Within-Day Test-Retest Reliability of the Timed Up & Go Test in Patients With Advanced Chronic Organ Failure

doi:10.1016/j.apmr.2013.03.024

Archives of Physical Medicine and Rehabilitation

Volume 94, Issue 11, November 2013, Pages 2131-2138

https://doi.org/10.1016/j.apmr.2013.03.024 Get rights and content

Abstract

Objective

To investigate the within-day test-retest reliability of the Timed Up & Go (TUG) test in patients with advanced chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), and chronic renal failure (CRF).

Design

Cross-sectional.

Setting

Patients' home environment.

Participants

Subjects (N=235, 64% men; median age, 70y [interquartile range, 61–77y]; median body mass index, 25.6kg/m² [interquartile range, 22.8–29.4kg/m²]) with advanced COPD (n=95), CHF (n=68), or CRF (n=72).

Interventions

Not applicable.

Main Outcome Measure

Time to complete the TUG test. Three trials were performed on the same day and by the same assessors. The intraclass correlation coefficient (ICC), kappa coefficient, standard error of measurement, and absolute and relative minimal detectable change (MDC) values were calculated.

Results

Good agreement was observed, in general, for both the total sample and subgroups (COPD, CHF, CRF), with ICC values ranging from .85 to .98, and kappa coefficients from .49 to 1.00. However, statistical improvement occurred in the total sample from the first to the second trial with large limits of agreement (mean difference, −.97s; 95% confidence interval, 3.00 to −4.94s; P<.01). The third trial added little or no information to the first 2 trials. For the total sample, a standard error of measurement value of approximately 1.6 seconds, an absolute value of MDC at the 95% confidence level (MDC_95%) of approximately 4.5 seconds, and a relative value of MDC at the 95% confidence level (MDC_95%%) of approximately 35% were found between the first 2 trials, with similar values found for the subgroups.

Conclusions

The TUG test is reliable in patients with advanced COPD, CHF, or CRF after 2 trials. Values of standard error of measurement and MDC may be used in daily clinical practice with these populations to define what is expected and what represents true change in repeated measures.

Section snippets

Study design and participants

The present study is part of a longitudinal observational study concerning palliative care needs of patients with advanced COPD, CHF, or CRF.20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 For the present study, only the results from the baseline assessment were considered. The study received approval from the Medical Ethical Committee of the Maastricht University Medical Center + (MUMC+), Maastricht, the Netherlands (MEC 07-3-054), and all patients gave written informed consent.

Patients were

Characteristics of participants

From the 265 subjects initially included in the main study,20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 30 were excluded from the current analysis because they were not able to perform 3 TUG trials. Table 1 presents the general characteristics of the 235 elderly subjects included. In general, the majority of patients had COPD, were men, and were former smokers. Almost half of the patients were regular users of walking aids and dependent in personal care. The median BMI was normal to overweight,

Discussion

This study has shown that there is high agreement in the TUG test results when the test was performed on the same day and in patients with advanced chronic organ failure (ICCs ranging from .85 to .98). Considering the classification proposed by Podsiadlo and Richardson,¹ good agreement was also found in general, but with a wider range of values (κ coefficients from .49–1.00). Despite good agreement, the result of the TUG test significantly improved from the first to the second trial, but not

Conclusions

To the best of our knowledge, this is the first study to investigate the reliability of the TUG test in patients with clinically stable, but advanced COPD, CHF, or CRF. The TUG test is reliable after only 2 trials, but relevant improvement occurs from the first to the second trial. The third trial adds little or no information to the previous ones. Therefore, we suggest doing only 2 TUG test trials in patients with these chronic diseases in advanced stage.

Values of standard error of measurement

Suppliers

a.
IBM North America, 590 Madison Ave, New York, NY 10022.
b.
GraphPad Software Inc, 2236 Avenida de la Playa, La Jolla, CA 92037.

Acknowledgments

We thank research nurses Els Verstraeten, RN, and Jamila Dekker-Heuts, RN, for data collection, and Linda Koolen, MS, for input of the data; and the physicians of the following collaborating hospitals and departments for their participation in this study: Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands: Departments of Respiratory Medicine, Cardiology, and Internal Medicine; Laurentius Hospital, Roermond, The Netherlands: Departments of Respiratory Medicine and

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: Supported by the CIRO+ Short Term Research Training Award 2012; the Brazilian Federal Government through the National Council for Scientific and Technological Development; Proteion Thuis, Horn, The Netherlands; The Netherlands Asthma Foundation, Leusden, The Netherlands (grant no. 3.4.06.082); Stichting Wetenschapsbevordering Verpleeghuiszorg (SWBV), Utrecht, The Netherlands; and The Weijerhorst Foundation, Maastricht, The Netherlands.

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

: Clinical Trial Registration No. Dutch Trial Register (NTR 1552).

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Original articleWithin-Day Test-Retest Reliability of the Timed Up & Go Test in Patients With Advanced Chronic Organ Failure

Abstract

Objective

Design

Setting

Participants

Interventions

Main Outcome Measure

Results

Conclusions

Section snippets

Study design and participants

Characteristics of participants

Discussion

Conclusions

Suppliers

Acknowledgments

Respir Med

Chest

Am J Transplant

Respir Med

J Am Med Dir Assoc

Chest

Chest

J Pain Symptom Manage

J Am Med Dir Assoc

J Chronic Dis

J Clin Epidemiol

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

The Timed “Up & Go”: a test of basic functional mobility for frail elderly persons

J Am Geriatr Soc

Reliability of gait performance tests in men and women with hemiparesis after stroke

J Rehabil Med

The Timed “Up & Go” test is a useful predictor of falls in community-dwelling older people

J Am Geriatr Soc

Reliability of outcome measures for people with lower-limb amputations: distinguishing true change from statistical error

Phys Ther

Psychometric properties of activity, self-efficacy, and quality-of-life measures in individuals with Parkinson disease

Physiother Can

Testing functional performance in people with Parkinson disease

Phys Ther

Foundations of clinical research: applications to practice

The effects of vitamin D supplementation on physical function and quality of life in older patients with heart failure: a randomized controlled trial

Circ Heart Fail

Vitamin D and muscle strength, functional ability and balance in peritoneal dialysis patients with vitamin D deficiency

Clin Nephrol

Age-graded reductions in quadriceps muscle strength and peak aerobic capacity in COPD

Rev Bras Fisioter

The prevalence of quadriceps weakness in COPD and the relationship with disease severity

Eur Respir J

Contribution of muscle weakness to postural instability in the elderly. A systematic review

Eur J Phys Rehabil Med

Original article
Within-Day Test-Retest Reliability of the Timed Up & Go Test in Patients With Advanced Chronic Organ Failure