Timed Up & Go (TUG)

AN ASSESSMENT OF MOBILITY & MAYBE MORE

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Learning Outcomes

At the conclusion of this session, participants will be able to:

• 1. Define the components of the TUG test.
• 2. Select appropriate patients for the TUG test.
• 3. Appraise the potential value of the TUG test in their own EMS system.
• 4. Apply the TUG test to patient scenarios.

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Background

NO ONE EVER FALLS, DO THEY?

Background Information

• Patient encounters for falls are a frequent occurrence for EMS practitioners.
• Fall reduction programs can be helpful, but EMS practitioners must use clinical judgement to determine who is safe to stay at home and who is at risk of further falls.
• The Timed Up and Go Test (TUG) is an objective, validated measure of a patient’s ability to move around their home, which may be necessary for the patient to meet their activities of daily living (ADLSs).
• Combining the TUG test with a focus on Maslow’s Hierarchy of Needs/Activities of Daily Living can assist in assuring patient safety in their homes.

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Basic Activities of Daily Living

• 1. Walking – moving around the home or outside
• 2. Personal hygiene – bathing/showering, grooming, nail care, and oral care.�3. Dressing – being able to make appropriate clothing decisions and physically dress and undress oneself.�4. Eating – the ability to feed oneself, though not necessarily the capability to prepare food.�5. Maintaining continence – being able to mentally and physically use a restroom. This includes the ability to get on and off the toilet and cleaning oneself.�6. Transferring/Mobility- being able to stand from a sitting position, as well as get in and out of bed. The ability to walk independently from one location to another.

Instrumental Activities of Daily Living

• 1. Basic communication skills – such as using a regular phone, mobile phone, email, or the internet.�2. Transportation – either by driving oneself, arranging rides, or the ability to use public transportation.�3. Meal preparation – meal planning, cooking, clean up, storage, and the ability to safely use kitchen equipment and utensils.�4. Shopping – the ability to make appropriate food and clothing purchase decisions.�5. Housework – doing laundry, washing dishes, dusting, vacuuming, and maintaining a clean place of residence.�6. Managing medications – taking the correct amount of medication at the correct time. Managing re-fills, and avoiding conflicts.�7. Managing personal finances – operating within a budget, writing checks, paying bills, and avoiding scams

Fall Risk

Fall Risk Factors

Modifiable Risk Factors

• Gait, strength, and balance deficits
• Medications that increase fall risk
• Home hazards
• Orthostatic hypotension
• Vision problems
• Foot issues/inappropriate footwear
• Vitamin D deficiency
• Comorbidities

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• Non-modifiable risk factors
• Age
• Sex
• Race/ethnicity
• History of falls

Falls Risk Assessment

Other Things to Consider

• Fall History
• Visual acuity
• Home safety hazards
• Gait dysfunction
• Sensory issues
• Footwear issues

Medication Screening

• Anticonvulsants
• Antidepressants
• Antihypertensives
• Antipsychotics
• Antispasmodics
• Benzodiazepines
• Opioids
• Sedative/hypnotics
• OTC medications

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The TUG Test

The TUG Test

• Timed Up and Go (TUG) test is a timed test of standing and walking that is a predictor of falls risk.
• It is a gait-speed test used to assess a person’s mobility and required both static and dynamic balance.
• Simple to perform.
• Requires little equipment.
• Takes little time.
• Data collection is simple.

Conducting the Test

1. Begin the test with the subject sitting correctly with the hips all the way to the back of the seat in a chair with arm rests.
2. The subject is allowed to use the arm rests during the sit-stand and stand-sit portions.
3. Place a piece of tape or other marker on the floor 3 meters away from the chair so that it is easily seen by the patient.
4. The patient should wear their regular footwear.
5. The patient may use any gait aid that they normally use during ambulation.
6. The patient may not be assisted by another person.
7. Tell them “On the word GO, you will stand up, walk to the line on the floor, turn around, walk back to the chair, and sit down. Walk at your regular pace.”

Obtaining the Data

1. Start timing on the word “GO”
2. Stop timing when the patient is seated again correctly in the chair with their back resting on the back of the chair.
3. There is no time limit.
4. The patient may stop and rest, but not sit down, if they need to.

Scoring the Test

• Normal healthy elderly patients usually complete the task in ten seconds or less.
• Very frail or weak elderly with poor mobility may take 2 minutes or more.
• The patient may be given a practice trial that is not timed before the actual testing.
• Results correlate with gait speed, balance, functional level, the ability to go out, and can change over time.

Normal Values

Other Organ Systems Involved In TUG

Beyond the TUG

The Balance Outcome Measure for Elder Rehabilitation (BOOMER)

• Assesses standing balance and functional mobility in the elderly population.
• A global multi-system static, dynamic and functional balance measure throughout all settings of elder rehabilitation.
• The combination of a variety of commonly used, single-item outcome measures makes the BOOMER a highly feasible and applicable tool that is both time and resource efficient.
• Time to administer 5-10 minutes, basic equipment required.

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Contents

Scoring the Boomer

• https://eprognosis.ucsf.edu/pps.php

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Thank you!

Melodie J. Kolmetz, MPAS, PA-C, EMT-P

melodie@amedicaltypeperson.com

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www.amedicaltypeperson.com

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@AMedTypePerson

Melodie-Kolmetz

Resources

• http://www.gericareonline.net/tools/eng/falls/attachments/Falls_Tool_2_Get_Up_and_Go_Test.pdf
• https://www.cdc.gov/steadi/pdf/TUG_test-print.pdf
• https://www.sralab.org/rehabilitation-measures/timed-and-go
• https://www.physio-pedia.com/Category:Older_People/Geriatrics_-_Outcome_Measures?utm_source=physiopedia&utm_medium=related_articles&utm_campaign=ongoing_internal
• https://www.cdc.gov/steadi/index.html

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References

• Agarwal G, Pirrie M, McLeod B, et al. Rationale and methods of an Evaluation of the Effectiveness of the Community Paramedicine at Home (CP@home) program for frequent users of emergency medical services in multiple Ontario regions: a study protocol for a randomized controlled trial. Trials. 2019;20(1):75. Published 2019 Jan 23. doi:10.1186/s13063-018-3107-4
• Geriatric Orthopedic Surg Rehabil. 2018; 9: 2151459318783453. Published online 2018 Jul 4. doi: 10.1177/2151459318783453
• Hsieh C-Y, Huang H-Y, Liu K-C, Chen K-H, Hsu SJ-P, Chan C-T. Subtask Segmentation of Timed Up and Go Test for Mobility Assessment of Perioperative Total Knee Arthroplasty. Sensors. 2020; 20(21):6302. https://doi.org/10.3390/s20216302
• Quatman CE, Mondor M, Halweg J, Switzer JA. Ten years of EMS Fall Calls in a Community: An Opportunity for Injury Prevention Strategies. Geriatr Orthop Surg Rehabil. 2018;9:2151459318783453. Published 2018 Jul 4. doi:10.1177/2151459318783453

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