Objective: To determine if a modified Timed Up and Go (TUG) test can be used to monitor motor improvement in patients with Parkinson’s disease (PD) dependent on ambulatory assistance during a 2-week in-patient multimodal intensive neurorehabilitation and care (i-MINC) stay.

Background: The TUG test is a widely used measure of functional mobility in the elderly and PD population. Its use is generally limited to patients able to walk independently.

Method: 76 PD patients (H&Y stage ≥3) were included. All required an assistive device and/or hands-on assistance on admission to i-MINC. They were assessed in their best ON state with a UPDRS examination and a modified TUG test allowing for ambulatory assistance at admission and prior to discharge. A paired T-test was used to analyze changes in TUG completion time and UPDRS scores, and a Wilcoxon signed-rank test for changes in TUG level of assistance (Table 1). The type of assistive device used during the test was recorded.

Results: 75 out of 76 patients showed improvement in TUG completion time. 76 patients improved in UPDRS total and motor scores. The average improvement in TUG completion time was 12.88 secs (p<0.0001), paralleled by a 16.84-point improvement in UPDRS total score and 6.41-point improvement in UPDRS motor score (p<0.0001). 79% of patients required a reduced level of assistance at discharge (p<0.0001). Only 8 patients required a more restrictive assistive device.

Conclusion: This study highlights the effectiveness of a modified TUG test as a marker for motor improvement in PD patients undergoing i-MINC. The joint reduction in TUG completion times, UPDRS total and motor scores strongly suggests that the modified test is a reliable and sensitive measure of motor function changes. Moreover, improvements in the level of assistance required during the test support the conclusion that i-MINC positively impacted functional mobility in the majority of patients. Adapting the TUG to accommodate patients dependent on ambulatory assistance creates a more inclusive assessment standard that can be used across the PD severity spectrum. Future studies may focus on formal reliability evaluation and application of the modified TUG test in other rehabilitation settings.

Table 1

References: Goetz, C. G., Tilley, B. C., Shaftman, S. R., Stebbins, G. T., Fahn, S., Martinez‐Martin, P.,Poewe, W., Sampaio, C., Stern, M. B., Dodel, R., Dubois, B., Holloway, R., Jankovic, J., Kulisevsky, J., Lang, A. E., Lees, A., Leurgans, S., LeWitt, P. A., Nyenhuis, D., … LaPelle, N. (2008). Movement disorder society‐sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS‐UPDRS): Scale presentation and Clinimetric testing results. Movement Disorders, 23(15), 2129–2170. https://doi.org/10.1002/mds.22340

Moondra, P., Rubin, L., McCrossin, M., Persaud, A., Di Rocco, A., Quartarone, A., & Ghilardi, M. F. (2024). In-Patient Multimodal Intensive Neurorehabilitation and Care Improve Motor and Non-Motor Functions in the Moderately Advanced Stages of Parkinson’s Disease: A Retrospective Study in a U.S. Facility. Biomedicines, 12(8), 1658. https://doi.org/10.3390/biomedicines12081658

Podsiadlo, D. and Richardson, S. (1991). “The timed “Up & Go”: a test of basic functional mobility for frail elderly persons.” J Am Geriatr Soc 39(2): 142-148.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/modified-timed-up-and-go-test-as-a-marker-for-motor-improvement-in-advanced-parkinsons-disease-after-in-patient-multimodal-intensive-neurorehabilitation-and-care/