TUDS test for Down Syndrome
Martin K, Natarus M, Martin J, & Henderson S. (2017). Minimal Detectable Change for TUG and TUDS Tests for Children With Down Syndrome. Pediatric Physical Therapy : The Official Publication Of The Section On Pediatrics Of The American Physical Therapy Association, 29(1), 77-82.
The purpose of this article was to evaluate the minimal detectable change (MCD) of both the timed up and go (TUG) and timed up and down stairs (TUDS) for individuals with Down Syndrome who were able to walk and navigate stairs independently as well as follow simple verbal directions. The study looked at twelve children (age 3-17) that had a diagnosis of Down Syndrome (DS) in two sessions, one week apart for 3 trials of TUG and two trials of TUDS during each session. For the purpose of this summary TUDS will be the focus. Only 2 trials of TUDS was performed due the physical demand, no practice trials were performed to avoid fatigue. There were 15 stairs (different from the original 14) and bilateral handrails (only 1 within reach for use) and participants could navigate stairs in any way they wanted with a 1 minute rest break between trials. Orthoses were allowed and verbal cues for direction and encouragement were used throughout if necessary for participants. The study used intraclass correlation coefficients and the standard error of measurement to determine test-retest reliability and calculation of minimal detectable change (MDC). Both the TUG and TUDS were found to have high test-retest reliability with TUDS despite only 8 participants completing due to the alternate testing location. However, the MDC was 12.52 seconds for TUDS and 1.26 seconds in TUG. The MDC numbers were determined too large in TUDS test to be clinically relevant for this population but small enough in the TUG test to be clinically relevant for use in the population. The element of sample size being too small was determined to be irrelevant due to the wide variety of the sample. The element of safety was also a possible determinant to the test due to the population having generally decreased postural stability and decreased motor performance and being taught throughout development that safety is more important than speed in navigating stairs. Overall TUG is a great outcome measure for this population and further research may be needed on TUDS to be claimed as a clinically relevant outcome measure for individuals with a diagnosis of Down Syndrome.
2 responses to “TUDS test for Down Syndrome”
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The TUDS seems to be a very easily performed test, requires little equipment, has good test-retest reliability, and can be used on a wide variety of populations. However, I find it interesting that the MDC was found to be so high in this patient population and agree that further research is warranted. I agree that safety could greatly affect the test. I also find it interesting that this study had the participants wear their orthoses even though the original testing protocol did not do so and I wonder what affect this could have on the test results. I am curious as to what the MDC is in other specific patient populations, for example patients with CP, stroke, or even generally deconditioned patients.
There were many things going through my mind as I read about this test. Is this test utilized at all with older age groups who are able to complete this type of higher level activity without assistance? There are some cases where I would be more interested in using a test such as this compared to the TUG. While I do understand that there is more research behind the TUG, sometimes I get the underlying feeling that I’m just completing it to prove that “because Mr. Smith is 1 second slower than the average time for his age he is at an increased risk for (insert diagnosis here).” A higher level test such as this seems like it could be more applicable for those who can complete it safely, but I digress.
I was curious to know why the researchers for the specific article you chose decided to stray from the original set 14 steps. It may not necessarily describe it in the article, but in order to accurately determine the comparison of 2 specific tests, I would think it is imperative to conduct those tests to the distinct instructions that are laid out. Regardless, I am glad that you found an article looking at the comparison between these 2 tests. While both seem very easy to conduct, physical therapists are always looking for the most reliable and valid measures.