Original article
Using the Timed Up & Go Test in a Clinical Setting to Predict Falling in Parkinson's Disease

https://doi.org/10.1016/j.apmr.2013.02.020Get rights and content

Abstract

Objective

To investigate the ability of the Timed Up & Go test to identify patients with Parkinson's disease at risk for a fall.

Design

Cross-sectional cohort study.

Setting

Sixteen participating National Parkinson's Foundation Centers of Excellence.

Participants

A query yielded a total of 2985 records (1828 men and 1157 women). From these, 884 were excluded because of a lack of crucial information (age, diagnosis, presence of deep brain stimulation, disease duration, inability of performing the Timed Up & Go test without assistance) at the time of testing, leaving 2097 patients included in the analysis.

Interventions

Not applicable.

Main Outcome Measures

The primary outcome measure for this study was falls. The chief independent variable was the Timed Up & Go test.

Results

The initial model examined the prediction of falls from the Timed Up & Go test, adjusting for all study covariates. The estimated models in the imputed data sets represented a significant improvement above chance (χ2 range [df=17], 531.29–542.39, P<.001), suggesting that 74% of participants were accurately classified as a faller or nonfaller. The secondary model in which the question of whether the effect of Timed Up & Go test was invariant across disease severity demonstrated 75% of participants were accurately classified as a faller or nonfaller. Additional analysis revealed a proposed cut score of 11.5 seconds for discrimination of those who did or did not fall.

Conclusions

The findings suggest that the Timed Up & Go test may be an accurate assessment tool to identify those at risk for falls.

Section snippets

Participants

A cross-sectional study design was used from the National Parkinson Foundation's Quality Improvement Initiative Registry (NPF-QII). The data were obtained from 16 participating National Parkinson Foundation Centers of Excellence from within the United States. All participants signed informed consent.

All evaluations were done in the on medication state. Included were all patients registered in the NPF-QII between 2009 and 2010. The database query yielded a total of 2985 records available (1828

Results

Model 1 examined the prediction of falls from the TUG test, adjusting for all study covariates. The estimated models in the imputed data sets each represented a significant improvement above chance (χ2 range [df=17], 531.29–542.39, P<.001). Measures of association were generally low to moderate (Cox and Snell R2 range, .22–.23; Nagelkerke R2 range, .30–.31). In each of the 5 models, 74% of participants were accurately classified (chance classification =54%; thus, the obtained classification

Discussion

This study examined the use of TUG scores for predicting fall risk in patients with PD in the clinical setting. We hypothesized that the TUG test may be a viable and reliable clinical assessments tool in patients with PD and may predict those at increased risk of a fall during the course of their disease. Our results suggest that when adjusting for covariates including disease severity, quality of life, cognitive abilities, and arthritis, the TUG test correctly classified over 70% of the sample

Conclusions

The limitations in identifying those with PD at risk for a fall are noteworthy. The findings of this study suggest that the TUG test may be an accurate assessment tool to identity those at risk for a fall. In a clinical setting, where time is critical, a quick and readily available evaluation tool, such as the TUG test, is warranted to provide fall risk insight and hopefully limit adverse outcomes. Using a cut point based on the TUG test may serve as a means to implement a fall prevention plan.

Supplier

  • a.

    SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.

References (17)

  • K.B. Foreman et al.

    Testing balance and fall risk in persons with Parkinson disease, an argument for ecologically valid testing

    Parkinsonism Relat Disord

    (2011)
  • M.J. Falvo et al.

    Six-minute walk distance in persons with Parkinson disease: a hierarchical regression model

    Arch Phys Med Rehabil

    (2009)
  • M.A. Hely et al.

    The Sydney multicenter study of Parkinson's disease: the inevitability of dementia at 20 years

    Mov Disord

    (2008)
  • B.R. Bloem et al.

    Falls and freezing of gait in Parkinson's disease: a review of two interconnected, episodic phenomena

    Mov Disord

    (2004)
  • R.M. Pickering et al.

    A meta-analysis of six prospective studies of falling in Parkinson's disease

    Mov Disord

    (2007)
  • B.R. Bloem et al.

    Clinimetrics of postural instability in Parkinson's disease

    J Neurol

    (1998)
  • L.J. Viccaro et al.

    Is timed up and go better than gait speed in predicting health, function, and falls in older adults?

    J Am Geriatr Soc

    (2011)
  • S.L. Huang et al.

    Minimal detectable change of the timed “up & go” test and the dynamic gait index in people with Parkinson disease

    Phys Ther

    (2011)
There are more references available in the full text version of this article.

Cited by (119)

  • Are movement-based mindful exercises (QIGONG, TAI CHI, AND YOGA) beneficial for stroke and Parkinson's disease? A scoping review

    2023, Complementary Therapies in Medicine
    Citation Excerpt :

    Yet, caution is warranted due to the low level of evidence and limited quality of reviews 50,51. Functional mobility, assessed with the TUG, can predict risk of falling in this population 52,53. In all included reviews, tai chi (up to 24 weeks) was superior to controls to improve performance in the TUG, which has been also confirmed following a one-year tai chi program 54.

View all citing articles on Scopus

Supported by the National Parkinson Foundation.

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

View full text