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Timed "Up & Go" Test as a Predictor of Falls Within 6 Months After Hip Fracture Surgery

MT Kristensen is Research Physiotherapist, Department of Physiotherapy, Hvidovre University Hospital, Copenhagen, Denmark.
NB Foss, MD, is Research Fellow, Department of Anaesthesiology and Orthopaedics, Hvidovre University Hospital.
H Kehlet, MD, PhD, is Professor, Section of Surgical Pathophysiology, The Juliane Marie Centre, Righospitalet, Copenhagen, Denmark

morten.tange.kristensen{at}hh.hosp.dk

BACKGROUND AND PURPOSE: Previous studies of Timed "Up & Go" Test (TUG) scores as a predictor of falls were based primarily on retrospective data, and no prospective studies of the TUG for predicting falls in people with hip fracture are available. The purpose of this study was to determine whether TUG scores obtained upon discharge from an acute orthopedic hip fracture unit can predict falls in people with hip fracture during a 6-month follow-up period.

SUBJECTS: The subjects included in this study were 79 consecutive elderly people who had hip fractures and were able to perform the TUG when discharged directly to their own homes or to assisted living facilities from a specialized acute orthopedic hip fracture unit, with 59 (75%) being able to participate in the follow-up interview.

METHODS: In this prospective study, all subjects were contacted for a 6-month follow-up interview about falls since discharge from the hospital. The score on the TUG performed at discharge (median of 10 days after surgery) was compared with the New Mobility Score, which describes functional level before the fracture and mental status on admission, sex, type of fracture, residence, and walking aids before and after the fracture. All subjects followed a well-defined care plan with multimodal fast-track rehabilitation including an intensive physical therapy program comprising 2 daily sessions; discharge was in accordance with standardized criteria. Analyses and correlations of all variables were examined for prediction of falls, and sensitivity, specificity, predictive values, and likelihood ratios were calculated. Falls were classified as "none" or as "1 or more."

RESULTS: Among the 59 subjects in the follow-up group, 19 subjects (32%) experienced 1 or more falls in the period since discharge; 4 of these falls resulted in new hip fractures. The TUG performed at discharge with a cutoff point of 24 seconds was the only parameter that significantly predicted falls during the 6-month follow-up period, with a negative likelihood ratio of 0.1 to be a faller as a nonfaller.

DISCUSSION AND CONCLUSION: The results suggest that the TUG is a sensitive measure for identifying people with hip fracture at risk for new falls, and it should be part of future outcome measures to decide for whom preventive measures against falls should be instituted.

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