Assessing Timed Up and Go in Parkinson’s disease: Reliability and validity of Timed Up and Go Assessment of biomechanical strategies
Bruna Adriana da Silva, Christina D.C.M. Faria, Mariana Palla Santos, Alessandra Swarowsky
Brazilian Parkinson’s disease Rehabilitation Initiative (BPaRkI), Physical Therapy Postgraduate Program, Physical Therapy Department, Santa Catarina State University (UDESC, Florianópolis, Brasil
Objective: To investigate the measurement properties of the Timed Up and Go Assessment of Biomechanical Strategies (TUG-ABS) to determine its adequacy for use with individuals with Parkinson’s disease.
Subjects: Fifty individuals with Parkinson’s disease.
Design: Diagnostic accuracy.
Methods: The study investigated the following properties: reliability (inter-examiner, intra-examiner, test-retest, internal consistency and minimal detectable change), construct validity, and floor and ceiling effect.
Results: Considering the total score, the inter-examiner, test–retest and intra-examiner reliabilities were classified as excellent (0.95 ≤ intra-class correlation coefficient (ICC)≤0.99). The TUG-ABS presented excellent internal consistency (α = 0.98). The minimal detectable change was 3.82 points. The construct validity between the TUG-ABS and the Unified Parkinson’s Disease Rating Scale (UPDRS) – part III was classified as moderate (ρ = –0.62). Significant, elevated and positive correlations were obtained between TUG-ABS and the Balance Evaluation System Test (BESTest)-VI (ρ = 0.72) and negative correlations between TUG-ABS and TUG (ρ = –0.78). The discriminant function obtained with the total score of TUG-ABS classified 60% of the individuals correctly with respect to the group (determined by the performance in TUG) to which they belonged. One-way analysis of variance (ANOVA) showed that TUG-ABS discriminated the individuals with Parkinson’s disease in all stages according to Hoehn & Yahr. There was a ceiling effect of 22%.
Conclusion: TUG-ABS presented adequate measurement properties in individuals with Parkinson’s disease.
Mobility changes are an inevitable consequence of Parkinson’s disease (PD). Of the tests available, to evaluate compromised functional mobility in PD, the Timed “Up and Go” test (TUG) is one of the most used and highly recommended. However, the result is only the time to perform the test, limiting the physiotherapeutic diagnosis. A new evaluation was developed to improve the results provided by the TUG, as well as an evaluation of the strategies that limit the individual's mobility (Timed “Up and Go” Assessment of Biomechanical Strategies – TUG-ABS). We studied the feasibility of applying this new assessment in 50 patients with Parkinson's disease. As the conclusion, TUG-ABS was shown to be an evaluation feasible to identify the strategies used by individuals with PD while carrying out the TUG test, being useful to be applied in clinical practice and to improve the physiotherapeutic diagnosis.