title: Responsiveness and predictability of gait speed and other disability measures in acute stroke. Responsiveness of mobility, daily living, and instrumental activities of daily living outcome measures for geriatric rehabilitation. Effect of seat height and turning direction on the timed up and go test scores of people after stroke. Effect of Stroke on Fall Rate, Location and Predictors: A Prospective Comparison of Older Adults with and without Stroke Prognostic validity of the Timed Up-and-Go test, a modified Get-Up-and-Go test, staff's global judgement and fall history in evaluating fall risk in residential care facilities. Clinical tests performed in acute stroke identify the risk of falling during the first year: postural stroke study in Gothenburg (POSTGOT). Risk factors for falls in post-stroke patients treated in a neurorehabilitation ward. Effects of the Direction of Turning on the Timed Up & Go Test with Stroke Subjects Does chair type influence outcome in the timed "Up and Go" test in older persons?
abstract: OBJECTIVES To identify the most responsive method of measuring gait speed , to estimate the responsiveness of other outcome measures , and to determine whether gait speed predicts discharge destination in acute stroke . DESIGN A prospect i ve cohort study . SETTING Five acute-care hospitals . PATIENTS Fifty subjects with residual gait deficits after a first-time stroke . INTERVENTIONS Five- ( 5mWT ) and 10-meter walk tests ( 10mWT ) at comfortable and maximum speeds , with 2 evaluations conducted an average + /- st and ard deviation ( SD ) of 8 + /- 3 and 38 + /- 5 days poststroke . MAIN OUTCOME MEASURE St and ardized response mean ( SRM = mean change/SD of change ) was used to estimate responsiveness for each walk test , the Berg Balance Scale , the Barthel Index , the Stroke Rehabilitation Assessment of Movement ( STREAM ) , and the Timed Up and Go ( TUG ) . RESULTS The SRMs were 1.22 and 1.00 for the 5mWT , and .92 and .83 for the 10mWT performed at a comfortable and maximum pace , respectively . The SRMs for the Berg Balance Scale , the Barthel Index , the STREAM , and the TUG were 1.04,.99,.89 , and .73 , respectively . The probability of discharge to a rehabilitation center for persons walking at < or = 0.3 m/s or > 0.6 m/s at the first evaluation was.95 and .22 , respectively . CONCLUSIONS The 5mWT at a comfortable pace is recommended as the measure of choice for clinicians and research ers who need to detect longitudinal change in walking disability in the first 5 weeks poststroke OBJECTIVES To assess and compare the ability of the Timed Up & Go ( TUG ) and subscales of the Functional Autonomy Measurement System ( SMAF ) to detect change in people undergoing geriatric rehabilitation in inpatient geriatric rehabilitation units ( GRUs ) and day hospitals . DESIGN Longitudinal design with repeated measures obtained at admission and discharge from rehabilitation and at 2 follow-up interviews . SETTING Inpatient and outpatient hospital-based setting s. PARTICIPANTS Subjects ( N=237 , age 80+/-7 y ) had data at admission and discharge from rehabilitation ( changing time frame ) , and of these , 160 had data at 2 subsequent follow-ups ( stable time frame ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The TUG was used to estimate basic mobility , and subscales of the SMAF were used to estimate general mobility ( SMAF-mobility ) , basic activities of daily living ( SMAF-ADL ) , and instrumental activities of daily living ( SMAF-IADL ) . Professionals ' perception of change was used as a criterion . RESULTS The TUG generated large values for the st and ardized response mean ( SRM ) and Guyatt 's responsiveness index in GRUs ( .98 and 1.12 ) and day hospitals ( .89 and 1.85 ) . Professionals ' perception of change in mobility was explained by a perceptible change in the TUG in day hospitals ( 15 % ) but not in GRUs . The SMAF-mobility , SMAF-ADL , and SMAF-IADL were associated with large values of SRM and Guyatt 's responsiveness index in GRUs ( .97 - 2.17 ) and with small to moderate values in day hospitals ( .29-.54 ) . Moderate to large portions in the professionals ' perceptions of change for mobility ( 20 % , 17 % ) , basic ADLs ( 10 % and 14 % ) , and IADLs ( 23 % and 19 % ) were associated with the respective change scores of the subscales of the SMAF in both GRUs and day hospitals . CONCLUSIONS Progress of older adults in the areas of mobility , basic ADLs , and IADLs can be captured using the TUG , SMAF-mobility , SMAF-ADL , and SMAF-IADL in both GRUs and day hospitals . The results support their use in setting s of high- and low-intensity rehabilitation , thus suggesting their adequacy for use in these 2 setting OBJECTIVE To identify the effect of chair seat height and turning direction on the Timed Up and Go scores of patients after stroke . DESIGN A cross-sectional study . SETTING A geriatric day hospital in Hong Kong . SUBJECTS Twenty-five patients with sub-acute stroke . METHODS The time taken to complete the Timed Up and Go test with various chair seat heights ( 65 % , 90 % and 115 % of each subject 's leg length - distance from lateral knee joint line to ground in sitting ) and turning directions ( toward the affected and unaffected side ) was recorded using a stopwatch with r and omized test order . RESULTS There were significant differences in Timed Up and Go scores between the 3 levels of chair seat height ( p < 0.001 ) , with the lowest Timed Up and Go scores recorded when the seat height was 115 % of the subject 's leg length and the highest at a seat height of 65 % of the subject 's leg length . Turning toward the affected side was found to be significantly quicker than turning toward the unaffected side ( p < 0.001 ) . CONCLUSION Chair seat height and turning direction significantly influence the Timed Up and Go scores of patients after sub-acute stroke . Optimizing chair seat height with reference to subject 's leg length and turning direction is essential when using the Timed Up and Go test as an outcome measure in stroke rehabilitation Background The literature suggests that stroke is a major risk factor for falls , but there is a lack of prospect i ve , controlled studies which quantify fall-risk after stroke . The purpose of this study was to compare the rates , location and predictors among individuals recently discharged home from stroke rehabilitation to age and sex matched controls . Methodology /Principal Findings A sample of 80 people with stroke and 90 controls received baseline assessment s of  balance , mobility and balance confidence . Falls were recorded prospect ively over 13 months for both groups . Group differences in fall rates and contribution of clinical measures to falls were determined using negative binomial regression . Fall location was compared between groups using χ2 statistics . The rate of falls for individuals with stroke was 1.77 times the rate for the control group . People with stroke were more likely to fall at home . Poorer balance ( Berg Balance Scale ) was associated with greater falls for both stroke and control groups ( incidence rate ratio [ IRR ] : 0.908 and IRR : 0.877 respectively ) . A faster Timed Up and Go Test was associated with greater falls for the stroke group ( IRR : 0.955 ) while better walking endurance ( Six Minute Walk Test ) was associated with greater falls for the controls ( IRR : 1.004 ) . Balance confidence was not an independent predictor in either group . Conclusions Individuals recently discharged home are at greater risk of falling than individuals without stroke . Attention to home environment is warranted . Balance function can predict falls for both people with stroke and age and sex matched controls . Increased mobility may increase exposure to fall opportunities OBJECTIVES to evaluate and compare the prognostic validity relative to falls of the Timed Up- and -Go test ( TUG ) , a modified Get-Up- and -Go test ( GUG-m ) , staff 's judgement of global rating of fall risk ( GLORF ) and fall history among frail older people . DESIGN cohort study , 6-month prospect i ve follow-up for falls . PARTICIPANTS 183 frail persons living in residential care facilities in Sweden , mean age 84 years , 73 % women . METHODS the occurrence of falls during the follow-up period were compared to the following assessment s at baseline : the TUG at normal speed ; the  GUG-m , a rating of fall risk scored from 1 ( no risk ) to 5 ( very high risk ) ; the  GLORF  ,  staff 's rating of fall risk as ' high ' or ' low ' ; a history of falls in the previous 6 months . These assessment tools were evaluated using sensitivity , specificity and positive and negative likelihood ratios ( LR(+ ) to rule in and LR(- ) to rule out a high fall risk ) . RESULTS 53 % of the participants fell at least once . Various cut-off values of the TUG ( 12 , 15 , 20 , 25 , 30 , 35 , 40 s ) and the GUG-m showed LR(+ ) between 0.9 and 2.6 and LR(- ) between 0.1 and 1.0 . The GLORF showed an LR(+ ) of 2.8 and an LR(- ) of 0.6 and fall history showed an LR(+ ) of 2.4 and an LR(- ) of 0.6 . CONCLUSIONS in this population of frail older people , staff judgement of their residents ' fall risk as well as previous falls both appear superior to the performance-based measures TUG and GUG-m in ruling in a high fall risk . A TUG score of less than 15 s gives guidance in ruling out a high fall risk but insufficient information in ruling in such a risk . The grading of fall risk by GUG-m appears of very limited value OBJECTIVE To assess the likelihood of clinical tests for postural balance , walking and motor skills , performed during the first week after stroke , identifying the risk of falling . DESIGN Prospect i ve study . SUBJECTS Patients with first stroke . METHODS Assessment s were carried out during the first week , and the occurrence of falls was recorded 3 , 6 and 12 months after stroke onset . The tests used were :  10-Metre Walking Test ( 10MWT ) , Timed Up & Go , Swedish Postural Assessment Scale for Stroke Patients , Berg Balance Scale and Modified Motor Assessment Scale .  Cut-off levels were obtained by receiver operation characteristic curves , and odds ratios were used to assess cut-off levels for falling . RESULTS The analyses were based on 96 patients . Forty-eight percent had at least one fall during the first year . All tests were associated with the risk of falling . The highest predictive values were found for the 10MWT ( positive predictive value 64 % , negative predictive value 76 % ) . Those subjects who were unable to perform the 10MWT had the highest odds ratio , 6.06 ( 95 % confidence interval 2.66 - 13.84 , p<0.001 ) of falling . CONCLUSION Clinical tests used during the first week after stroke onset can , to some extent , identify those patients at risk of falling during the first year after stroke BACKGROUND AND PURPOSE Patients with neurological disorders , including post-stroke patients , are at high risk for falls . The purpose of the study was to estimate the number and type of falls and fall-related injuries in patients of a neurological rehabilitation ward and to identify risk factors for falls . MATERIAL AND METHODS 353 consecutive post-stroke patients of the Neurorehabilitation Unit at the Institute of Psychiatry and Neurology in Warsaw were enrolled into the study and observed during the hospital stay . Falls occurring in patients during their hospital stay were registered and an analysis of fall-related data and the routinely obtained medical data was performed . RESULTS In the evaluated group , 35 ( 10 % ) patients suffered 50 falls , which corresponds to an incidence rate of 5.02 [ 95 % confidence interval ( 95 % CI ) : 3.70 - 6.52 ] falls per 1000 patient-days . Most falls occurred in patients ' rooms ( 80 % ) , most of them taking place while transferring from one place to another or while changing position . 2 % of falls caused severe injury . There was a higher percentage of patients with unilateral neglect in the group of fallers ( p=0.0007 ) , who also demonstrated poorer performance in activities of daily living as expressed by the Rankin score ( p < 0.0002 ) and the Barthel Index ( p < 0.0001 ) , and greater neurological deficit in the Sc and inavian Stroke Scale ( SSS ) ( p=0.002 ) at admission as well as at discharge from hospital than non-fallers . The risk of a fall showed greatest association with low Barthel Index at admission ( < 15/20 ; RR=10.3 ; 95 % CI : 2.8 - 50.7 ) , performance in the Rankin score of > 3 ( RR=5.12 ; 95 % CI : 2,41 - 14,8 ) , low SSS score on admission ( 0 - 39 ; RR=3.40 ; 95 % CI : 1.62 - 9.14 ) , and the presence of hemispatial neglect ( RR=3.42 ; 95 % CI : 1.23 - 6.53 ) . The multiple-fallers group did not differ significantly from the group of single-fallers . CONCLUSIONS Among post-stroke patients , falls are a complication especially affecting persons with a large neurological deficit , severe disability and the neglect syndrome Abstract Purpose : To compare the  Timed Up & Go ( TUG ) test between subjects with and without hemiparesis , considering the direction toward which they turned , and to determine the potential clinical variables that could explain possible observed differences between the groups and /or the turning directions . Method : Twenty-two hemiparetic and 22 matched control subjects performed the TUG twice , with each one turning in both directions .  Measures of the strength and tonus of the quadriceps , gait speed , balance , and fear of falling were also collected . Results : Stroke subjects were slower in the TUG than the control group , independent of the direction toward which they turned ( F = 45.87 ; p < .001 ) . For both groups , similar performances were observed when turning toward the paretic and nonparetic/matched sides ( F = 0.50 ; p = .48 ) . The absolute differences between the two TUG trials were greater for the stroke subjects ( p = .001 ) and were significantly correlated with gait speed , balance , and fear of falling ( −0.69 < r < − 0.52 ; p < .013 ) , with fear of falling being the only variable retained in the regression model ( R2 = 0.44 ; p = .001 ) . For the control subjects , no significant correlations were found . Conclusions : The larger differences between the two TUG trials for the stroke subjects illustrated the impact of the turning direction on test performance . These differences were not related to hemiparesis , but to the fear of falling OBJECTIVE To test the effects of the use of a collapsible , portable chair ( chair B ) , as opposed to a ' st and ard ' chair ( chair A ) , on the outcome of the timed " Up and Go " ( TUG ) test . DESIGN Cross-sectional . SETTING Multi purpose senior centres . PARTICIPANTS Mobile older persons ( N=118 , mean age 77 years ( range 62 - 99 years ) ) . OUTCOME MEASURES Time to complete the timed " Up and Go " test  using chair A and chair B , and inter-rater agreement in the time scores . RESULTS Time taken to complete the TUG test did not differ by chair type [ median ( interquartile range , IQR ) = 12.3 ( 9.53 - 15.9 ) and 12.6 ( 9.7 - 16.6 ) ] seconds for Chair A and B respectively , p-value=0.87 . In multiple regression analyses , factors that impacted on time difference in test performance for the two chairs were use of a walking aid during the test [ Odds ratio ( OR ) = 3.7 95%CI 1.1 - 11.9 , p=0.031 ] , observed difficulty with mobility ( OR= 27.7 95%CI 2.6 - 290 , p=0.006 ) , and a history of arthritis in the knees ( OR= 2.9 95%CI 1.0 - 8.7 , P=0.05 ) . In an inter-rater agreement analysis , no significant difference was found between time scores recorded by the two raters ; median ( IQR ) = 12.4 ( 10.9 - 15.9 ) and 12.3 ( 7.2 - 59.1 ) seconds for the occupation therapist and for the research assistant , respectively ( Wilcoxon matched pairs test , p=0.124 , Spearman correlation coefficient = 0.99 , p < 0.001 ) . CONCLUSION The use of a portable canvas chair with st and ardised specifications offers an acceptable alternative to the use of a ' st and ard ' chair in assessment s of fall risk using the TUG test in field setting s where field workers are reliant on public transport
target: Conclusion : The TUG can be recommended for measuring basic mobility skills after stroke in patients who are able to walk .
background: Abstract Objective : To systematic ally review and summarize the clinimetric properties , including reliability , validity , and responsiveness , the procedures used , and the meanings of the scores in the Timed Up and Go Test ( TUG ) .
  The TUG is a performance test that identifies problems with functional mobility in patients with stroke .