Exploration of Timed up and Go Scores with and without a Cognitive Challenge in People with MS and a Healthy Reference Group

Background: The Timed Up and Go (TUG) test is a quick and easily administered test of dynamic mobility. It may be useful in identifying those in need of rehabilitation interventions and distinguishing between fallers and non-fallers. Adding a cognitive challenge to the TUG may further enhance its usefulness.

Objectives: 1) To evaluate if the scores on the Timed Up and Go (TUG) and the TUG with a cognitive challenge (TUG-C) differ between people with MS and a healthy reference group.  2) To evaluate the differences between the TUG and TUG-C scores for each of those groups. 3) To evaluate the difference in TUG and TUG-C scores between people with MS who do and do not report a fall in the past three months.

Methods: A cross sectional study which took place in a University, an MS society and an Outpatient Neurology clinic. The average of three TUG walks and the average of three TUG walks while subtracting numbers in threes were analysed. A faller was defined as a person with MS who reported one or more falls in the past three months.  

Results: 50 University students (age 22.7 range 18-40, 14 males, 36 females) were used as a healthy reference sample and 28 people with MS (age 53.39 range 29-69, 7 males, 21 females) also took part. The mean TUG score for the reference group (REF) was 5.8±0.8 and for the MS group was 13.4±8.6, these were statistically different using non-parametric statistics (p<0.01). The mean TUG-C scores were also statistically different (REF 6.0±1.0, MS 17.3±11.9, p<0.01). There was a significant difference between the TUG and TUG-C scores for the REF (0.2±0.5, p=0.02) and the MS groups (3.9±7.6, p<0.001). Seven people reported a fall in the previous three months, their TUG score (13.5±5.6) was not significantly different to that of the non-fallers (n=21, 13.4±9.5, p0.640). Similarly there was no difference between fallers and non-fallers for the TUG-C (p0.836). 

Conclusions: People with MS have significantly slower TUG and TUG-C scores compared to a healthy reference group. While the mean differences between TUG and TUG-C are significant for both groups, the absolute differences are much larger for the MS cohort. There was no difference between fallers and non-fallers, but this requires confirmation using prospective monitoring of falls status.