Timed Up and Go (TUG)

Purpose of the measure

The TUG is a general physical performance test used to assess mobility, balance and locomotor performance in elderly people with balance disturbances. More specifically, it assesses the ability to perform sequential motor tasks relative to walking and turning (Schoppen, Boonstra, Groothoff, de
Vries, Goeken, & Eisma, 1999; Morris, Morris, & Iansek, 2001).

Available versions

The “Get Up and Go” test (the original TUG) was developed by Mathias, Nayak, and Issacs in 1986.

The TUG was published by Podsiadlo and Richardson in 1991 to address the issues of poor inter-rater reliability observed with intermediate scores in the “Get Up and Go”. The TUG incorporates time as the measuring component to assess general balance and function.

Features of the measure

Items:
There are no actual items in the TUG. The individual must stand up from a chair (which should not be leaned up against a wall), walk a distance of 3 meters, turn around, walk back to the chair and sit down – all performed at a comfortable and safe pace (Figure 1). One practice trial is permitted to allow the individual to familiarize him/herself with the task. Timing commences with the verbal instruction “go” and stops when the client returns to seated position. The individual wears their regular footwear and is permitted to use their walking aid (cane/walker) with its use indicated on the data collection form. No physical assistance is given.

Figure 1.

Scoring:
Performance of the TUG is rated on a scale from 1 to 5 where 1 indicates “normal function” and 5 indicates “severely abnormal function” according to the observer’s perception of the individual’s risk of falling (Podsiadlo &
Richardson, 1991). The score consists of the time taken to complete the test activity, in seconds.

Steffen, Hacker and Mollinger (2002) reported that on average, healthy individuals between the ages of 60-80 years complete the TUG in 10 seconds or less. Males between the ages of 80-89 years old take on average 10 ± 1 seconds to complete, and women take 11 ± 3 seconds to complete. Formal norms have not yet been established for patients with stroke.

Standardized cut-off scores to predict risk of falling have not yet been established. In one study, a cut-off score of ? 13.5 seconds has been shown to predict falling in community-dwelling frail elders, but this score has not been verified in other studies (Shumway-Cook et al., 2000).

Scoring and interpretation of the TUG
Score Interpretation
< 10s Completely independent
With or without walking
aid for ambulation and transfers
< 20s Independent for main transfers
With or without
walking aid, independent for basic tub or shower transfers and
able to climb most stairs and go outside alone
> 30s Requires assistance
Dependent in most
activities

(Adapted from Podsiadlo & Richardson, 1991)

Subscales:
None typically reported.

Equipment:
The TUG does not require any specialized equipment and can therefore be accomplished in community as well as institutional settings.

  • Standard chair with armrests (46cm seat height and 63-65cm armrest height)
  • Tape measure
  • Brightly colored tape or cone to mark off the 3m path 3m path free from obstruction
  • Stopwatch or wrist watch with a second hand to time the performance.

Training:
Minimal
training is required to score the test or interpret the results. The assessor should be aware of safety issues during mobility in individuals with stroke.

Time:
The TUG requires 1 to 2 minutes to administer (Finch, Brooks, Stratford, & Mayo, 2002).

Alternative forms of the TUG
  • TUG Cognitive (Shumway-Cook, Brauer, & Woollacott, 2000).  In the TUG Cognitive, patients must complete the task while counting backwards from a randomly selected number between 20 and 100.
  • TUG Manual (Lundin-Olsson et al., 1998). In the TUG Manual, patients must complete the task while carrying a full cup of water. Lundin-Olsson et al. (1998) found that frail older adults who had a time difference of greater than 4.5 seconds between the TUG Manual and the TUG were more prone to falls during the following 6 months.
Client suitability

Can be used
with:
patients with stroke.

  • The TUG can be administered to geriatric clients ? 65 years old with any diagnosis (e.g. arthritis, stroke, vertigo, Parkinson’s disease, cerebellar disorders and general deconditioning) (Shumway-Cook & Woollacott, 2001; Hayes & Johnson, 2003; Morris et al., 2001).
  • The TUG can also be used with patients ? 18 years old with an acute neurological diagnosis (Shumway-Cook & Woollacott, 2001).
  • Clients must be able to walk approximately 6 meters with or without an assistive device but without the assistance of another person.
  • Clients must have sufficient vision to walk to the 3-meter line.
  • Non-English speakers must receive appropriate translation.

Should not be used in:

  • The TUG is not appropriate for clients with severe cognitive impairments that prevent understanding of the tasks. Rockwood, Awalt, Carver, and MacKnight (2000) found that in cognitively impaired frail elderly individuals, 35.5% were unable to physically perform the test.
  • Severely affected patients such as those who cannot leave a seated position.
    There may be a floor effect with these patients. Instead, you may wish to consider the Postural Assessment Scale for Stroke Patients (PASS), which was designed as a balance assessment for patients with stroke and is applicable for all patients with stroke, even those with the most severe postural performance (Benaim,
    Pérennou, Villy, Rousseaux, & Pelissier, 1999).
  • Since the TUG is administered through direct observation of task completion. A proxy respondent cannot complete it.
  • The TUG is a limited measure assessing few aspects of balance. For a more comprehensive measure of balance, the Postural Assessment Scale for Stroke Patients (PASS) (Benaim et al., 1999) or the Berg Balance Scale (Berg, Wood-Dauphinee, Williams, & Maki, 1992) is suggested.
In what languages is the measure available?

Given the simplicity of the instructions, the TUG can be administered in different languages with informal translations (Tremblay, Savard, Casimiro, & Tremblay, 2004).