Description #
This unit will describe the correct administration, scoring and interpretation of the Timed Up & Go (TUG) test performed for TJA patients.
Learning Objectives #
By the end of this unit, the learner will be able to perform the following tasks for TJA patients:
– Administer the Timed Up & Go (TUG) test
– Score the Timed Up & Go (TUG) test
– Interpret the Time Up & Go (TUG) test
What is the Timed Up and Go Test? #
The Timed Up and Go (TUG) Test is a valid3,4, reliable5,6, and responsive6,7 measure that is useful for assessing THA and TKA patients and falls within the WHO’s ICF domain of Activity9 (Figure 1). The TUG measures strength, agility, mobility and dynamic balance by having the patient rise from a chair, walk a short distance (3 metres), change direction and then return to the chair1,2. In addition, it can be completed relatively quickly requiring approximately 2 minutes to administer and score.
Figure 1. The International Classification of Functioning, Disability and Health (ICF) Conceptual Model. Taken from Riddle, D. & Stradford, P. (2013). Is this Change Real? Interpreting Patient Outcomes in Physical Therapy. Figure 2-110.
When do I use it? #
When do I use the Timed Up and Go Test? #
The Timed Up and Go (TUG) Test can be used in all phases along the TJA Continuum of Care. Specifically, as seen in Figure 2, the TUG is recommended for use in the Pre-Operative, Acute, Post-Acute, and Active Living phases. Health professionals can therefore use this outcome measure to monitor change in the patient’s status as he or she moves through these phases of care.
Figure 2. The phases along the TJA Continuum of Care for which the TUG Test is recommended.
Equipment needed? #
What equipment is used to perform the Timed Up and Go Test? #
To perform the Timed Up and Go (TUG) Test with a patient, the following pieces of equipment are required:
- Standard arm chair (44 – 46 cm seat height) backed against a wall
- Stopwatch
- Tape or other marker on the floor 3 metres away from the chair
- The patient’s usual walking aid if they use one.
Floor and ceiling effects for the TUG have been reported in the TJA population.
- Floor effects have been reported in acutely hospitalized older adults with about 25% of them being unable to perform the test8.
- Ceiling effects were found in patients 6 months prior to TJA surgery6.
How do I administer the Timed Up and Go Test? #
- A written version of the instructions can be found at the following link → Instructions
- Do you want all the module information on a single piece of paper? If so, click this link! → TUG Test One Pager
How do I score the Timed Up and Go Test? #
Scoring the Timed Up and Go (TUG) Test is easy to do:
- Measure the total time it takes the patient to rise from the chair, walk 3 metres, turn around, return to the chair and sit down.
- Two trials should be performed by the patient and the faster of the two is recorded to the nearest 10th of a second1.
What does it mean? #
How do I interpret the Timed Up and Go Test? #
It is simple to interpret the Timed Up and Go (TUG) Test: the faster a person can safely complete the TUG, the better their performance. Furthermore, did you know that a TRUE CHANGE is indicated by an improvement of only 2.49 seconds in patients with hip and knee OA awaiting TJA6? It’s true! It has been established that the:
MDC is 2.49 sec in patients with advanced hip and knee OA awaiting TJA6
- What does this mean for my patient? It means that the change in score between test occasions must be greater than 2.49 sec in order to reflect a true change and not just measurement error.
MCID is 0.8 – 1.4 sec in patients with hip OA5
- What does this mean for my patient? It means that in patients with hip OA, the change in score between test occasions must be greater than or equal to 1.4 seconds, in order to indicate that a clinically meaningful change has occurred.
DID YOU KNOW?
If the patient scores:
- ‹ 20 sec – it indicates independence with most ADLs and outdoor mobility
- 20-29 sec – it indicates probable need for a gait aid and supervision for outdoor mobility
- ≥ 30 sec – it indicates that these patients will need assistance with many mobility tasks, such as chair, toilet, tub, and shower transfers. Furthermore, patients who score ≥ 30 are unable to climb the stairs without assistance and require the use of a gait aid for ambulation1,2.
Examples #
Mr. S has advanced hip OA and is awaiting THA. He has come to your clinic so that he can improve his strength, balance and ambulation prior to receiving surgery. On initial assessment, Mr. S’s TUG score is 45.4 seconds. After 3 weeks of treatment, Mr S’s TUG score is now 29.8 seconds. Please determine if:
- True change has occurred
- Clinically meaningful change has occurred
Has true change occurred? #
1. Calculate the change in score between test occasions
45.4 sec – 29.8 sec = 15.6 sec
2. To determine if true change has occurred, compare the MDC to the change in score. The MDC is 2.49 seconds for the TUG test
15.6 sec > 2.49 sec
Yes, true change has occurred because the difference between test occasions is greater than the MDC of 2.49 seconds.
Has clinically meaningful change occurred? #
1. Calculate the change in score between test occasions
45.4 sec – 29.8 sec = 15.6 sec
2. To determine if clinically meaningful change has occurred, compare the MCID to the change in score. The MCID is 0.8 seconds to 1.4 seconds.
15.6 sec > 1.4 sec
Yes, true change has occurred because the difference between test occasions is greater than the MCID of 1.4 seconds.
References #
- Dobson F, Hinman RS, et al. OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Osteoarthritis Cartilage 2013;21(8):1042-52. Manual available at: www.oarsi.org/sites/default/files/docs/2013/manual.pdf
- Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39(2):142-8.
- Bennell K, Dobson F, et al. Measures of physical performance assessments. Arthritis Care Res 2011;63:S350-70.
- Arnold CM, Faulkner RA. The history of falls and the association of the timed up and go test to falls and near-falls in older adults with hip osteoarthritis. BMC Geriatrics 2007;7:17.
- Wright AA, Cook CE, et al. A comparison of 3 methodological approaches to defining major clinically important improvement of 4 performance measures in patients with hip osteoarthritis. J Orthop Sports Phys Ther 2011;41:319-27.
- Kennedy DM, Stratford PW, et al. Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty. BMC Musculoskelet Disord 2005;6:3.
- French HP, Fitzpatrick M, et al. Responsiveness of physical function outcomes following physiotherapy intervention for osteoarthritis of the knee: an outcome comparison study. Physiotherapy 2011;97(4):302-8.
- De Morton NA, Keating JL, et al. Exercise for acutely hospitalised older medical patients. Cochrane Database Syst Rev 2007;1:CD005955
- WHO International Classification of Functioning, Disability, and Health – http://www.who.int/classifications/icf/icf_more/en/
- Riddle, D. & Stradford, P. (2013). Is this Change Real? Interpreting Patient Outcomes in Physical Therapy. F.A. Davis Company: Philadelphia.