Further Validation of the Timed up and Go in Persons with Multiple Sclerosis

Background: Previous studies have reported evidence supporting the validity of the timed up and go (TUG) test in persons with multiple sclerosis (pwMS).  However, the two studies were of small sample size and may not be representative of the MS population. In addition, one study reported validity but stated the TUG was inconclusive compared to elderly and unilateral lower limb populations.

Objectives: To provide further validation of the TUG among a large sample of pwMS.

Methods: Participants were randomly selected from the patients seen at a community-based comprehensive MS care center as a part of a larger study. A total of 251 pwMS agreed to participate and  completed the following assessments: timed up and go (TUG), patient determined disease status (PDDS), timed 25 foot walk (T25FW), functional status index (separated into subcategories for analysis of average assistance [FSI-A], mobility [FSI-Mobility] and difficulty [FSI-D]), multiple sclerosis walking scale 12 (separated into MSWS-12 total score and benchmarks), multiple sclerosis impact scale (MSIS-29) and Disabilities of the Arm, Shoulder, and Head (DASH).  Age, gender and disease duration were obtained from each participant’s medical record. Data were analyzed using spearman’s rank-order correlations with a p-value of <0.01 considered significant.

Results: The TUG had a strong, positive and significant association with all of the following (p-value <0.001): a valid quantitative measure of lower extremity function (T25FW, r_s= .902), perceived level of mobility (FSI-Mobility, r_s=.667; MSWS-12, r_s=.696), perceived limitations and difficulty in daily activities (FSI-D, r_s= .519; MSIS-29, r_s= .567; DASH, r_s= .646), perceived need of assistance in daily activities (FSI-A, r_s=  .716), perceived overall disability (PDDS, r_s=.716), and  with recently defined MSWS-12 benchmarks (r_s=.669).

Conclusions: This study provides further validation of the TUG and it’s use as a clinical measure of pwMS by enhancing existing research through validation on a larger more representative study sample.  Increased difficulty on the TUG was strongly associated with increased disability on all measures assessed.  In addition, this study supports using the TUG as a measure of mobility impairment and decreased functional independence in pwMS.