The reliability and validity of the Timed Up and Go as a clinical tool in individuals with and without disabilities across a lifespan: a systematic review

Depression and Functional Mobility Decline in Long Term Care Home Residents with Dementia: a Prospective Cohort Study

Objective

Assess the association between depression among new long-term care residents (<3 months stay) with dementia and functional mobility decline.

Methods

A multi-site prospective cohort study was carried out among 26 participants diagnosed with dementia. Functional mobility was measured by Timed-Up-and-Go (TUG) and 2-Minute walk test (2MWT) at baseline, and 60-day post-baseline while participants received usual care. Linear mixed models were applied to examine the association between depression and functional mobility decline.

Results

Residents experienced a statistically significant decline in functional mobility in as soon as 60 days. Each additional year of age was associated with a 2% increase in TUG. The interaction between depression and time spent in LTC was statistically significant. Age and time living in LTC were significantly associated with functional mobility decline in new residents with dementia.

Discussion

Further work determining why residents with dementia experience decline in functional mobility at an accelerated rate is needed.

Menopausal Symptoms, Postural Balance, and Functional Mobility in Middle-Aged Postmenopausal Women

The aim of the present study was to determine the associations between the severity of the menopausal symptoms and postural balance and functional mobility in middle-aged postmenopausal women. A cross-sectional study was performed (171 participants, 57.18 ± 4.68 years). Severity of the menopausal symptoms (on the Menopause Rating Scale), postural balance (stabilometric platform) with eyes open and closed, and functional mobility (timed up and go test) were determined. A multivariate linear regression was performed, with body mass index, waist to hip ratio, age and fall history as possible confounders. Our findings showed that a greater severity of the menopausal symptoms at a psychological level was associated, under both eyes open and closed conditions, with worse postural control assessed by the length of the stabilogram (adjusted R2 = 0.093 and 0.91, respectively), the anteroposterior center of pressure displacements (adjusted R2 = 0.051 and 0.031, respectively) and the center of pressure velocity (adjusted R2 = 0.065 for both conditions). Older age was related to greater mediolateral displacements of the center of pressure with eyes open and closed (adjusted R2 = 0.45 and 0.58, respectively). There were no associations between the menopausal symptoms' severity and functional mobility. We can conclude that a greater severity of psychological menopausal symptoms was independently associated with worse postural balance in middle-aged postmenopausal women.

Telerehabilitation for Individuals with Parkinson's Disease and a History of Falls: A Pilot Study

Purpose: Falls among persons with Parkinson's disease (PD) decrease health-related quality of life (HRQOL) and are a risk factor for hospitalization. Although physiotherapy can decrease falls and improve functional capacity, people living in remote areas have limited access to such services. This pilot study aimed to document the feasibility of a physiotherapy telerehabilitation intervention for patients with PD and to estimate the change over time in functional capacity, HRQOL, and the rate of falls. Methods: Eleven persons with PD participated in an 8-week physiotherapy telerehabilitation intervention. We assessed feasibility by computing retention rate and assiduity, number of undesirable health events, and technical problems. We assessed functional capacity, HRQOL, and falls at baseline, after the intervention, and at the 3-month follow-up. Results: Retention rate and assiduity were 91% and 100%. We resolved all technical problems (21.9% of sessions). No undesirable health events occurred. Point estimates suggest an improvement in functional capacity (Mini-BESTest) and HRQOL. Forty percent of participants fell during the intervention phase. Conclusion: Physiotherapy telerehabilitation is feasible and safe for persons with PD. Improvements in functional capacity and HRQOL must be confirmed with an appropriate design.

Sex Differences in Age-Related Physical Changes among Community-Dwelling Adults

The prevalence of physical functioning limitations is positively correlated with age in both men and women. However, whether the appearance of deterioration differs depending on physical function and sex remains unclear. This study aimed to clarify the modes of age-related changes in physical function and sex differences in middle-aged and older adults. This study comprised 124 (46 men and 78 women) healthy adults aged 30 years or older and examined gender differences in physical function. The results of this study showed that one-leg standing time had the highest rate of age-related decline in both men and women, followed by knee extension strength, skeletal muscle mass, the 5 m walking test, and the timed up and go test. The sex-specific points showed a high rate of decline in trunk forward bending in men and a high rate of decline in forced expiratory volume (1 s) and gradual rate of decline in the bone area ratio in women. After middle age, it is desirable to start monitoring and training balance, muscle function, and walking. Men require early intervention for flexibility, and women require early intervention for respiratory function and continued intervention for bone mineral density.

Measures of postural control and mobility during dual-tasking as candidate markers of instability in Huntington's disease

BACKGROUND

Individuals with Huntington's disease (HD) have impairments in performing dual-tasks, however, there is limited information about the effects of changing postural and cognitive demands as well as which measures are best suited as markers of underlying motor-cognitive interference.

METHODS

Forty-three individuals with HD and 15 healthy controls (HC) completed single tasks of walking (Timed Up & Go (TUG), 7 m walk), standing (feet together, feet apart and foam surface) and seated cognitive performance (Stroop, Symbol Digit Modalities Test (SDMT), Delis-Kaplan Executive Function System (DKEFS) Sorting test) and dual cognitive-motor tasks while standing (+ Stroop) and walking (+ DKEFS, TUG cognitive). APDM Opal sensors recorded measures of postural sway and time to complete motor tasks.

RESULTS

Individuals with HD had a greater increase in standing postural sway compared to HC from single to dual-tasks and with changes to support surface. Both groups demonstrated a decrease in gait performance during the TUG cognitive, however, this difference was greater in people with HD compared to HC. While those with HD showed a greater dual-task motor cost compared to HC, both groups behaved similarly as condition complexity increased.

CONCLUSIONS

Standing postural sway is a more sensitive marker of instability than change in standard gait speed, particularly under dual-task conditions. The more complex TUG cognitive is a sensitive measure of walking dual-task performance. The results of this study provide insights about the nature of motor-cognitive impairments in HD and provide support for a distinction between static and dynamic postural control mechanisms during performance of dual-tasks.

Proposed Mobility Assessments with Simultaneous Full-Body Inertial Measurement Units and Optical Motion Capture in Healthy Adults and Neurological Patients for Future Validation Studies: Study Protocol

Healthy adults and neurological patients show unique mobility patterns over the course of their lifespan and disease. Quantifying these mobility patterns could support diagnosing, tracking disease progression and measuring response to treatment. This quantification can be done with wearable technology, such as inertial measurement units (IMUs). Before IMUs can be used to quantify mobility, algorithms need to be developed and validated with age and disease-specific datasets. This study proposes a protocol for a dataset that can be used to develop and validate IMU-based mobility algorithms for healthy adults (18–60 years), healthy older adults (>60 years), and patients with Parkinson’s disease, multiple sclerosis, a symptomatic stroke and chronic low back pain. All participants will be measured simultaneously with IMUs and a 3D optical motion capture system while performing standardized mobility tasks and non-standardized activities of daily living. Specific clinical scales and questionnaires will be collected. This study aims at building the largest dataset for the development and validation of IMU-based mobility algorithms for healthy adults and neurological patients. It is anticipated to provide this dataset for further research use and collaboration, with the ultimate goal to bring IMU-based mobility algorithms as quickly as possible into clinical trials and clinical routine.

Test-Retest Reliability of the Timed Up and Go Test in Subjects with Parkinson's Disease: Implications for Longitudinal Assessments

BACKGROUND

Despite the frequent use of the Timed Up and Go (TUG) test in clinical trials, evaluation of longitudinal test-retest reliability is generally lacking and still inconclusive for patients with Parkinson's disease (PD).

OBJECTIVE

We aimed to further investigate long-term reliability and sensitivity of the TUG test among this population. Furthermore, we explored alternative assessment strategies of the test aimed at elucidating whether the inclusion or combination of timed trials may have potential implications on outcome measure.

METHODS

Relative and absolute reliability of the TUG performance were obtained in forty-three subjects with PD over three timed trials in two different testing sessions separated by a two-months period.

RESULTS

Our results reported excellent intra-session and moderate inter-session reliability coefficients. The use of different assessment strategies of the TUG was found to have an important impact on outcome measure, highlighting the averaging of several timed trials in each testing session as a recommended alternative to minimize measurement error and increase reliability in longitudinal assessments. Nevertheless, beyond acceptable reliability, poor trial-to-trial stability of the measure appears to exist, since the ranges of expected variability upon retesting were wide and the incidence of spurious statistical effects was not negligible, especially in longitudinal repeated testing.

CONCLUSION

Limitations may exist in the interpretation of the TUG outputs as part of longitudinal assessments aimed at evaluating treatment effectiveness in PD population. Researchers and practitioners should be aware of these concerns to prevent possible misrepresentations of functional ability in patients for a particular intervention.

Clinical assessment of gait and functional mobility in Italian healthy and cognitively impaired older persons using wearable inertial sensors

AIM

The main purpose of the present study was to verify the feasibility of wearable inertial sensors (IMUs) in a clinical setting to screen gait and functional mobility in Italian older persons. In particular, we intended to verify the capability of IMUs to discriminate individuals with and without cognitive impairments and assess the existence of significant correlations between mobility parameters extracted by processing trunk accelerations and cognitive status.

METHODS

This is a cross-sectional study performed on 213 adults aged over 65 years (mean age 77.0 ± 5.4; 62% female) who underwent cognitive assessment (through Addenbrooke's Cognitive Examination Revised, ACE-R) instrumental gait analysis and the Timed Up and Go (TUG) test carried out using a wearable IMU located in the lower back.

RESULTS

Individuals with cognitive impairments exhibit a peculiar gait pattern, characterized by significant reduction of speed (- 34% vs. healthy individuals), stride length (- 28%), cadence (- 9%), and increase in double support duration (+ 11%). Slight, but significant changes in stance and swing phase duration were also detected. Poorer performances in presence of cognitive impairment were observed in terms of functional mobility as overall and sub-phase TUG times resulted significantly higher with respect to healthy individuals (overall time, + 38%, sub-phases times ranging from + 22 to + 34%), although with some difference associated with age. The severity of mobility alterations was found moderately to strongly correlated with the ACE-R score (Spearman's rho = 0.58 vs. gait speed, 0.54 vs. stride length, 0.66 vs. overall TUG time).

CONCLUSION

The findings obtained in the present study suggest that wearable IMUs appear to be an effective solution for the clinical assessment of mobility parameters of older persons screened for cognitive impairments within a clinical setting. They may represent a useful tool for the clinician in verifying the effectiveness of interventions to alleviate the impact of mobility limitations on daily life in cognitively impaired individuals.

Die deutsche Version des Brunel Balance Assessments zur Erfassung der Gleichgewichtsfähigkeit bei Menschen nach einem Schlaganfall: kulturelle Adaptation und erste psychometrische Evaluation

Hintergrund Das Brunel Balance Assessments (BBA) ist ein klinisches Messinstrument zur Erfassung der Gleichgewichtsfähigkeit von Menschen nach Schlaganfall. Die englischsprachige Originalversion des Assessments weist gute Gütekriterien auf.

Ziel Übersetzung und kulturelle Adaptation des BBA für den deutschsprachigen Raum sowie erste Einschätzung der Praktikabilität und Konstruktvalidität.

Methode Das BBA wurde konform einer etablierten Leitlinie ins Deutsche übersetzt. Als Teil dieses Prozesses wurde eine präfinale deutsche Version des Assessments über einen Zeitraum von 10 Wochen in einem ambulanten Rehabilitationszentrum von Physiotherapeut*innen klinisch angewendet. Die anschließende Überarbeitung des Assessments basierte auf den Erfahrungen der Anwender*innen. Eine erste Analyse der Konstruktvalidität folgte dem Ansatz des Hypothesentestens. Es wurde angenommen, dass das BBA stark mit Testwerten anderer Assessments des funktionellen Gleichgewichts und der Gehfähigkeit korreliert. Als Indikator der Praktikabilität wurde die Durchführungszeit des BBA erfasst.

Ergebnisse Die präfinale deutsche Version wurde von 10 Therapeut*innen mit 25 Patient*innen nach Schlaganfall klinisch angewendet. Durch geringfügige Anpassungen wurde eine finale deutsche Version des BBA erstellt. BBA-Testwerte korrelierten moderat mit Testwerten des TUG und Testwerten der FAC. Die durchschnittliche Durchführungszeit des BBA betrug 17 ± 4 Minuten.

Schlussfolgerung Das BBA wurde übersetzt, kulturell für den deutschsprachigen Raum adaptiert und steht nun für die klinische Anwendung zur Verfügung. Vorläufige Analysen weisen auf eine moderate Konstruktvalidität bei Patient*innen nach einem Schlaganfall im ambulanten Setting hin. Eine ausführliche Überprüfung der Gütekriterien steht aus.

Effect of movement speed on lower and upper body biomechanics during sit-to-stand-to-sit transfers: Self-selected speed vs. fast imposed speed

Preferred and fast speed sit-to-stand and stand-to-sit (STS) tests are prevalent in literature, but biomechanical changes between the different speeds of STS have never been studied. Understanding differences between these STS techniques will better inform experimental design for research assessing functional ability in clinical populations. The purpose of this study was to investigate the effect of different speeds of STS transfers on lower body and trunk kinematics and kinetics in healthy adults. Nineteen healthy middle-aged and older adults participated in this study. Two different speeds of STS were tested: self-selected speed and fast speed (as quickly as possible). Ten Vicon cameras and two AMTI force platforms were used to collect three-dimensional kinematic and kinetic data. During sit-to-stand transfer, peak knee extension velocity and knee extension moment were significantly increased for the fast speed STS as compared to the preferred speed STS. During stand-to-sit transfer, peak knee extension moment and lower back moment were significantly increased while STS time was decreased for the fast speed STS as compared to the preferred speed STS. Our results indicate that the fast speed STS could be more challenging for participants compared to the preferred speed STS evidenced by greater knee and lower back joint movements. Therefore, fast STS tests should be reconsidered when testing middle-aged and older adults with chronic low back pain and knee joint problems.

[Group-based exercise to prevent falls in community-dwelling older adults : Update of the 2009 recommendations of the German Federal Initiative to Prevent Falls]

Dieser Beitrag stellt eine Aktualisierung des Empfehlungspapiers der Bundesinitiative Sturzprävention für das körperliche Gruppentraining zur Sturzprävention bei älteren, zu Hause lebenden Menschen aus dem Jahre 2009 unter Berücksichtigung aktueller Evidenz dar. Das aktualisierte Empfehlungspapier zielt darauf ab, die Umsetzung ambulanter Sturzpräventionsgruppen zu fördern sowie konkrete Empfehlungen für deren Einrichtung und Durchführung auszusprechen. Die Empfehlungen beziehen sich auf die Identifikation und Ansprache der Zielgruppe für gruppenbasierte Sturzpräventionsprogramme sowie auf die Programmgestaltung und Qualitätssicherung. Hintergründe zu Finanzierung und Trainer*innen-Ausbildung werden samt einer Auflistung der in Deutschland etablierten Programme ebenfalls dargelegt.

Timed Up and Go: Reference Values for Community-Dwelling Older Adults with and without Arthritis and Non-Communicable Diseases: The Tromsø Study

Purpose

The Timed Up and Go (TUG) test is used to assess a person’s mobility and balance. We aimed to provide updated reference values for TUG performance for the community-dwelling older population according to age and sex, and according to the presence of arthritis and non-communicable diseases (NCDs).

Participants and Methods

Cross-sectional data from the seventh wave (2015–2016) of the population-based Norwegian Tromsø Study counting 5400 community-dwelling people (53% women), aged 60–84 years were used. Reference values were presented as percentiles and means for men and women by age at five-year intervals.

Results

Median TUG score was stable during age 60–65 years, and after age 65 years median TUG score increased significantly with age (increase by 0.14 sec per 1 year higher age in both men and women, p<0.001). At the youngest ages (<65 years), in both men and women, there were no differences in TUG performance for those with NCD or arthritis compared to those without these diseases. After age 65 however, those without these diseases performed significantly better (p<0.05) in both men and women.

Conclusion

The present study provided percentile reference values for TUG performance in community-dwelling older adults in Norway by age and sex, and in subgroups of those having arthritis and NCDs. TUG scores increased with age, and performance was significantly poorer among participants with arthritis or NCDs after age 65 years. The findings may guide clinical interventions for individuals with mobility and balance disabilities.

Reliability and Validity of the Six Spot Step Test in People with Intellectual Disability

Clinical tests for the evaluation of balance in people with intellectual disability that have been most commonly used depend on the subjective evaluation of the evaluator, easily reach the ceiling effect and are poorly sensitive to small changes; but new tests have been developed, such as the Six Spot Step Test. The aim of this study was to determine the validity and within-day and day-to-day test–retest reliability of the Six Spot Step Test in people with intellectual disability. A descriptive cross-sectional study was conducted with 18 people with intellectual disability. The participants conducted the Six Spot Step Test three times and a set of five clinical tests for the balance assessment. The relative reliability was excellent (Intraclass Correlation Coefficient (ICC) = 0.86 − 0.97), and the absolute reliability ranged between 4.7% and 7.3% for coefficient variation and between 0.6 and 1.2 for the standard error of measurement. Linear regression models showed that that test can explain the results of the Timed Up & Go, Four Square Step Test and the Berg Balance Scale. The Six Spot Step Test proved to be as valid and reliable for the evaluation of dynamic balance in people with intellectual disability as the most frequently used tests for the clinical evaluation of postural control.

Cohort profile: Design and implementation of the Danish Physiotherapy Research Database for patients receiving primary care with chronic disease

PURPOSE

Free of charge physiotherapy (FCP) is free physiotherapy provided by the Danish government for patients with a range of chronic diseases. To date, the population has not been described in depth making evaluation and decision making difficult. The purpose of this study was to (1) describe the development and the content of a novel clinical physiotherapy database for FCP (PhysDB-FCP) and (2) present the cohort profile based on the data collected.

PARTICIPANTS

Ninety-nine clinics (17 460 FCP patients) were invited to participate in the development process from 2018 to 2019. Eleven clinics consented (2780 FCP patients) and 534 patients performed the physiotherapy assessment using the PhysDB-FCP tool, with 393/534 completing the patient survey.

FINDINGS TO DATE

The content of the PhysDB-FCP was developed through an iterative process involving consensus between clinical and research workgroups. Prior to using the tool all consenting sites received training to use/administer the tool. All data were collected/stored using the PhysDB-FCP. Items finally chosen for the PhysDB-FCP included demographic information, questions about health status and daily functioning, functional tests, treatment plan and validated questionnaires. The initial patient cohort composed of 63.4% women with main diagnoses of multiple sclerosis (22.7%) and Parkinson's disease (17.0%). The ability to perform personal/instrumental activities of daily living and functional ability varied widely. Other non-physiotherapy related issues were identified in numerous patients (ie, 34.9% of patients were at risk of depression) and multidisciplinary interventional approaches could be considered.

FUTURE PLANS

The current study has provided a comprehensive description of patients receiving FCP, using data collected from the novel PhysDB-FCP. Collected information can be used to facilitate microlevel to macrolevel programme evaluation and decisions. Although the PhysDB-FCP is promising, the tool requires optimisation before it is implemented regionally and/or nationally.