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The Timed Up and Go Test

The Benefits of The Timed Up and Go Test for Healthcare Professionals

ABSTRACT

The Timed Up and Go test is a simple test that is used to assess the mobility of geriatric patients.

Ageing presented a decline in functional mobility, putting patients are risk for falls and other

injuries. The purpose of this paper is to recognize the strengths of using The Timed Up and Go

test in healthcare settings. This test can be performed relatively easy by participants. It requires a

stopwatch and a chair to perform. It is an effective tool for assessments.

As people age, their mobility may become diminished. Detecting these age-related

changes in mobility is very important in order to provide the best care for patients. There are

many tools that can be used to measure the decline in patients, however The Timed Up and Go

test (TUG) has shown to be an easy and effective method to record patients’ progression. The

test can be efficiently implemented by healthcare professionals in order to provide

comprehensive care for patients.

Mobility can be defined as a person’s ability to ambulate and change their position from

one place to another. It’s a vital aspect in the quality of life for individuals. As mobility declines,

the prevalence of depression, isolation, and death increase (Soubra, Chkeir, & Novella, 2019).

Mobility can be impaired for various reasons such as cognitive or physical diseases. These

impairments cause a decline in independence, affecting the ability to perform activities of daily

living. As we age, musculoskeletal disorders increase in prevalence (Soubra et al. 2019). These

include diseases such as osteoporosis, hip fractures, osteoarthritis, and lower back problems.

These disease cause “decline in independence, physical disability and injuries,

institutionalization, and an increase in hospital admissions’’ (Soubra et al., 2019, p. 2).

order to provide appropriate treatment. It becomes increasingly essential to recognize these

changes in mobility Healthcare providers need tools in order to provide the best treatment plan

for their clients. This is where the Timed Up and Go (TUG) test can show its strengths. There are

many assessment instruments providers can choose from to measure their client’s mobility.

These include the “TUG test, Short Physical Performance Battery (SPPB), Dynamic Gait Index

(DGI), and Berg Balance Scale (BBS)” (Soubra et al., 2019, p. 2). A study conducted by Racha

Soubra , Aly Chkeir, and Jean-Luc Novella at Universite ́ de Technologie de Troyes compared

different assessment tools to identify elderly mobility assessment tests and review their

measurement properties.

The TUG test was one of many tools that were evaluated. The Timed Up and Go test was

introduced in 1991 by Podsiadlo and Richardson as a modification of the Up and Go test (Soubra

et al., 2019, p.3). It is used to measure balance and the ability to ambulate in elderly patients. In

order to perform this test, patients are asked to “rise from an armed chair of approximately 46 cm

seat height and 65 cm arm height, walk at their usual pace a distance of 3 meters towards a line

marked on the floor, turn 180 degrees, walk back to the chair, and sit down” (Soubra et al., 2019,

p. 3).

While they are performing this task, they are observed and timed in seconds until

completion. Patients are directed to wear their normal footwear and use their regular walking

aids if needed. A stopwatch is used to record the time it takes the patient to complete their task.

The test begins with a “go” command and ends when the patient is sitting with their back against

a chair, sitting down. This test is very simple to perform and is highly recommended. It mimics
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Benefits of The Timed Up and Go test
activities of daily living and easy to understand. The TUG test should be implanted in more

health care settings.

The emergency department is one area that the TUG test could prove as reliable

assessment tool for the elderly patients that are admitted. In Canadian emergency departments,

there lacks a standard assessment tool for elderly patients admitted with trauma secondary to a

fall. Trauma accounts for twenty-five percent of patient admissions over the age of sixty-five.

These injuries are secondary to a fall eighty percent of the time (Eagles, Perry, Sirois, Lang,

Daoust, Lee, Griffith, Wilding, Neveu, & Emond., 2016, p. 216).

A study conducted by Debra Eagles, Jeffrey J. Perry, Marie-Josée Sirois, Eddy Lang,

Raoul Daoust, Jacques Lee, Lauren Griffith, Laura Wilding, Xavier Neveu, Marcel Emond

found that using the TUG test “in older, minor trauma ED patients will help identify frail patients

at risk of functional decline” (Eagles et al., 2016, p. 216).

The strengths of using the TUG test were evident in their study. Using this tool can help

predict fall risks for elderly patients. It was found that the TUG test scores within the emergency

department correlated with frailty and functional decline at three to six months post injury. It was

found that patients who took over thirty seconds to complete the TUG test were at a 3.7

increased risk of frailty than patients with the normal less than ten seconds (Eagles et al., 2016,

p.217). These findings were consistent with other studies using the TUG test conducted in non-

emergency room departments.

Not only can it help predict patient outcomes, it is a fairly easy tool to use. It required no

special equipment to perform; as well as the duration. Ninety-seven percent of the time it was
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Benefits of The Timed Up and Go test
performed, it took less than thirty seconds to complete. Seventy-six percent of patients who were

asked to perform this test were able to do so. These findings show that the TUG test is reliable

and useful even in emergency situations. Additionally, the TUG test is beneficial as early

identification of patients at greater risks can help provide them with more comprehensive care.

To make it even easier to access this tool, there is now an application for smart phones

utilizing the TUG test. This application has helped to screen patients for vestibular or balance

deficiencies. As balance diminishes with age, patients are at a greater risk for falls. These falls

lead to a lower quality of life for patients. Ageing affect the visual and somatosensory systems.

As people reach age fifty and above, their visual perception starts to decline regarding depth

perception and contrast sensitivity (Gerhardy, Gordt, Jansen, & Schwenk, 2019, p. 1). The

vestibular sense is also affected by ageing, as the number of vestibular receptors decrease.

Testing a patient’s sense of balance, coordination, and visual acuity is time consuming and

requires special equipment.

This is where the TUG test can come in to provide a simpler method of testing. The TUG

test is effective in measuring mobility in patients; but can fall short as it does not differentiate

between loss of mobility and loss of mobility due to sensory deficits. It also does not

differentiate between loss of mobility at points through the test such as: turning, standing from a

chair, walking, and sitting down. Advances in technology have made it possible to distinguish

mobility and deficits between subphases of this test.

Using inertial measurement units and common technology such as smartphones,

researchers at The Institute of Sports and Sports Sciences in Heidelberg, Germany were able to

distinguish these subphases. An instrumented TUG test was performed on subjects using a
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Samsung Galaxy S4 smartphone attached to an elastic belt, which was then secured to the lower

back. They found that “the proof-of-concept to use the mTUG subphases as a screening tool for

deficits in clinically relevant sensory system performance, impacting on everyday mobility

performances which are required for safe and independent ambulation. The results are also in

line with a recent study of Hafström et al., which demonstrated that an impaired somatosensory

system impacts on postural stability and balance control” (Gerhardy et al., 2019, p. 6). They also

found that other methods of measuring sensory system performance were too time consuming

and required specially trained personnel. The smartphone implemented TUG test was easy to use

and did not require any additional materials or time. They found that this method could be

implemented on a large scale without many supplementary resources (Gerhardy et al. 2019, p. 7).

As patients age and their risk for frailty increases, their muscle strength is also decreased.

This decrease has a negative correlation with the TUG test. Wisniowska-Szurlej, Cwirlej-

Sozanska, Woloszyn, Sozanski, and Wilmowska-Pietruszynska found that hand grip strength is a

predictive factor in impaired mobility for geriatric patients (Wisniowska-Szurlej, Cwirlej-

Sozanska, Woloszyn, Sozanski, & Wilmowska-Pietruszynska, 2019, p. 1). As patients age, there

is a decline is muscle mass with an increase in fat mass. There is a reduction in muscle mass of

three to eight percent per year after age thirty.

This loss in muscle mass relates to a loss of muscle strength as a fifteen percent

degeneration per decade. Having a weaker grip strength puts patients at a risk for multiple

morbidities and poorer health (Wisniowska-Szurlej, Cwirlej-Sozanska, Woloszyn, Sozanski, &

Wilmowska-Pietruszynska, 2019, p. 1). Weaker handgrip strength is associated with reduced

mobility and independence. Research participants showed that as hang grip strength declined,
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Benefits of The Timed Up and Go test
there was an rise in the length of time it took to perform the TUG test. Wisniowska-Szurlej,

Cwirlej-Sozanska, Woloszyn, Sozanski, and Wilmowska-Pietruszynska agreed that the TUG test

displayed the physiological changes that occur with age. Detecting early reductions in muscle

strength can help identify patients at risk for mobility issues

Ageing affects the body in many ways, leading to functional decline in geriatric patients.

As people age, they begin to experience loss of strength, balance, and coordination. This puts

geriatric patient at risk for falls and injuries. When these age-related changes are detected earlier

on, interventions can be implemented. Using the TUG test is a quick way to identify reductions

in mobility in elderly patients. As seen, it takes less than thirty seconds to perform and only

requires a stopwatch and a chair. As technology improves, patients can use smartphone to track

their progression. This only makes the TUG test easier to use. Within the fast-paced emergency

department, having a tool that only takes thirty seconds to perform is great. Moreover, the TUG

was a reliable predictor of falls for patients who presented to the emergency department. This

can help providers single out which patients may need further care upon discharge. Using this

tool will improve outcomes for geriatric patients overall.