.7s, NS

Non-fallers

Pre: 10.57s

Post: 10.86s, NS

Controls:

Pre: 8.4s

Post: 7.4 s, NS

Fallers and non-fallers needed

sign greater time to complete

TUG than controls (p<.01)

Community

dwelling

elderly

69 McMurdo, 1995 81

Rx 1 (n=21): stretching +

progressive strength exercises

Rx 2 (n=20): stretching exercises

Control (n=28): health education

Intensity: HEP with 24 daily

exercises, 15 min daily for 6 mos;

30 min visit from PT every 3-4 wks

for all groups

no Change in scores (pre to

post):

Rx 1: median = (-.1), range -

2.9 to 21.6, NS

Rx 2: median = (-1.8), range -

6.9 to 17.2, NS

Control: median = (.1), range

-18.3 to 47.1, NS

No significant diff between

groups


Seniors living

continuing-care

retirement

facilities

47 Edelberg, 2000 82

Rx: no specific Rx

Prospective study monitoring

ability to manage medication, x12

mos

Appears to

show change over time,

without Rx

Mean (SD):

Initial: 13.1(5.9)sec

6 mo: 17.5(10.8) sec

12-mo: 18.6 (16.3) sec

Both 6 and 12 month times

changed sig. from baseline

(p<.05)

Community

dwelling older

adults with hx

of falls

45 Rose, 2000 83

Rx (N=24): dynamic balance

training

Control (N=21): no alteration in

daily activity; no ↑ in exercise

Intensity: 45 min sessions, 2x/wk,

x 8 wks

yes Mean (SD):

Rx:

Initial: 14.5 (8.9)

End: 11.8 (6.2) (p<.01)

Effect size: small-mod = -.30

Control:

Initial: 12.4(5.7)

End: 12.7 (5.4)

Effect size: small = .03

Sig. difference between

groups (p=.026), effect size:

mod = -.54

Seniors living

continuing-care

retirement

facilities

47 Edelberg, 2000 82

Rx: no specific Rx

Prospective study monitoring

ability to manage medication, x12

mos

Appears to

show change over time,

without Rx

Mean (SD):

Initial: 13.1(5.9)sec

6 mo: 17.5(10.8) sec

12-mo: 18.6 (16.3) sec

Both 6 and 12 month times

changed sig. from baseline

(p<.05)

Community

dwelling older

adults w/ knee

OA, awaiting

TKR

59 Thomas, 2003 24

No Rx

Adults w/ OA (n=59) compared to

adults w/o OA (n=79)

yes

Sensitive to

group diff

Mean (SD):

Males w/ OA: 10.0 (.5) sec

Females w/ OA: 13.8 (.4) sec

Males w/o OA: 7.4 (.5) s

Females w/o OA: 7.6 (.3) s

Group diff: p<.001

Older Persons 97 Hui, 200984

Intervention group n=52

23 sessions of dance over twelve

weeks

Control group n=45

no intervention

yes

Baseline 7.5(1.43)

three months 6.97(0.92)

change -0.58(0.95)

baseline 7.58(0.95)

three months 7.47(1.12)

change -1.12(0.62)

p=0.01

Clients with

hip and knee

joint

replacements

200 Gandhi, 200925

preoperative TUG scores n=200

12 week follow-up n=200

yes

18.6(7.9) seconds

12.8(4.7) seconds

p ˂ 0.0001

Residents of

geriatric

facility with

knee OA

24 Ng, 2003 85

Rx 1(N=8): Electroacupuncture

Rx 2 (n=8): low-frequencyTENS

Control (n=8): OA knee care &

education

Intensity: 8 sessions in 2 weeks, 20

min/session

yes Mean (SD):

Rx 1: initial: 22.25 (9.72)

End: improved 11% (p<.01)

2 wk p Rx: NS diff from

initial

Rx 2: initial: 26.25 (15.63)

End: improved 7% (p<.05)

2wk p Rx: NS diff from initial


Control: initial: 32.19 (8.90)

End: no significant change

Older females

who have or

are at risk for

osteoporosis

31 Murphy, 200886

Intervention was 2x/wk 12 weeks

of Tai Chi 1day at home

yes

post intervention -1.4,

p<<0.0001 n=31

6 months post intervention

-1.4, p<0.0001 n=29

12 months post intervention

-1.1 p<0.001 n=30

older residents

living in

residential care

facility in

Aukland, New

Zealand

149 Peri, 200787


individualized activity program

based on ADL 1x/week

control group n=76

no individualized program

no

baseline 29.2(2.4)

3 months 27.8(2.4)

6 months 30.2(2.4)

baseline 29.9(2.3)

3 months 28.4(2.4)

8 months 29.8(2.4)

p=NS

clients with

mild hip or

knee

osteoarthritis in

the Netherlands

104 Wetzels, 200888

Intervention was self

management by client in one of

four areas of exercise, weight

loss, use of walking aid or use of

pain medications

no

both groups improved in TUG

no stats givens

Clients

following total

knee

arthroplasty

66 Bruun-Olsen 200989


CPM and active exercise

Control Group n=33

active exercise alone

yes preoperative TUG 12(4) s

3 months postoperative TUG

11(5) s

preoperative TUG 13±6 s

3 months postoperative TUG

12(6) s

elderly

inpatients

62 Tal-Akabi,200790

intervention group n=33 received

high intensity strength training 3

weeks

control group n=29 received

regular intensity strength training

Both groups

improved

baseline 27.6

final 15.90

p<0.0001

baseline 29.6

final 17.60

Community

dwelling

elderly with

OA

18 Hinman, 2003 91

With-in subject design with 3

conditions:

Condition 1: Untaped

Condition 2: wearing therapeutic

knee tape

Condition 3: wearing neutral knee

tape

no No significant difference on

TUG scores between

conditions, NS


sedentary

adults

453 Shumway-Cook,200792

intervention group n=212

received 1 hour, three times per

week group exercise, 6 hours of

fall prevention education,

comprehensive falls risk

assessment

control group n=217

received written materials on fall

prevention

yes

baseline10.5(2.8)

final 9.1(3.5)

baseline 10.8(3.3)

final 10.1(4.4)

p=.005 between group

comparison

community

dwelling

elderly

individuals

with chronic

anemia

62 Agnihotri, 200793

phase 1 intervention weekly for

16 weeks, subcutaneous epoetin

alfa n=32

placebo=26

phase two crossover to opposite

treatment

epoetin alpha n=24

placebo n=30

no

27.9(2.8)

27.9(3.2) p=NS

23.8(1.7)

24.5(1.5 )p=.NS

community

dwelling older

adults

40 Cromwell, 200794

intervention group n=20, Tae

Kwon Do exercise class one hour

twice per week for 11 weeks

control group n=20 no exercise

yes

pretest 9.5(1.7)

posttest 8.6(2.1)

p<.05

pretest 11.3(2.7)

posttest 10.9(2.9)

community

living elderly

adults

37 Nakagawa, 200795

control group n=17

no exercise instruction


received instruction in trunk and

lower extremity strengthening

program. Told to exercise 2-

3x/week

yes

before intervention

male n=11 5.8(0.97)

female n=6 6.3(1.47)

after intervention

male 5.5(70) p=NS

female 6.0(.78) p=NS

before intervention

male n=13 6.9(2.43)

female n=7 61.(0.91)

after intervention

male 6.4(1.68) p=NS

female 5.7(0.90) p=NS

clients with hip

fracture

72

Ganz, 2007

96

surgical repair

mean(SD)

admission 6.95(43.9)

discharge 32.8(18.7)

p=0.001


Women in

nursing home

10 Connelly, 1997 97

Rx: low intensity, progressive

resistance quad strengthening

Intensity: 3x/wk, x8 wks

strengthening (follow-up @ 1 yr

post exercise)


Post-exercise: 15.9 (7)s

1 yr after end-exercise:24.5

(15)s

P<.05

Frail elderly

residents of

LTC facility

20 Baum, 2003 98

RCT with semicrossover:

Rx: group exercise (n=11): group

exercise; seated strength and

flexibility

Control(N=9): Recreational

therapy (after 6 months this group

also began exercising)

Intensity: 1 hr, 3x/week for 6

months

Follow-up x 1 year

yes Mean:

Rx:

Initial:45 sec

End change: 18 sec faster

(improved)

Control:

Initial: 49 sec

End change: 5.5 sec slower

(worse)

Control crossover:

Initial: 49 sec

End change: 24 sec faster

(improved)

All data: Effect size: .54

Community

dwelling older

adults with dx/

o Diabetes

31 Brandon, 2003 99

Randomized repeated measures

controlled trial:

Rx (N=16): LE strength training

at 50, 60, 70% of 1 rep max

Control group (N=15): not

described

Intensity: 3 sets of 8-12

reps/exercise, 2.6 days/week for

24 months

no Mean (SD):

Rx:

Initial: 8.2 (2.1) sec

6 mos: 8.0 (2.5) sec

24 mo: 7.6 (1.8) sec, NS

Control:

Initial: 8.1 (2.2)s

6 mos: 7.4 (1.4) sec

24 mo: 8.3 (1.0) sec, NS

Elderly in adult

day care, with

dx/o mild

dementia

13 Thomas, 2003 100

(Ave MMSE=18)

Pretest-posttest design

Rx: Moderate-intensity

progressive resistive training of

Les using theraband Intensity: 1

set of 15 reps, ave. of 2x/wk for

6 weeks

no Mean (SD):

Pre: 25 (13.29) sec

Post: 21.3 (10.30)sec

14% improvement in TUG, NS

Effect size: -3.47 ±14 (small)

Frail Elderly LaStayo, 2003 101

Rx: High force LE eccentric cycle

ergometer

Control: traditional LE resistance

exercise

Intensity: 11 weeks, 3x/week, 10-

20 minutes

yes Mean (SD):

Rx:

Pre:16.65 (.81) sec

Post: 11.96 (.72) sec (p<.05)

Control:

Pre: 17.20 (.87)

Post: 15.55 (1.45) sec (p<.05)

Between group diff = NS

s/p Hip fx 56 Crotty, 2003 102

Rx 1 (n=28):early discharge /

home-based rehab program

Rx 2 (n=28): Hospital-based team

rehabilitation (usual care)

Intensity: no information

yes Median scores:

Rx 1:

Initial: 37s

After 1 yr: 19s, p<.003

Rx 2:

Initial: 41.5s

After 1 yr: 24.5s, p<.001


Population

descriptor


intervention

Responsive

Yes / No

Data supporting responsiveness

s/p Hip fx 20 Mendelsohn, 2003 22

Rx: Intensive in-patient rehab

program

Intensity: approx 80 min/session,

5x/wk, 3-5 wks

yes Mean (SD):

Initial: 49(26) s

End: 28(9)s

p<.01

clients with hip

fracture in an

inpatient

rehabilitation

unit

20 Mendelshon, 2008103

Both groups received physical

and occupational therapy 5 times

a week

training group n=10 used an arm

crank ergometer 3 times per

week for 4 weeks

control group n=10 received no

additional training

yes

mean(SD)95%CI

admission 93.3(40.2) (67-120)

discharge24.7(8.7) (19-30)

admission91.2(23.6) (76-107)

discharge 39.5.4(12.34)(31-48)

p<.05 between group

comparison

clients with

total and hemi

hip arthroplasty

in treatment of

displaced

femoral neck

fracture

40 Macaulay, 2008104

Intervention: hemiarathroplasty

n=23

Intervention: total hip

arthroplasty n=17

no

16.5 (10.1)

17.2(13.5)

p=NS

older hip

fracture clients

53 Mard, 2008105


12 week supervised intensive

progressive strength-power

training twice per week

control group n-29 maintained

pre study level of activity

no

baseline 7.9(2.2) seconds

end 7.9(2.7)seconds

baseline 9.3(3.4)

end 8.9(2.5)

p=NS

clients in

inpatient

rehabilitation

unit

165 Gosselin, 2008106

intervention was inpatient

rehabilitation

comparison of TUG score of

patients older than 65 years

n=17

patients less than 65 years old

n=42

Yes for

rehab

No diff

between age

groups

differences between admission

and discharge

5.4(5.8) p<0.01

8.7(15.9)p<0.01

p=NS between groups

Women

postmenopause

53 Gunendi,200846

Group 1 n=26 postmenopausal

women with osteoporosis

intervention was submaximal

aerobic exercise program on

treadmill, lasting for 30 minutes,

twice a week for 4 weeks

group 2 n=25 postmenopausal

women without osteoporosis

received no intervention

yes

initial 7.1(0.6)

final 6.2(0.8)

p<0.001

initial 6.9(1.2)

final 6.8(1.2)

p=NS


Nursing home

residents

31 MacRae, 1996 107

Rx (n=19): Supervised self-

paced walking program

Control (n=12): social visit,

1x/wk

Intensity: 5 days/wk, x12 weeks,

times increased 10% weekly

no Mean scores (SD):

Rx:

Initial: 24 (17) s

End: 36(27)s

Control:

Initial: 40(34)s

End: 34(14)s

NS

28 Carmeli, 2000 108

Rx: supervised group exercise

(warm-up; aerobics;

strengthening; stretching;

relaxation)

divided into males(A) and

females(B) and

younger old (1) and older old

(2):

Control (n=29): non-exercising

Intensity: 3x/wk, x12 week

no in

“younger

old”

yes in

“older old”

Mean scores:

Rx:

A1: pre: 9.2; post: 8.3s

A2: pre: 15.7; post: 11.4s (p<.05)

B1: pre: 10.2; post: 9.2s

B2: pre: 14.2; post: 10.1s (p<.05)

Control: pre: 9.1 s; post: 9.0 s

Older adults in

residential care

with mild

cognitive

impairment

17 Carmeli, 2003 28

Rx (N=17): ball exercises and

walking program

Control A: in residential care,

with cog imp (N=12): no Rx

Control B: in community, w/o

cog imp (N=20): no Rx

Intensity: 5 days/wk for 27

weeks

no Mean (SD):

Rx:

Pre: 24.2 (2.4) s

Post: 21.5 (3.6)s, NS

Control A:

23.9 (2) sec

Control B:

18.1 (3.5)

Controls signif diff than post-

exercise group: (p<.05)

26 Carmeli, 2002 109

Rx: (N=16) treadmill walking

program

Control (N=10): non-walking

group

Intensity: time initially 10-15

min and increased to 45min;

3x/wk for 25 weeks

yes Mean (SD):

Pre: 28.5 (4)s

Post: 25.9 25.9 (3) sec

Mean difference: -3.2 (9%)

(p<.05)

Outpatients with

hemiplegia, s/p

stroke

13 Geiger, 2001 110

Rx (N=7): same tx as control

group plus Balance Master

training

Intensity: 2-3 sessions/wk on PT

interventions (35 min), 15 min

on Balance Master

Control group (N=6): PT to

improve muscle force, ROM,

balance and mobility

Intensity: 50 min, 2-3 x/wk, x4

weeks

yes Mean change pre to post (SD):

Rx: -5.69 (5.64) sec

Control: -8.79 (9.68) sec

Diff between groups, NS

Combined groups:

Pre: 23.08(13.7)

Post: 14.62(11.18) (p<.008)


Population

descriptor


intervention

Responsive

Yes / No


clients post

stroke , long-

term survival

13 Sharp, 1997 111

Rx: LE strengthening &

stretching exercises

Intensity: (3 days/wk, 40

min/day, x6 wks)

no Mean scores(SD):

Initial: 31 (27) sec

End: 30 (27 sec)

Follow-up (4 wks): 31 (31) sec

NS clients post

stroke

46 Walker, 2000 112

Rx 1(n=16): regular therapy +

visual feedback training on

Balance Master

Rx 2(n=16): regular therapy + 30

min balance training

Control(n=14): regular PT/OT

therapy

Intensity: 2 hrs minimum, 5

days/wk, 3-8 wks

yes Mean (SD):

Rx 1:

Initial: 54.2 (34.4)

Discharge: 33.4 (20.3)

1 month p d/c: 28.2 (20.2)

Rx 2:

Initial: 45.8 (26.8)


1 month p d/c: 17.8 (9.8)

Control:

Initial: 52.8 (40.1)


1 month p d/c: 28.8 (25.2)

All groups improved

significantly over time (p<.001)

Bilateral

vestibular loss

9 Brown, 2001 113

Rx: Customized PT program,

with vestibular adaptation,

balance and gait training,

strengthening and flexibility

Intensity: 2-9 visits

yes Mean scores:

Initial: 22s

End: 18 s

p=.007

Dx/o

Osteoporosis

and vertebral fx

Papaionnou, 2003 114

Rx (N=37): Home-based

exercise program following

“lifestyle exercise”

Control (N=37): no exercise

Intensity: 60 min/day, 3 days/wk

for 12 months

no No significant change in TUG

scores after 6 or 12 months.

s/p Lumbar

surgery

Kumar, 2001 115

Grp 1: (N=28) Lumbar fusion for

degenerative disc disease

Grp 2: (N=28) S/p DDD surgery

w/o fusion

no NS difference between 2 grps

Persons

attending

geriatric day

hospital

Malone, 2002 116

Clients received at least 5 visits

yes Significant improvement at

discharge

Persons with

residual gait

deficits

50 Salbach, 2001 117

(SRM has

been used to indicate

responsiveness of a measure to

change; SRM = mean change

score / SD of change score )

yes SRM (standardized response

mean) = .73

stroke survivors

with low hand

function

3 Carter, 2008118

Intervention was structured

whole body, increased intensity,

activity dependent practice

strategy

yes meanTUG score

initial 14.9 seconds

post 6.8 seconds


clients who use

cane for

ambulation

assist

47 Marston, 2007 119

Comparison of patients using

moulded vs conventional cane.

yes mean change in

tug score for moulded stick -

5.3(6.5) and for conventional

cane 1.8(3.9)

Older adults 1165 Dam, 2008120

In women, not men, lower

25(OH) Vitamin D levels were

associated with impaired

performance on TUG

yes

Men baseline 10.8(2.8)

absolute change baseline to

follow-up .22(2.4)

percent change 3.3(20.1)

Women baseline 10.9(3.1)

absolute change 1.19(3.1)

percent change 11.2(26.6)

Persons with

Multiple

Sclerosis

16 Widener, 2009121

The study looked at whether

weight placed on the trunk in

response to directional balance

loss would enhance function and

stability in people with MS using

BBTW( balance based torso

weighting )

yes

baseline15.2(14.1)

no weight 14.3(13.9)

BBTW 13.6(12.1)

p=0.03

chronic stroke

survivors

30 Wing, 2008122

intervention was comprehensive

stroke rehabilitation

yes pretest 31(7.8 )seconds

posttest20.2(3.9) seconds

p=.03

In hemiplegic

clients,

4 Pavlik, 2008123

TUG scores compared with AFO

and without AFO

mean with AFO 27.5(19.87)

without AFO 30.92(17.99)

p=NS

Community

dwelling older

people in Japan

71 Arai, 2007124

Intervention was 3 months of

exercise sessions

yes pre 8.3(3.2) seconds

post 7.6 (3.6)

follow up 7.9±4.2

p=0.01

post

menopausal

women in

Australia

104 Tan, 200841

The study looks at comparison of

physical performance

measurements by osteoporotic

fracture risk group

non osteoporotic group n=55

osteoporotic group n=49

no

TUG score 7.8(1.2) seconds

TUG score 8.4(1.4 )seconds

p=NS clients

following

transtibial

amputation

27 Johannesson, 2008125

removable vacuum formed rigid

dressing n-13

conventional rigid plaster of

paris dressing n=10

no

41(24) seconds

29(14) seconds

mean difference 14(-2-30)

p=NS

at the 3-month follow-up


Population

descriptor


intervention

Responsive

Yes / No


clients with

rheumatoid

arthritis in

warm or cold

climates

124 Staalesen Strumse, 2009126

intervention was 4 week

rehabilitation

Mediterranean climate n=72

Norwegian climate n=52

both made

progress,

climate did

not matter

baseline 13.9(2.4)

week 4 - baseline-1.5(1.4)ok

week 16 - baseline -0.7(1.6)

p=0.001

baseline 14.4(3.2)

week 4 -1.6(2.5)

p=0.001

week 16 -1.2(2.4)

p=0.002

No difference between groups

clients with

COPD from an

institutional

pulmonary

rehabilitation

program

19 Chang,2008127

The study assessed the effect of

an exercise task(6 minute walk

test) on TUG performance

no pre exercise score 8.77(1.95)

post exercise score 9.01(2.27)

p=NS

community

dwelling

elderly

19 Batson, 2008128

intervention was 2 weeks of

balance instruction using

Alexander technique

yes pretest average 11.22 seconds

posttest average 9.53 seconds

p=0.006

residents of

care homes

249 Sackley, 2007129


PT and OT targeted to mobility

control group n=121 received

standard care

no baseline 60(42)

three months 68(50)

six months 59(37)

baseline 57(54)

three months 59(56)

six months 55(37)

Effects of drug

therapy

TUG has been used to assess the effects of drug therapy 130, 131

especially the “on” and “off” phase

of the levodopa cycle in patients with PD.

Ceiling & floor effect: This issue has not been discussed in the literature. The TUG test is limited to those who can

independently stand up and walk 3 meters with or without an assistive device.

Reference data:

Subjects TUG

(N=10) (ages 70-84, mean 75 years)

Healthy men and women1

Mean =8.5 sec (range, 7-10 sec)

(N=20) (ages 65-86 years)

Independent community dwelling elderly persons8

Mean(SD) =13.05 sec (2.6)

(range 8.7-17.3)

(N=251) (mean age 74, range 60-95)132

Community dwelling older adults; study included 31 persons using an

ambulatory device and the test protocol varied from the original in use of a

10-foot distance from the chair to the turn around point and a 41-cm chair

height.

Mean (SD) = 15 sec (6.5)

(range 5.4-40.8 sec)

(N=92) People who return to the community after a hip fracture vs. healthy,

matched cohort (N=92)133

Follow-up was at 6-12 months after surgery.

Mean= 19s (s/p hip fx)

= 10.5 s (matched cohort)

*differences despite age and gender

match. This means many do not

return to prefracture lifestyle.


(N=1805) (mean age=66)

Large study of clients awaiting THA or TKA, males and females134

Males Mean score= 14.3 + 7.5 sec

Females Mean score= 16.4 + 7.3 sec

(N=19) Subjects with total hip arthroplasty for osteoarthritis vs. control

(N=5) 135

Women awaiting arthroplasty took 2.2 times longer and men took

1.9 times longer to complete the TUG compared with their healthy controls.

Pre-op Patients= 14.3s

Control= 9.5 s

136

(n=240) Ambulatory middle aged and elderly subjects in Turkey TUG scores were significantly

different for age groups in males and

females. TUG scores decrease with

age. There was no significant

difference in the scores for fallers

and non fallers in the TUG

n=85, people admitted to acute geriatric or old age psychiatry ward in the

Netherlands in 2004-5137

median 19.3(5-134)seconds

54 n=215 ambulatory rehabilitation patients ,men 31.7(29.2), women 33.7(21.8)

Several studies give test scores for client populations.6, 32, 138-141

There is no consensus in the literature regarding the effect of aging on TUG scores.138, 140, 142

Vereeck 143

n=78 TUG time and age (0.82) Women score significantly less than men in asymptomatic

adults in Belgium

Table 1 shows reference data by gender for 60-89 year olds.144

Lusardi, et al (2003) reported TUG scores by decades

and gender for community dwelling elderly; sample sizes in the 80-89 year and 90-101 age groups are useful.145

These 2 data sets demonstrate an increased (slower) score on TUG as one ages.

Table 1.

Timed-Up and Go Scores: Means (X), Standard Deviations (SD), and 95%

Confidence Intervals (CI), by Age and Gender (seconds)

Timed-Up and Go

Age (yrs) Gender N X SD CI

60-69 Male 15 8 2 7-8

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

Interpreting results: Two studies of community dwelling older adults showed that TUG scores >13 seconds

correctly categorized fallers (sensitivity 80- 89%).12, 31

Compare patient/client test results to the 95% confidence

intervals in the reference data, categorized by age and gender (see Table 1).


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