Timed Up and Down Stairs (TUDS)

Posted on: March 15, 2015 | By: rpine | Filed under: Timed Up and Down Stairs (TUDS)

Timed Up and Down Stairs (TUDS)

Descriptive Information

  1. Title, Edition, Dates of Publication and Revision* –
    1. Zaino CA, Marchese VG, Westcott SL. Timed up and down stairs test: preliminary reliability and validity of a new measure of functional mobility. Pediatr Phys Ther. 2004;16(2):90-8.
  2. Author (s) – Zaino CA, Marchese VG, Westcott SL
  3. Source (publisher or distributor, address) – Author contact information: Sarah L. Westcott, 5019 218th NE, Redmond, WA 98053. Email: wests@isomedia.com.
  4. Costs (booklets, forms, kit)* – Free; cost of the test is the time required to administer the test.
  5. Purpose* – TUDS is a simple measure of functional mobility that can be easily done in a variety of settings and should be considered for testing and potentially documenting improvement of children with suspected limitations in functional mobility and balance. Use of this measure could be an easy method of monitoring change across time or with therapy. Responsiveness of the TUDS is yet to be determined.
  6. Type of Test (eg. screening, evaluative; interview, observation, checklist or inventory)* – The TUDS test is a screening test to identify children with suspected limitations in functional mobility and balance.
  7. Target Population and Ages* – 8-14 y/o; with and without CP
  8. Time Requirements – Administration and Scoring* – The length of time needed for participant to ascend/descend full flight of stairs.

Test Administration

  1. Administration – The participant stands 1 foot from the bottom of a 14-step flight of stairs. The participant is instructed to “Quickly, but safely go up the stairs, turn around on the top step (landing) and come all the way down until both feet land on the bottom step (landing.” The participants are allowed to choose any method of traversing the stairs. This includes using a step-to or foot over foot pattern, running up the stairs, skipping steps, or any other variation. Handrails can be available. The participants wear shoes but no orthotics. The subjects are given the cues “ready” and “go.”
  2. Scoring – The TUDS score was the time in seconds from the “go” cue until the second foot returned to the bottom landing. Shorter times indicated better functional ability.
  3. Type of information, resulting from testing (e.g. standard scores, percentile ranks) – Score range (seconds) based on normative data of typically developing (TD) 8-14 y/o children.
  4. Environment for Testing – Stairs (14 steps), with handrails on one or both sides.
  5. Equipment and Materials Needed – Stopwatch, stairs (14 steps), participant wearing shoes but no orthotics.
  6. Examiner Qualifications – Ability to administer and time the test.
  7. Psychometric Characteristics* – The TUDS demonstrated excellent intrarater, interrater, and test-retest reliability [ICC (2,1) > or =0.94] and moderate to high concurrent validity (Spearman r(s) = 0.78, -0.57, and -0.77, with the TUG, FRT, and TOLS, respectively). Age accounted for 37% and 56% of the variance in the TUDS for the TD group and for the Gross Motor Function Classification Scale level I CP group, respectively. Significant differences in TUDS scores were found between all three functional level groups. The TUDS has adequate reliability and validity in children with and without CP and appears to complement current clinical measures of functional mobility and balance.
  8. Standardization/normative data – 8.1 sec (range 6.3-12.6 sec), age 8-14 y/o (N=27) or 0.58 sec/step for ascending/descending.
  9. Evidence of Reliability – The TUDS demonstrated excellent intrarater, interrater, and test-retest reliability [ICC (2,1) > or =0.94].
  10. Evidence of Validity – The TUDS demonstrated moderate to high concurrent validity (Spearman r(s) =0.78, -0.57, and -0.77; p < 0.001, with the TUG, FRT, and TOLS, respectively.)
  11. Discriminative – The TUDS scores for the typically developing (TD) group averaged to 0.58 sec/step for ascending/descending. This average is almost half of the 1.11 sec/step for children with CP, GMFCS level I and one third of the 1.75 sec/step for children with CP, GMFCS level II/III. As a result, it appears use of this measure could be an easy method of monitoring change across time or with therapy. Age accounted for 37% and 56% of the variance in the TUDS for the TD group and for the Gross Motor Function Classification Scale level I CP group, respectively. Significant differences in TUDS scores were found between all three functional level groups.
  12. Predictive – The TUDS was hypothesized to reflect changes in children’s functional mobility and balance and when functional abilities were measured more directly using the GMFCS to assign subjects to groups. The analysis revealed differences in the TUDS scores across all three functional groups of children.

Summary Comments*

  1. Strengths – The TUDS has adequate reliability and validity in children with and without CP and appears to complement current clinical measures of functional mobility and balance.
  2. Weaknesses – Further investigation needed across larger age ranges and samples.
  3. Clinical Applications – It appears use of this measure could be an easy method of monitoring change across time or with therapy.

 

Adapted from:

  1. Stangler S, Huber C, Routh D: Screening Growth and Development of Preschool Children: A Guide to Test Selection. New York, McGraw-Hill, 1980, pp 55-59.
  2. Anastasi A: Psychological Testing, 4th New York, MacMillan, 1976, pp 705-70

 

Article Summary:

Bonnyaud C, Zory R, Pradon D, Vuillerme N, Roche N. Clinical and biomechanical factors which predict timed up and down stairs test performance in hemiparetic patients. Gait Posture. 2013;38(3):466-70.

The purpose of this study was to determine the clinical (maximal gait speed, strength and spasticity) and biomechanical (spatio-temporal, kinematic and kinetic gait parameters) gait parameters, which could best predict the time taken by ambulatory hemiparetic patients to ascend and to descend a flight of stairs as quickly but as safely as possible. The study population included sixty hemiparetic patients (mean age: 50.3 years +/- 13.1, 30 with right hemiparesis, 30 with left hemiparesis, 45 men and 15 women, time post-stroke: 5.7 years +/- 6.7). The methods parameters were such that each patient participated in three types of assessment: the Timed Up and Down Stairs test (TUDS); the clinical assessment (LE strength using the MRC scale, LE spasticity using the Modified Ashworth Scale, and the nFAC/Barthel Index/10mWT); and a 3D-gait analysis. The primary outcome measures included the results from the Timed Up and Down Stairs test (TUDS); the clinical assessment (LE strength using the MRC scale, LE spasticity using the Modified Ashworth Scale, and the nFAC/Barthel Index/10mWT); and a 3D-gait analysis. There was no intervention. The results indicated that maximal walking speed on the 10mWT and strength of the ankle dorsiflexors were the clinical variables most related to TUDS test performance.

Strengths included consistency with prior data indicating that the 10mWT and ankle/knee extensor strength was the main factor predictive of stair performance. Limitations included patients who had moderate to good recovery, thus results should be interpreted relative to similar populations.

Overall, this study demonstrated that maximal walking speed during the 10-m walk test, ankle dorsiflexor strength, and the percentage of time spent in single support phase on the paretic lower limb are the main factors that predict the capacity of ambulatory hemiplegic patients to ascend and descend a flight of stairs as fast, but safely, as possible. This information can help therapists identify patients with impaired stair climbing performance and adapt the rehabilitation program to result in improved independence with functional activities.

 

One response to “Timed Up and Down Stairs (TUDS)”

  1. condrey says:
    March 15, 2015 at 7:04 pm

    This seems like it could be a very useful outcomes measure in children with CP, and possibly with other diagnoses that effect gait and function in children. I like that it allows children to ascend/descend the stairs in whatever way they like (step to, etc.); I think it may be useful to track improvements in the quality of gait patterns while ascending/descending the stairs with improvements in the quantitative aspect of this test.

    I also thought not having the child wear orthotics was interesting. I think this is good, so it allows the tester to see any deficits before assistive devices are used. I’d like to know if any studies have been done that compare test scores with and without use of orthotics. This may be useful to determine the effectiveness of the orthotic device with functional activities, such as stair ascension/descension.

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