Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta- analysis

Emma Barry; Rose Galvin; Claire Keogh; Frances Horgan; Tom Fahey

doi:10.1186/1471-2318-14-14

Table 1 Descriptive characteristics of the studies included in the review

From: Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta- analysis

Study	Participants (n) sex, mean age (+/− SD)	Time frame of follow-up	Person administering test	Definition of falls	Method of administering the test	Method of recording falls	Number of individuals who fell
Greene et al. 2012*	N = 349	2 years	Not recorded	Tinetti 1997	Test completed once. Assistive device not permitted.	Self report with collateral information from relatives and medical records	N = 83
	M = 103
	F = 246
	Mean age 71.5+/− 6.7
Herman et al. 2011 and 2010	N = 265	3 years	Physiotherapist	Leveille 2009 and Mackensie 2006	Test performed twice (mean score used). Assistive device not permitted	Self report falls diary monthly	N = 64 (1 year follow up)
	M = 111						N = 64 (1 year follow up)
	F = 154						N = 131 (2 year follow up)
	Mean age 76.4+/−4.3						N = 131 (2 year follow up)
	Mean age 76.4+/−4.3						N = 73 retrospective
Russell et al. 2008*	N = 344	1 year	Physiotherapist, occupational therapist or medical doctor	Kellogg 1987	As per original TUG.	Self report falls diary bi-monthly	N = 164
	M = 106
	F = 238
	Mean age 75.9+/−8.5
Viccaro et al. 2011*	N = 457	1 year	Not recorded	Defined as unintentionally coming to rest on the ground or other surface.	As per original TUG. Average of 2 trials reported.	Interview at 3/12 visit	N = 174
	F = 201 M = 256
	Mean age =74
Killough et al. 2006*	N = 122	6 months	Unrecorded	Not defined	Administered test only once unless misunderstood and a second trial was used.	Interviewed every 3 months by telephone	N = not recorded
	M/F = unrecorded
	Mean age = unrecorded
Thomas unpublished study*	N = 31	12 months	Physiotherapist	Kellogg 1987	Shoe should have maximum heel height of 4 cm. TUG not described in any further detail.	Self report by monthly prepaid postcards and follow up phone call at 3, 6, 9/12.	N = 16 had 2 or more falls, 15 had 1 or no falls
	M = 6
	F = 25
	Mean age = 81.6
Aoyama et al. 2011*	N = 58	6 months	Physiotherapist	Tinetti 1988	As per original TUG. Two test trials and mean score recorded.	Self report by falls diary, collected at 6 month	N = 25
	F = 58
	M = 0
	Mean age 80.5+/−5.7
Sai et al. 2009*	N = 137	12 months	Trained clinical staff	Buchner 1993	Time taken for subject to get up from chair (with arms crossed across chest) walk 10 ft, turn around and sit back down as quickly as possible.	Self report by falls diary. This was followed by monthly phone-calls.	N = 70
	M = 48
	F = 89
	Mean age 76.7 +/− 6.1
Alexandre et al. 2012*	N = 63	12 months	Trained Physical therapists	Kellogg Working Group 1987	As per original TUG seat height 42 cm, back 79 cm, arms 60 cm from ground. Participants used own foot wear and used assistive device if needed.	Interviewed every 3/12 by blinded evaluator and self report via log book collected every 3/12.	N = 21
	Male = 30
	Female = 33
	Mean age Fallers = 66.68+/−5.57.Non fallers =66.36+/−4.60
Yamada et al. 2010	N = 171	1 year	Trained staff members	Koski 1996	As per original TUG, height 40 cm, 3 m at normal pace turn walk back to chair and sit down. 2 trials average time recorded	Monthly telephone calls using structured questionnaire. Self report by mail every month.	N = 59
	F = 134
	M = 37
	Age 80.5+/ -5.6
Yamada et al. 2012	N = 252.	1 year	Trained researchers	Koski 1996	Participants asked to stand up from a standard chair seat height 40 cm, walk a distance of 3 m at a maximum pace, turn walk back and sit down. Better performance of two attempts recorded. Walking aid permitted	Interview at end of follow up	N = 71
	231 who completed study:
	Male = 54
	Female = 177
	Mean age =
	T1 = 73.9+/−6.6
	T2 = 79.1+/−7.0
	T3 = 82.0+/−6.9
Wrisley et al. 2010	N = 35	6 months	Physical therapist	Defined as unintentional contact below pt’s height and classified as unexplained or unexplained. A fall was considered explained if there was medical environmental or task-related explanation for the fall that was unavoidable. An unexplainable fall was all other falls.	As per original TUG. Participants were allowed 1 practice trial and then preformed 3 timed trials. The average of 3 trials reported	Self report by daily falls calendar; return a separate postcard providing details of any falls with follow up phone call.	N = 17 (6 participants reported 7 unexplained falls)
	Mean age =72.9 +/−7.8
	M = 17
	F = 18
Pai et al. 2010	N = 13	1 year	Not recorded	Defined as any event in which they landed unintentionally on a lower surface such as a chair, the floor or ground	As per original TUG, one practice trial given.	Contacted by telephone between 29–32 months into study	N = 4
	M = 9
	F = 4
	Mean age =72+/−5
Okumiya et al. 1998	N = 328	5 years prospective	Not recorded	Not defined	As per original TUG	Self-administered questionnaire	68
	M = 151
	F = 177
	Mean age =80.3
Lin et al. 2004	N = 1200	1 year	Trained interviewer	Not defined	As per original TUG standard chair with seat height of 40-50 cm height	Self report by postcard when a fall occurred and telephoned every 3/12.	Not recorded
	M = 709
	F = 491
	Mean age = 73.4
Buatois et al. 2006	N = 206	16 months	Not recorded	Tinetti 1988	As per original TUG	Self report by falls calendar and questionnaire	N = 57
	M = 116
	F = 90
	Mean age = 70+/−4
Buatois et al. 2010	N = 1618	Mean time 25+/−5 months (18–36 months)	Not recorded	Tinetti 1999	As per original TUG	Self report by questionnaire at end of study. Mean follow up period 25 +/−5 months range 18-36months.	N = 333
	M = 821
	F = 797
	Mean age 70
Bergland et al. 2003*	N = 307	1 year	Not recorded	Falls defined as an unintentional change in position resulting in the victim lying on the floor or on the ground.	The subject was instructed to rise from a chair, walk 3 m as quickly as possible, cross a line, turn, walk back, and sit down again.	Self report by daily calendar, to return calendar every 3/12 with follow up phone call if a fall occurred. Subjects who did not return the calendar were contacted	155
	N = 307				Wearing ordinary shoes and used customary walking aids if needed.
	M = 0
	F = 307
	Mean age 80.8
Trueblood et al. 2001	N = 198	6 months	Researcher	Anacker 1992	As per TUG, armless chair, 3 timed trials average time recorded	Telephone survey 4 and 6 months using a formalised script.	N = 30
	M = 38
	F = 160
	Mean age 78.1+/−8.2
Shimada et al. 2009	N = 445	1 year	Day centre staff nursing allied health or similar qualifications	Nevitt 1989 Cumming 2008	As per TUG, measured once at usual pace assistive device allowed	Self report questionnaire, with collateral if difficulty in recall	N = 99
	F = 310
	M =135
	Mean age 80.5+/−7.2
Melzer et al. 2009*	N = 100	1 year prospective	Research assistant	Tinetti 1988	Not described in detail but referenced as per AGS/BGS which in turn references Podsiadlo	Self report by daily calendar. Contacted by research assistant at one month intervals to monitor falls.	N = 49
	Male = 26
	Female = 72
	Mean age 78.4+/−5.7
Beauchet et al. 2007 and 2008	N = 187	1 year	Trained evaluator	Defined as unintentionally coming to rest on the ground, floor or lower level	Not described reference to Podsiadlo	Monthly phone call using a standardised questionnaire. Collateral obtained if cognitive impairment	N = 54
	M = 29
	F = 158
	Mean Age = 84.8+/−5.2
Garber et al. 2010	N = 904	6 months	Trained bilingual field interviewers	Not defined	Armless chair 3 m as quickly 2 trials –first practice second recorded time	Not recorded	Not recorded
	Male = 263
	Female = 641
	Mean age 76.6+/−0.5

Asterix * indicates studies included in meta analysis.
Definition of a fall:
• Tinetti 1988 [1] “an event which results in a person coming to rest unintentionally on the ground or lower level, not as a result of a major intrinsic event (such as a stroke) or overwhelming hazard. An overwhelming hazard was defined as a hazard that results in a fall by the youngest healthiest person”.
• Levielle 2010 [53] “A fall was defined as unintentionally coming to rest on the ground or other lower level not as a result of a major intrinsic event (eg, myocardial infarction, stroke, or seizure) or an overwhelming external hazard (eg, hit by a vehicle).
• Mackenzie 2006 [54] “a fall was defined as an unintentional event where a person fell to the ground”
• Buchner 1993 [55] “unintentionally coming to rest on the ground, floor or some other lower level”.
• Kellogg Working Group 1987 [56]: “unintentionally coming to the ground or some lower level and other than as a consequence of sustaining a violent blow, loss of consciousness, sudden onset of paralysis as in stroke or epileptic seizure”.
• Anacher 1992 [57] “any disturbance of balance during routine activities that resulted in a person’s trunk, knee or hand unintentionally coming to rest on the ground or some level below the waist”.
• Cumming 2008 [58] “unintentionally coming to rest on the ground or other lower level not as a result of a major internal (for example, stroke) or external event”.
• Koski 1996 [59] “as an unexpected event where a person falls to the ground from an upper level or the same level”.
• Original TUG: Podsiadlo 1991 [8] “The timed up and go measures, in seconds, the time taken by an individual to stand up from a standard arm chair (approximate seat height of 46 cm), walk a distance of 3 metres, turn, walk back to the chair and sit down again. The subject wears his regular footwear and uses his customary walking aid (none, cane, or walker). No physical assistance is given. He starts with his back against the chair, his arms resting on the chair’s arms and his walking aid at hand. He is instructed that, on the word “go”, he is to get up and walk at a comfortable and safe pace to a line on the floor 3 metres away, turn, return to the chair and sit down again. The subject walks through the test once before being timed in order to become familiar with the test.

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