Timed Up and Go: Reference Data for Children Who Are School Age
Summary: In this study the authors investigate the use of the TUG outcome measure in children aged 5 to 13 in attempt to identify sex and age-based reference values for the typically developing population. In this study, 653 males and 846 females performed 2 trials of the TUG. The test was performed by using a chair with a height that allowed the child to sit with 90 degrees knee flexion and feet flat on the floor. They were instructed to stand up and “walk but not run” to the line marked on the floor 3m away, turn around and walk back to the chair and sit down. These instructions were intentionally worded to mimic a typical indoor walking environment for a child. The time to complete the TUG was recorded for each trial and statistical analysis was performed to determine the age based normative data for both males and females. Statistically significant differences were found between the males and females for ages 8, 9 and 11; however the authors concluded these differences do not represent a clinically meaningful or functional difference. The TUG time shows a decreasing trend as children age. Another measure that the authors investigated was the relationship between BMI and TUG time, however no significant correlation was found.
Strengths: This research study is particularly useful because of the large sample population that was used. It included a diverse group of children including those from urban and rural backgrounds and different race and ethnicities. This allows for the results to be generalized to a large percentage of the population. Additional, the authors of this article emphasize the clinical utility of the TUG because of its ease of administration and functional use in everyday activities for typically developing children.
Limitations: One of the limitations of this study is that they did not compare the results of this test with other tests or functional outcomes. If they had looked at the comparison of the TUG scores with participation in school or home life activities it could allow for an improved understanding of what a clinically significant difference in TUG score could be. Additionally, sit to stand and walking are skills that are developed before school-age, so it would be beneficial to include children at a younger age in the study to further the reference tool.
Conclusion: This study is beneficial to clinicians because it provides us with reference data for typically developing children and allows us to make age comparisons to determine if a child is functioning at a slower pace than typical for their age. However, further research is needed to determine the functional implications of a decreased TUG time.
Itzkowitz A, Kaplan S, Doyle M, et al. Timed Up and Go. Pediatric Physical Therapy. 2016;28(2):239-246. doi:10.1097/pep.0000000000000239.
6 responses to “Timed Up and Go: Reference Data for Children Who Are School Age”
Leave a Reply
You must be logged in to post a comment.
It is important to have studies that give reference values to give us a better understanding of how a child is typically developing. Due to the obesity epidemic in children of the United States, I wonder how increased BMI can effect the TUG score and is something that is considered when performing this outcome measure.
Autumn, great article! Going off our discussion in Geriatric’s with regards to aerobically trained older adults vs. non-trained and their outcomes, I wonder if there is an implication in the activity levels of children (eg. children who participate in sports) and their performance on the TUG. It seems logical that despite the developmental stage of the child, children with increased exposure to situations in which their balance is challenged, will demonstrated greater outcomes. Did the study perform any data collection regarding the child’s activity level?
Great review, Autumn! I used the TUG quite often in pediatric inpatient rehab during one of my clinicals. When choosing tests to perform, one problem I ran into often is that many of the tests and measures have very limited normative data for pediatric populations. Fortunately, the TUG is one that has reference data for a large age group as well as information for specific populations. During that clinical I found the study that you reviewed, as well as two others (below), to be very helpful for comparing the patients I saw to age- and diagnosis- matched values for evaluation.
1. Nicolini-Panisson RD, Donadio MVF. Normative values for the Timed ‘Up and Go’ test in children and adolescents and validation for individuals with Down syndrome. Developmental Medicine & Child Neurology. 2014;56(5):490-497. doi:10.1111/dmcn.12290
2. Williams EN, Carroll SG, Reddihough DS, Phillips BA, Galea MP. Investigation of the timed “up & go” test in children. Dev Med Child Neurol. 2005;47(8):518-524.
I was interested to see that relationship with BMI and TUG time was also investigated. I am curious in this case if BMI was representative of physical activity levels for the children participating in this study (implying that those with higher BMI’s engage in less physical activity). As you know we have been discussing outcome norms in the geriatric population and the accuracy of these norms relative to those whom are sedentary vs. those who are engaging in recommended levels of physical activity. I wonder in the pediatric population if TUG norms would differ between children whom are meeting or exceeding physical activity recommendation vs. those who do not meet these recommendations. Although this study determined that no significant correlation was found between BMI and TUG time I wonder at which age and/or stage of life physical activity levels/body composition do begin to impact outcomes such as the TUG.
Very interesting article Autumn! I found it interesting that there was no significant differences found between the BMI and TUG values. In the recent years childhood obesity has becomes more of an issue with more children wanting to stay sedentary in front of a computer or TV screen instead of running around and playing outside. In your limitations section, you mention how they did not look at the child’s participation in school or home activities. It would be interesting to see a similar study done that takes into account the child’s physical activity level and how that might play a factor in their TUG scores. It could also be interesting to see a study that determines if adding endurance interventions results in improved TUG times for children with higher BMIs.
In response to the comments above, the relationship between BMI and activity level was not investigated in this particular study. However, I agree that this would be important to identify if there is a relationship between activity level and TUG scores. It is possible that participation in higher level activities can challenge dynamic balance, motor control and gait speed, all of which can impact the ability to perform the TUG. In addition, further studies are indicated to determine normative TUG scores for children with atypical development and the role that activity participation may play in improving these scores.