What is the purpose and procedure of the stand up and go (Timed Up and Go) test in assessing mobility and fall risk in patients?

Timed Up and Go Test: Purpose and Procedure

The Timed Up and Go (TUG) test is a validated functional mobility assessment that identifies older adults at increased fall risk, with a completion time ≥12 seconds indicating elevated fall risk and need for comprehensive fall prevention intervention. 1

Primary Purpose

The TUG test serves as a rapid screening tool to assess mobility and predict fall risk in older adults, with the goal of preventing falls and their associated morbidity and mortality including hip fractures, subdural hematomas, and loss of independence. 1, 2

• Fall risk stratification: Completion time ≥12 seconds identifies patients at increased risk for falling 1
• Functional mobility assessment: The test quantifies basic mobility skills including sit-to-stand transitions, gait speed, turning ability, and balance 3
• Frailty identification: Used specifically to identify patients at risk for frailty and falls, particularly in cardiac rehabilitation and geriatric populations 1

Test Procedure

The standardized procedure requires the patient to rise from a standard armchair, walk 3 meters (10 feet) at normal pace, turn around, return to the chair, and sit down while being timed. 1

Step-by-Step Administration:

• Patient positioning: Patient sits back in a standard armchair with armrests 1
• Footwear and assistive devices: Patient wears regular footwear and may use their usual walking aid if needed 1
• Starting command: On "Go," the patient stands up from the chair 1
• Walking phase: Patient walks forward 3 meters (10 feet) at their normal, comfortable pace 1
• Turning: Patient turns around at the marked line 1
• Return phase: Patient walks back to the chair at normal pace 1
• Completion: Patient sits down in the chair, and timing stops 1

Interpretation and Clinical Action

A time ≥12 seconds indicates increased fall risk and mandates broader fall risk assessment and intervention. 1

Risk Stratification:

• <10 seconds: Normal mobility in healthy adults over 60 2
• ≥12 seconds: Increased fall risk requiring comprehensive evaluation 1
• ≥15 seconds: Optimal cut-point for identifying high-risk patients in specialized falls clinics (70% sensitivity) 4

Required Follow-up Actions:

When TUG ≥12 seconds, clinicians must initiate:

• Physical therapy referral for exercise program development and walking aid evaluation 1
• Multifactorial risk assessment addressing the P-SCHEME factors: Pain (axial/lower extremity), Shoes (footwear), Cognitive impairment, Hypotension (orthostatic), Eyesight (vision), Medications (centrally acting), Environmental factors 1
• Exercise interventions focusing on balance and strength training (tai chi, walking, resistance exercises) which show moderate benefit with high certainty of evidence 1, 2
• Vitamin D supplementation which demonstrates moderate benefit with moderate certainty of evidence 2

Clinical Validity and Reliability

The TUG demonstrates excellent reliability and validity, correlating strongly with established functional measures. 3

• Inter-rater reliability: Excellent when standardized training is provided (correlation coefficient 0.86) 5
• Correlation with Berg Balance Scale: r = -0.81 3
• Correlation with gait speed: r = -0.61 3
• Correlation with Barthel Index of ADL: r = -0.78 3
• Predictive validity: Predicts ability to go outside alone safely 3

Critical Implementation Considerations

Standardized training for all clinical staff is essential - inter-rater reliability between physical therapists and nurses improved significantly from 0.77 to 0.86 (p = 0.001) after tool-specific training. 5

Common Pitfalls to Avoid:

• Inconsistent distance measurement: Always use exactly 3 meters (10 feet), not approximate distances 1
• Rushing the patient: Instruct patient to walk at their "normal pace," not as fast as possible 1
• Improper timing: Start timing on "Go" command, stop when patient sits down completely 1
• Ignoring positive screens: Any TUG ≥12 seconds requires action, not just documentation 1

The test requires no special equipment, takes less than 2 minutes to complete, and is easily incorporated into routine clinical examination, making it highly practical for primary care and specialty settings. 3