The Timed Up and Go (TUG) test is a foundational assessment in geriatric healthcare, valued for its simplicity and accuracy in measuring functional mobility. Developed as a modified version of the original “Get-Up-and-Go” test, the TUG specifically measures the time it takes an individual to complete a series of everyday movements. This quick test requires only a standard chair, a stopwatch, and a small, unobstructed space, making it a highly practical tool in various clinical and home care settings. By performing this test, healthcare professionals can gain valuable insights into an individual's gait speed, balance, and overall mobility, which are key indicators of independence and fall risk.
How the TUG Test is Administered
The TUG test is a performance-based measure, meaning the patient's score is based on their direct physical performance of the task. The procedure is straightforward, but accuracy in administration and observation is crucial for meaningful results. The test begins with the patient sitting fully back in a standard, arm-supported chair with their feet on the floor. A marker, often a piece of tape, is placed on the floor 3 meters (10 feet) away.
Step-by-step administration:
- Instruction: The administrator explains the task to the patient and provides a practice run to ensure understanding.
- Start signal: On the command “Go,” the stopwatch begins, and the patient is instructed to stand up from the chair.
- Walk: The patient walks at their normal, comfortable pace to the 3-meter mark.
- Turn: At the marker, the patient turns around.
- Return: The patient walks back to the chair at their normal pace.
- Sit down: The test concludes, and the stopwatch is stopped when the patient is seated again with their back resting against the chair.
During the test, the clinician observes the patient's overall performance, noting factors like posture, gait quality, and any signs of unsteadiness. The use of an assistive device, if any, is also recorded.
Interpreting the Results and What They Mean
The time taken to complete the TUG test provides a clinical measure of functional mobility. The interpretation of the results varies based on the individual's baseline health and age, but established benchmarks offer a general guide for clinicians.
TUG test score interpretations:
- Less than 10 seconds: Considered a normal result for healthy older adults, indicating good mobility.
- Less than 20 seconds: Represents good functional mobility. Individuals in this range are typically able to walk outdoors alone and do not require a walking aid.
- 20 to 30 seconds: Suggests mobility limitations and a need for assistance with some activities. The individual may not be able to walk outside alone and could benefit from a walking aid.
- More than 30 seconds: Indicates significant mobility impairment and a higher degree of dependence on assistance for daily activities.
For fall risk specifically, a time of 13.5 seconds or longer is often used as a cut-off threshold indicating an increased risk. However, the TUG is just one part of a comprehensive fall risk assessment and should be used in combination with other evaluations and clinical judgment.
Comparison of TUG with other mobility assessments
The TUG test is often used alongside or in contrast with other clinical assessments. Understanding how it compares to other tests can help clinicians create a more comprehensive mobility profile.
| Assessment Test | Key Focus | Advantages | Disadvantages |
|---|---|---|---|
| Timed Up and Go (TUG) | Measures combined functional mobility, balance, and gait. | Simple, quick, and requires minimal equipment; widely validated for older adults. | Less sensitive for highly functioning individuals; may miss subtle balance deficits. |
| Berg Balance Test (BBT) | Measures static and dynamic balance across 14 specific tasks. | Comprehensive assessment of balance abilities; identifies specific balance deficits. | Time-consuming; can have a ceiling effect for high-functioning individuals. |
| Functional Gait Assessment (FGA) | Evaluates walking ability under various demanding conditions (e.g., walking with head turns). | Captures a wider range of functional gait challenges; less susceptible to ceiling effects than BBT. | More complex to administer than TUG; requires more space and equipment. |
| 30-Second Sit-to-Stand Test | Assesses lower extremity strength and power. | Quick and easy to perform; excellent for monitoring leg strength changes over time. | Does not directly measure balance, gait, or turning abilities. |
Limitations of the TUG test
While the TUG test is an invaluable tool, it does have some limitations that require consideration during clinical use.
- Ceiling and floor effects: The test may not effectively differentiate between very high-functioning individuals (ceiling effect) or accurately measure decline in those who are severely impaired (floor effect).
- Inadequate for severe cognitive impairment: Individuals with severe cognitive issues may have difficulty understanding and performing the test, making the results unreliable.
- Predictive ability: While the TUG is a reliable indicator of mobility, it is not a perfect predictor of future falls and should not be used as the sole determinant.
Conclusion
The Timed Up and Go (TUG) test is a cornerstone of geriatric assessment due to its simplicity, speed, and reliability. By providing a snapshot of an older adult's functional mobility, balance, and gait, it offers a pragmatic way for healthcare providers to screen for fall risk and track progress over time. While its limitations mean it should not be the only assessment used, its ability to integrate multiple components of daily movement into a single, time-based metric makes it a powerful tool in supporting the health, independence, and safety of older adults. Incorporating the TUG with other complementary assessments allows clinicians to develop a comprehensive understanding of a patient's mobility status, leading to more tailored interventions and a higher quality of life. For more detailed information on TUG administration and research, refer to the CDC's STEADI Toolkit.
