TIMED “UP & GO” TEST AS A PREDICTOR OF FALLS WITHIN SIX MONTHS AFTER HIP FRACTURE SURGERY (1).

Abstract

BACKGROUND AND PURPOSE: Previous studies using the Timed Up & Go (TUG) as a predictor of falls have primarily been based on retrospective data, while no prospective studies using the TUG to predict falls in hip fracture patients are available. The purpose of this study was to determine if the TUG could predict falls in hip fracture patients during six months follow up.

SUBJECTS: Seventy nine elderly consecutive unselected hip fracture patients being able to perform the TUG when discharged directly to their own home or assisted living facilities from a special acute orthopedic hip fracture unit, with 59 (75 %) being able to participate in the follow-up interview.

METHODS: In a prospective study all patients were contacted for a six months follow up interview about falls since discharge from the hospital and the TUG performed at discharge was compared with the New Mobility Score describing functional level before fracture, mental status on admission, gender, fracture type, residence and walking aids before and after fracture. All patients followed a well-defined care plan with multimodal fast track rehabilitation including an intensive physiotherapy program comprising two daily sessions and discharge was according to 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 vs. one or more.

RESULTS: Among the 59 patients in the follow up group, 19 patients (32 %) had experienced one ore more falls in the period since discharge, four of which resulted in new hip fractures. The TUG at discharge using a cutoff point of 24 seconds was the only parameter that significantly (P =.01) predicted falls within six months follow up, resulting in a sensitivity of 95%, a negative predictive value of 93%, and a negative likelihood ratio of 0.1.

DISCUSSION and CONCLUSION: The results suggest that the TUG is a sensitive measure for identifying hip fracture patients in risk of new falls, and it should be part of future outcome measures to decide in whom falls preventative measures should be instigated.