Does the timed up and go test predict future falls among British community-dwelling older people? Prospective cohort study nested within a randomised controlled trial.

Gotaro Kojima,Jonathan Treml,Richard Morris,Denise Kendrick,Steve Iliffe,Tahir Masud,Sheena Gawler

doi:10.1186/s12877-015-0039-7

Abstract

BackgroundFalling is common among older people. The Timed-Up-and-Go Test (TUG) is recommended as a screening tool for falls but its predictive value has been challenged. The objectives of this study were to examine the ability of TUG to predict future falls and to estimate the optimal cut-off point to identify those with higher risk for future falls.MethodsThis is a prospective cohort study nested within a randomised controlled trial including 259 British community-dwelling older people ≥65 years undergoing usual care. TUG was measured at baseline. Prospective diaries captured falls over 24 weeks. A Receiver Operating Characteristic curve analysis determined the optimal cut-off point to classify future falls risk with sensitivity, specificity, and predictive values of TUG times. Logistic regression models examined future falls risk by TUG time.ResultsSixty participants (23%) fell during the 24 weeks. The area under the curve was 0.58 (95% confidence interval (95% CI) = 0.49-0.67, p = 0.06), suggesting limited predictive value. The optimal cut-off point was 12.6 seconds and the corresponding sensitivity, specificity, and positive and negative predictive values were 30.5%, 89.5%, 46.2%, and 81.4%. Logistic regression models showed each second increase in TUG time (adjusted for age, gender, comorbidities, medications and past history of two falls) was significantly associated with future falls (adjusted odds ratio (OR) = 1.09, 95% CI = 1.00-1.19, p = 0.05). A TUG time ≥12.6 seconds (adjusted OR = 3.94, 95% CI = 1.69-9.21, p = 0.002) was significantly associated with future falls, after the same adjustments.ConclusionsTUG times were significantly and independently associated with future falls. The ability of TUG to predict future falls was limited but with high specificity and negative predictive value. TUG may be most useful in ruling in those with a high risk of falling rather than as a primary measure in the ascertainment of risk.

Highlights

A limited number of studies validated Timed up and go test (TUG) among large cohorts of community-dwelling older people [15,16,17,18,19,20,21]. These studies were from the US [15,16,17], Ireland [18], Norway [19], Taiwan [20], and Japan [21]; and no study has investigated TUG as a predictor of future falls among community-dwelling older people in England
Of the entire cohort (N = 259), 59 participants (22.8%) had one or more falls over the 24-week follow-up period and were defined as fallers
One fall was reported by 38 participants (64.4%), two falls by 11 (18.6%), three falls by 6 (10.2%), four falls by 2 (3.4%), and both five and seven falls by one each (1.7% each)

Summary

Introduction

While retrospective studies consistently demonstrated significant positive relationships between TUG time and history of falls, the predictive ability of TUG to identify future falls risk has recently been challenged by metaanalyses [12,13,14]. These meta-analyses included heterogeneous populations and some of the study cohorts were small. These studies were from the US [15,16,17], Ireland [18], Norway [19], Taiwan [20], and Japan [21]; and no study has investigated TUG as a predictor of future falls among community-dwelling older people in England

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