Objective: To determine whether the “Timed Up and Go” (TUG) scale can be effectively utilized in patients with advanced Parkinson’s disease (PD) as an outcome measure for gait disorder and fall risk, in the context of multi-modal intensive inpatient rehabilitation.

Background: The TUG scale has been used effectively in PD to measure gait and balance function, and indirectly, the risk of falls [1,2]. However, its use has been validated only in patients with Hoehn and Yahr (H&Y) stage 3 or less [3,4,5]. Our PD Acute Inpatient Rehabilitation Program (PDIAR) treats patients with H&Y stage 3 and 4, measuring performance outcomes of the 2-week intense multi-modal rehabilitation. As no alternative scale to TUG has been validated in more advanced stages of PD, we decided to evaluate its use in patients H&Y stage 4.

Method: 27 H&Y stage 4 patients were evaluated with TUG Scale at the beginning and end of their 2 weeks stay of the PDIAR. For patients with motor response fluctuations, the scale was applied during practically defined “Best-On.” All patients required assistive devices, as well as additional hands-on assistance at either minimal-assist or contact-guard level. While in PDIAR, patients participated in intensive multimodal therapy, inclusive of 3 hours of individualized therapy and 2 hours of group therapy daily, 5 days a week.

Results: Average TUG time was 58.2 on admission and 39.8 on discharge, a 31.6% improvement. This directly correlated with changes in patients’ Unified Parkinson’s Disease Rating Scale (UPDRS) score during the same time. Average UPDRS score on admission was 104.6 and on discharge was 68.4, a 36.1% improvement.

Conclusion: Although this study lacks the power to validate TUG use in advanced PD, it provides the basis to extend its use beyond Stage 3. Functional scales are important as baseline initial assessment to measure outcomes of a specific intervention. As rehabilitation medicine expands its scope to rehabilitate and restore gait function in patients with more advanced disease, it is important to define instruments that can provide a measurable assessment and can be utilized over time to determine response to treatment or disease progression. Formal studies are needed to validate and define the use of TUG in advanced stages of PD.

References: [1] Lang AE. The evidence for multidisciplinary care in Parkinson’s disease. Expert Rev Neurother. 2020 Jun;20(6):539-549. doi: 10.1080/14737175.2020.1771184. Epub 2020 Jun 1. PMID: 32479209. 

[2] Meloni, M., Saibene, F. L., Di Tella, S., Di Cesare, M., Borgnis, F., Nemni, R., & Baglio, F. (2021). Functional and Cognitive Improvement After an Intensive Inpatient Multidisciplinary Rehabilitation Program in Mild to Severe Parkinson’s Disease: A Retrospective and Observational Study. Frontiers in neurology, 12, 626041

[3] 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.

[4] Winser SJ, Kannan P, Bello UM, Whitney SL. Measures of balance and falls risk prediction in people with Parkinson’s disease: a systematic review of psychometric properties. Clinical Rehabilitation. 2019;33(12):1949-1962. doi:10.1177/0269215519877498

[5] Kegelmeyer, D., Ellis, T., Esposito, A., Gallagher, R., Harro, C., Hoder, J., Hussey, E., & Oneal, S. (Eds.)(2013, April). Parkinson Evidence Database to Guide Effectiveness. Practice resources. Retrieved March 3, 2023, from https://www.neuropt.org/practice-resources/neurology-section-outcome-measures-recommendations/parkinson-disease

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MDS Abstracts - https://www.mdsabstracts.org/abstract/novel-application-of-the-timed-up-and-go-scale-as-a-reliable-tool-to-measure-functional-improvement-and-fall-prevention-after-inpatient-parkinsons-disease-specific-rehabilitation-for-advanced-stages/