Influence of Procedural Factors on the Reliability and Performance of the Timed Up-and-go Test in Older Adults

Background: Timed up-and-go (TUG) test is a clinical assessment commonly used to quantify functional mobility and fall risk in older adults. While the concept of the test is simple, procedural variations can significantly impact the reliability and the performance. The purpose of the study was to determine the influence of specific procedural factors on the test-retest reliability and TUG test performance in older adults. Methods: Adults over the age of 60 years (N = 83, mean age, 69.3 +/- 6.9 years; range, 60-91 years) participated. The procedural factors examined included: (1) timing method (handheld stopwatch vs. load-based timing); (2) distances of test (3 m, 6m, and 9 m); and (3) seat height (standard vs. individual specific). Test-retest reliability obtained from each combination of timing and distance was evaluated. The interaction of seat-height settings and the stature of the participant on TUG performance was investigated by comparing the TUG performance of short and tall participants in the two seat-height settings. Results: Timing method and walking distance modestly influenced the TUG test reliability. The current standard procedure (stopwatch timing and 3-m distance) yielded the lowest but acceptable reliability (intraclass correlation coefficient = 0.887). Taller individuals exhibited significantly better TUG performance when individualized seat heights were used in comparison with the standard lower seat height. The influence of seat height was not as pronounced in shorter individuals. Conclusion: Seat height is an important procedural factor affecting the performance of the TUG test, especially in older adults who are taller. Load-based timing may be used to improve the consistency of the TUG performance assessment. Copyright (C) 2016, Taiwan Society of Geriatric Emergency & Critical Care Medicine. Published by Elsevier Taiwan LLC.