Timed Up and Go test (TUG)

What the Timed Up and Go test measures

The TUG is a quick test of basic mobility. It puts several everyday tasks into one timed trial: getting up from a chair, walking, turning and sitting back down. Podsiadlo and Richardson described it in 1991, as a timed version of the older "Get-Up and Go" test, in 60 patients referred to a geriatric day hospital (mean age 79.5 years).

In that study the time was reliable between and within raters. Using log-transformed scores, it correlated well with the Berg Balance Scale (r = -0.81), gait speed (r = -0.61) and the Barthel Index (r = -0.78). The authors noted that it is quick and needs no special equipment or training.

How to do the TUG test

You need a stopwatch, a standard chair with arms and a line on the floor 3 meters (about 10 feet) from the chair. The Geriatric Assessment Tool Kit from the University of Missouri gives the seat height used in the original directions as about 46 cm.

1. The patient wears their regular footwear and uses their usual walking aid, if they have one. Give no physical help, but stay close for safety.
2. They sit with their back against the chair and their arms on the armrests, with the walking aid at hand.
3. Say: "When I say 'go', I want you to stand up, walk to the line at your normal pace, turn, walk back to the chair at your normal pace and sit down again." This is the CDC STEADI wording. The original study asked for a comfortable and safe pace. Pick one wording and use it every time you retest the same patient.
4. Start timing on the word "go". Stop timing when the patient is sitting back down.
5. Record the time in seconds and note which walking aid was used.

In the original directions the patient walks through the test once before the timed trial, so they know what to do. The CDC STEADI form also asks you to watch how they move, for example a slow tentative pace, loss of balance, short strides, shuffling, turning en bloc or steadying themselves on the walls. The form notes that these signs may point to neurological problems that need further evaluation.

How to read the result

Bohannon (2006) pooled 21 studies of apparently healthy people aged 60 and over to give reference values by age. The table shows the mean TUG time for each age group and its 95% confidence interval.

Bohannon suggests that a patient whose time is above the upper limit of the confidence interval for their age can be considered to have worse than average performance. Keep in mind that the confidence interval describes the average, not the full spread of healthy people. The pooled studies also differed from each other, a point Bohannon makes himself.

These values start at age 60. Younger adults have no matching group in this table, so the calculator does not compare them.

The TUG falls-risk cutoff and its limits

The cutoff most often quoted is 13.5 seconds or longer. It was first described by Shumway-Cook and colleagues in 2000, in a study of 15 community-dwelling older adults with no history of falls and 15 who had fallen 2 or more times in the previous 6 months, aged 65 to 95. The CDC STEADI toolkit uses a lower screening threshold: an older adult who takes 12 seconds or more is at risk for falling.

A single cutoff should not be used on its own to judge falls risk. Barry and colleagues (2014) reviewed 25 studies and pooled 10 of them. At 13.5 seconds, pooled sensitivity was 0.31 (95% CI 0.13 to 0.57) and specificity was 0.74 (95% CI 0.52 to 0.88).

In plain terms, most people who went on to fall scored under the cutoff. The authors concluded that the TUG has limited ability to predict falls in community-dwelling older people and should not be used in isolation. They also pointed to the small case-control design of the original study.

So a fast time does not rule out falls risk, and a slow time is a reason to look further, not a diagnosis. Barry and colleagues advise assessing falls risk in a thorough way that accounts for the many causes of falls, rather than relying on a single test of mobility.

Sources

1. Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society. 1991;39(2):142-148. doi:10.1111/j.1532-5415.1991.tb01616.x
2. Bohannon RW. Reference values for the timed up and go test: a descriptive meta-analysis. Journal of Geriatric Physical Therapy. 2006;29(2):64-68. doi:10.1519/00139143-200608000-00004
3. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Physical Therapy. 2000;80(9):896-903. doi:10.1093/ptj/80.9.896
4. Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC Geriatrics. 2014;14:14. doi:10.1186/1471-2318-14-14
5. Centers for Disease Control and Prevention. STEADI assessment: Timed Up and Go (TUG). 2017. cdc.gov/steadi
6. University of Missouri Geriatric Assessment Tool Kit. Timed Up and Go test (TUG), directions after Podsiadlo and Richardson 1991. geriatrictoolkit.missouri.edu
7. Shirley Ryan AbilityLab Rehabilitation Measures Database. Timed Up and Go instructions, derived from Podsiadlo and Richardson 1991. sralab.org

This tool compares a TUG time with published values for education. It is not a medical assessment.