Inter-rater reliability of Timed Up and Go test in older adults measured by physiotherapist and caregivers

Abstract

Introduction

Globally and in Nepal, 28–35% of older adults experience fall-related injuries annually. The ‘Timed Up and Go’ (TUG) test is a valid measure to assess risk of falls when administered by health professionals; but the reliability of the TUG administered by older adults’ primary caregiver is unknown. The aim of this study was to examine the inter-rater reliability of the TUG assessed by caregivers compared to a trained student physiotherapist in older adults.

Methods

One hundred older adults were recruited with their primary caregivers in a rural community of Nepal. The researchers trained primary caregivers prior to assessment following an a priori protocol. Both the caregiver and a trained student physiotherapist administered the TUG. The two tests were performed at an interval of five minutes, and the two testers were blinded to each other’s assessment. The inter-rater reliability was evaluated using the two-way random-effects model absolute agreement intra-class correlation coefficient (ICC_2,1). The Bland–Altman plot was created to visualise systematic errors between the measurements.

Results

The ICC was found to be 0.87 (95% CI: 0.82–0.91) indicating excellent inter-rater reliability of the TUG between primary caregivers and the student physiotherapist.

Conclusions

Caregivers’ assessment of the TUG is reliable compared to a trained student physiotherapist. Therefore, caregivers could be used to assess risk of fall and to monitor changes after discharge, without having to be assessed by a physiotherapist in a rural community setting. This could help overcome both geographic and economic barriers.

Keywords:

• Inter-rater reliability
• Timed Up and Go test
• caregiver
• reliability
• outcome assessment
• psychometrics
• balance

Acknowledgements

We would like to thank all the student physiotherapists and the study participants who volunteered during the study. The authors would like to thank all the students/staff who assisted in the data collection. The authors would also like to thank Dr. Ross Wilson for proof-reading the manuscript. All data generated or analysed during this study are included in this article.

Ethics approval and consent to participate

This study was approved by the Institutional Review Committee of Kathmandu University School of Medical Sciences, Dhulikhel, Nepal (ethical approval number 60/17). Informed consent to participate in the study was obtained from all participants.

Authors’ contributions

GMN, MB, and SS led the design of the study, performed the statistical analyses, and drafted the manuscript. GMN and SS critically revised the manuscript for important intellectual content. All authors were involved in the review of the draft manuscript, read, and approved the final version prior to submission.

Disclosure statement

No potential conflict of interest was reported by the authors.