The Timed Up and Go Test (TUG) assesses mobility, balance, walking ability, and fall risk in older adults.
Less than 3 minutes
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.
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
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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
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:
(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)
Alzheimer’s Disease:
(Ries et al, 2009, Alzheimer’s Disease)
Alzheimer’s Disease:
(Ries et al, 2009, Alzheimer's Disease)
Chronic Stroke:
(Flansbjer et al, 2005; n = 50; mean age = 58 (6.4) years; 6-46 months post-stroke; Swedish sample, Chronic Stroke)
Chronic Stroke:
(Flansbjer et al, 2005)
Stroke:
(Flansbjer et al, 2005; 7 days between assessments, 16 to 18 months from stroke onset to initial assessment, Chronic Stroke)
Stroke:
(Flansbjer et al, 2005, Chronic Stroke)
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 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)
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)
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.)
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)
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)
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
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
SCI:
(In Lam 2007, calculated from, van Hedel 2005, n = 20, Acute SCI)
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)
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 36.7SCI:
(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)
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)
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)
Community-Dwelling Elderly People with a variety of medical conditions:
(Podsiadlo and Richardson, 1991)
TUG score (sec)
Functional Mobility Skill
independent for basic transfers
dependent on transfers, needed help to enter/ exit shower or tub, did not go out alone
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
Mean
SD
95% CI
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
FIM
Community-Dwelling Elderly People:
(Steffen et al, 2002, Community-Dwelling Elderly)
(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 the cognitively unimpaired (ICC = 0.50)
Community-Dwelling Elderly People with a variety of medical conditions:
(Podsiadlo and Richardson, 1991; n = 24)
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)
Older People Residing in Residential Care Facilities: (Nordin et al, 2006, Older People in Residential Care Facilities)
Elderly Adults:
(Podsiadlo & Richardson 1991; n = 60 patients referred to a geriatric day hospital; mean age = 79.5 years)
(Wrisley and Kumar, 2010; n = 35)
(Bhatt T et al, 2011)
Discriminant Validity:
Geriatric Rehabilitation:
(Brooks et al, 2006)
* 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)
Community-Dwelling Older Adults with vestibular disorders:
(Marchetti et al, 2011)
Elderly Adults:
(Rockwood et al, 2000, Elderly Adults)
Older Acute Patients:
(de Morton et al, 2008; literature review included 178 studies, Older Acute Patients)
Community-Dwelling Older Adults:
(Lin et al, 2004; in terms of Effect Sizes (ES), Community-Dwelling Older Adults)
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.
Bilateral Vestibular Hypofunction
(Brown et al, 2001)
Unilateral Hypofunction:
(Gill-Body KM, et al 2000)
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)
Vestibulopathic Elderly:
(Whitney SL et al, 2004)
(Caixeta GC et al., 2012)
Convergent Validity:
Community-Dwelling Older Adults with vestibular disorders:
(Marchetti et al, 2011)
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)
Osteoarthritis:
(Wright et al, 2011; n = 91; mean age = 66.3 (9.4) years; duration of symptoms ranging from < 1-10 years, Hip Osteoarthritis)
Convergent Validity:
Osteoarthritis:
(Maley et al, 2005; n = 54; mean age = 68.3 (8.7) years; physician-diagnosed medial-compartment knee OA, Osteoarthritis)
(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)
(Sabirli et at, 2012, Osteoarthritis)
Osteoarthritis:
(French et al, 2010; n = 39 knee OA patients undergoing physical therapy; mean age: 65.3 (6.9) years, Osteoarthritis)
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)
(Dal Bello-Haas et al, 2011, Parkinson's Disease)
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rehabilitation measuresWe have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.