Tug test
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Here is a full, textbook-sourced overview of the Tug Test (Timed Up and Go Test):
Timed Up and Go (TUG) Test
What It Is
The TUG test is a simple, widely used, performance-based clinical measure of functional mobility, balance, and fall risk. Originally described by Podsiadlo and Richardson (1991) as the "Timed Up and Go," it evolved from the earlier "Get-Up-and-Go" test.
How to Perform It
- The patient is seated in a standard hard-backed chair with armrests
- They may use their usual assistive device (cane, walker) if needed
- On the command "go," the patient:
- Rises from the chair
- Walks 3 meters (10 feet) at their normal pace
- Turns around
- Walks back to the chair
- Sits down again
- The clinician records the time in seconds to complete the entire sequence
Interpretation
| Time | Interpretation |
|---|---|
| < 12 seconds | Generally normal; low fall risk |
| > 12 seconds | High fall risk; warrants further assessment (per Harrison's Principles of Internal Medicine) |
| > 14 seconds | Associated with poor health outcomes (Firestein & Kelley's Rheumatology) |
| > 15 seconds | Used as a frailty marker in surgical risk assessment (Miller's Anesthesia) |
Clinical Applications
1. Fall Risk Assessment (Primary Use)
- Recommended for all community-dwelling adults, especially older adults
- Patients with a history of falls or TUG > 12 sec should have a full falls assessment
- Shown to discriminate future recurrent fallers from non-fallers in the 12 months following hip fracture, per Rheumatology (Elsevier, 2022)
2. Osteoarthritis (Hip & Knee OA)
- Part of the recommended core performance-based test battery (alongside 30-second chair stand, 40-m fast-paced walk, stair climb, 6-minute walk tests)
- Validated in patients with hip and knee OA awaiting joint replacement surgery
3. Vestibular / ENT
- A TUG score > 11 seconds indicates increased fall risk in vestibular disorders (Cummings Otolaryngology)
4. Preoperative / Anesthesia Assessment
- Used as part of frailty assessment before surgery - TUG ≥ 15 seconds is included in some frailty definitions (Miller's Anesthesia)
5. Inflammatory Myositis & Other Neuromuscular Conditions
- Used alongside other functional tests (6-minute walk, sit-to-stand) when disease-specific tools are impractical
6. Gastroenterology / Nutrition / Sarcopenia
- Used as a functional performance test to identify sarcopenia risk and predict poor outcomes including hospitalization
What It Assesses (Components)
- Transitioning from sit to stand (lower limb strength)
- Walking speed and gait quality
- Turning (dynamic balance)
- Sit-back-down (controlled descent, postural stability)
The test provides both a quantitative score (time in seconds) and a qualitative observation opportunity for the clinician to assess gait abnormalities and balance difficulties.
Practical Notes
- Equipment needed: a chair, a stopwatch, and a 3-meter walkway - minimal setup
- Results correlate only moderately with patient self-reported function; self-reports tend to overestimate actual performance
- Prospective studies have not consistently found an association between TUG time alone and actual falls, so qualitative observation during the test adds important clinical value beyond the number
- Age-adjusted norms exist; older patients will naturally take longer
Sources: Harrison's Principles of Internal Medicine 22E (2025), Rheumatology 2-Volume Set (Elsevier, 2022), Firestein & Kelley's Textbook of Rheumatology, Miller's Anesthesia 10e, Campbell's Operative Orthopaedics 15e, Cummings Otolaryngology
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