The Timed Up and Go test

The Timed Up and Go test provides a quick and valid way to estimate an older person's risk of falls, as well as other adverse outcomes

The observation of gait has long been a valued component of the physical examination. For older patients in particular, examination of gait can be extremely revealing, aiding identification of a number of neurological and musculoskeletal pathologies. A comprehensive history and physical examination should be included as part of the evaluation of older people, especially those with a history of falls, frailty or functional impairment. Such an evaluation should include a review of prior falls, examination of gait and balance, examination of the feet and shoes, testing of visual acuity and peripheral sensation, measurement of postural blood pressure, review of medication use, and assessment of risks in the patient's home environment.

The evaluation of gait in particular is an important and underutilised component of this assessment. It is surprising how often gait is not examined by doctors, even when the patient's presenting problem is a fall. Gait changes have broader implications for an individual. Gait speed has been found to correlate with survival, health and wellbeing among older people.1 Because of the importance of mobility assessment, a number of tools have been developed in an effort to standardise assessment of gait and balance. These include the Functional Reach test, the Performance Oriented Mobility Assessment, and the Berg Balance Scale. The Timed Up and Go test (TUG) provides an approach to observing gait and can help to predict an individual's risk of falls and other adverse outcomes.2

The test consists of timing how long it takes a person to rise from a chair, walk 3 metres, turn, and then sit again (Box 1). A method for performing the TUG is described in Box 2 and a video of the test can be viewed in the Supporting Information.

The TUG can be used to predict the risk of falls. A time of 35 seconds or more predicts falls with a likelihood ratio of 2.6;3 completing the test in less than 15 seconds predicts a reduced risk of falls with a likelihood ratio of 0.1.3 As might be expected, short cut‐off points increase the sensitivity of the test for predicting falls, but reduce its specificity. It is also a useful measure of function after stroke.4 The test can predict the likelihood of nursing home placement and death.5

Some authors have questioned the ability of the TUG to predict falls in certain populations, and there is substantial variability between studies as to what cut‐off point should be used to predict an increased falls risk. A recent meta‐analysis suggested that the ability of the TUG to distinguish between fallers and non‐fallers is most reliable when it is applied to functionally impaired older people in residential care, and is less reliable when predicting falls in healthy older people living in the community.6 Another meta‐analysis, which used the relatively short cut‐off point of ≥ 13.5 seconds to detect increased falls risk, also suggested the tool was not predictive of falls in community‐dwelling older adults, and that it should not be used as a single assessment tool.7 A 2015 study used a 12.6‐second cut‐off point to predict falls risk, and emphasised the clinical, as opposed to screening, utility of the test.8

Mean values and ranges based on age for the TUG are shown in Box 3.9

Despite the limitations described, the test is a simple clinically useful tool which can be readily incorporated in the examination of frail and functionally impaired older patients and patients with a history of falls. It requires minimal equipment, space and training. Regular inclusion of gait examination as a part of patient assessment, including the TUG, can facilitate diagnosis and management.

Box 1 – Timed Up and Go test

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The test involves timing how long it takes a person to rise from a chair, walk 3 metres, turn, and then sit again. ◆