Differences between TUG and SPPB | Which one should you use? How to choose based on evaluation purpose
TUG and SPPB are commonly used when assessing the physical function of elderly individuals.
Since both evaluate standing up, walking, and balance,
you might wonder,
“Which one is better for assessing fall risk?”
“If I measure TUG, is it unnecessary to do SPPB?”
“What exactly is the difference between them?”
To clarify the differences first,
TUG looks at a series of movements: standing, walking, turning, returning, and sitting.
SPPB looks at balance, walking, and standing up by dividing them into three tasks.
However,
it is not the case that they can be completely separated into
“TUG is an evaluation for movement” and “SPPB is an evaluation for muscle strength.”
TUG results are also influenced by muscle strength, balance, walking speed, pain, and anxiety.
SPPB also includes actual movements such as standing and walking.
What differs is the way they
capturephysical function and movement.
It is not a matter of which one is superior,
but rather what the individual is struggling with.
And what you want to know in order to consider those difficulties.
You choose the evaluation based on this.
1. TUG is an evaluation that looks at a “series of movements”
TUG is an abbreviation for the Timed Up and Go Test.
Generally, it starts from a seated position in a chair.
Stand up from the chair
Walk 3 meters
Turn around
Return to the chair
Sit down again
The time taken for this sequence of movements is measured.
The TUG was reported in 1991 as a method for quantitatively evaluating the basic mobility of frail elderly people. The original study examined 60 elderly people referred to a geriatric day hospital [1].
Observing the quality of movement along with the time
The main value obtained from a standard TUG is the total time from start to sitting down.
However, when I observe a TUG, I do not stop at just the number of seconds.
For example,
Are they unsteady immediately after standing up?
Do their feet stop when starting to walk?
Are their steps small and shuffling when turning?
Are they operating their cane or walker safely?
Do they sit down into the chair with too much force?
I also check these types of movements.
Even with the same 12 seconds, the way of moving is not necessarily the same.
The things to look at next differ between someone who took a long time to stand up and someone who was cautious during the turn.
With TUG,
we consider which part of the sequence of movements showed difficulty or instability.
The TUG time alone does not reveal the cause.
Just because a TUG test takes a long time,
you cannot immediately conclude that the patient is
“weak in muscle strength”
or
“prone to falling.”
There are multiple possibilities behind why it took time, such as:
muscle strength or balance,
joint mobility or pain,
fear of falling,
handling of a cane or walker,
or moving while checking for safety.
The TUG result is not the cause itself, but rather
a tool to help determine what to examine in more detail next.
The measurement method, reference values, and how to observe movements for TUG are organized in detail in this article.
2. SPPB is an evaluation that "looks at three separate tasks"
SPPB stands for Short Physical Performance Battery.
We will check physical function, focusing on the lower limbs, using the following three tasks.
1. Standing balance
We check if the person can maintain a standing posture while changing the position of their feet.
Side-by-side stand
Semi-tandem stand
Tandem stand
2. Gait speed
We measure the time it takes to walk a set distance at a normal pace.
3. Five-times chair stand
With arms folded across the chest, we measure the time it takes to stand up from a chair five times in a row.
Basically, each of the three tasks is scored from 0 to 4 points, for a total score of 0 to 12 points.
SPPB was developed as a method to objectively evaluate lower limb function in the elderly, and the original study examined over 5,000 elderly people aged 71 and older [2].
Looking at which task had a low score
With SPPB, you can check not only the total score but also the results of the
balance items
gait speed
chair stand
separately.
For example, even with the same score of 8,
a person with a low score on the balance items
People with low walking speed scores
People who took a long time to stand up from a chair
In these cases, the next steps to check will differ.
Even with SPPB, you cannot determine the cause.
Even if the score for standing up from a chair is low, muscle strength is not necessarily the only cause.
Foot position, the movement of shifting the body forward, pain, joint movement, balance, and chair height also have an impact.
The same applies if walking speed is slow.
Various backgrounds can be considered, such as stride length, pain, endurance, and caution.
SPPB is also not a test that provides an answer, but rather material to consider what to check next.
The implementation method and scoring for SPPB are summarized in this article.
▶ How to perform SPPB and score criteria | Includes evaluation sheet for clinical use
3. What is the difference between TUG and SPPB?
The differences between TUG and SPPB are summarized as follows.
Comparison perspective TUG SPPB Evaluation form Series of movements Three tasks Main content Standing, walking, turning, returning, sitting Balance, walking, standing up Main results Total time Score for each item and total score What is easy to see Connection of movements, turning, sitting Which task had a low score Points to note Cause cannot be determined by time alone Cause cannot be determined by score alone
What to be careful about here is
TUG is an evaluation that looks at movement
SPPB is an evaluation that looks at physical function
separating them completely.
TUG results are also influenced by muscle strength, balance, and walking speed.
SPPB also includes movements such as walking and standing up.
Both are influenced by similar physical functions, but
TUG is viewed as a continuous movement
SPPB is organized by dividing it into three tasks
These are the differences.
4. Choose based on what you want to know
When choosing an evaluation, before looking at the test name,
what you want to know
what you want to use the results for
should be considered.
Use TUG if you want to observe the flow of movement or turning
For example,
staggering immediately after standing up
feet stopping when starting to walk
becoming unstable when turning
unable to approach the chair well
moving with too much force when sitting down
wanting to observe movement including the use of a cane or walker
are such cases.
In TUG, the actions of standing, walking, turning, returning, and sitting occur in sequence.
Therefore, it becomes easier to check theconnection between movements, which is difficult to see with individual actions alone.
Use SPPB if you want to observe the three tasks separately
For example,
Can they maintain a standing posture?
What is their usual walking speed?
Can they repeatedly stand up from a chair?
In which items were the scores low?
I want to organize physical functions by item.
These are the cases.
With SPPB, you can evaluate balance, walking, and standing up separately.
If information is insufficient, combine both.
You do not necessarily have to decide on just one, either TUG or SPPB.
For example,
The standing balance item was performed successfully in SPPB. However, there was unsteadiness during the turn in TUG.
There are cases like this.
Instability that was not apparent in tasks requiring a static posture may become visible in TUG, which involves moving while changing direction.
Conversely,
TUG was completed without significant stops. However, the results for walking speed and chair stand-ups in SPPB were concerning.
There are also cases like this.
Even if a series of movements can be performed, breaking down walking and standing up can reveal areas that require additional confirmation.
Rather than trying to learn everything from a single evaluation,
it is important to adopt the mindset of supplementing missing information with another evaluation.
This approach is important.
5. Which is better for assessing fall risk?
When considering fall prevention,
you might wonder,
"Which is better at identifying people who will fall, TUG or SPPB?"
To give you the conclusion first,
you cannot determine future falls based on the results of just one of these.
In a study that followed community-dwelling adults aged 75 and older for one year, neither TUG nor SPPB was sufficient to distinguish those who would subsequently fall.
However, this is the result for one specific target group and cannot be applied directly to all elderly people [3].
This does not mean that TUG or SPPB are useless.
With TUG, you can observe how they move, and with SPPB, you can organize the status of their balance, gait, and sit-to-stand ability.
However, falls are caused by factors other than physical function, such as:
history of falls
medication effects
drop in blood pressure when standing up
vision and hearing
cognitive function
feet and footwear
home environment
nighttime movement
fear of falling
Daily activities
and other factors are involved.
The World Falls Guidelines, an international guideline for fall prevention, also recommends that for older adults at high risk of falling, a multifaceted assessment including physical, cognitive, psychological, and environmental factors, in addition to fall history and gait/balance, should be conducted [4].
A fast TUG score does not guarantee safety.
A perfect SPPB score does not mean one will not fall.
Conversely, a poor result does not mean one will definitely fall.
None of these can be stated definitively.
Test results should be used as one piece of evidence to consider the factors leading to falls.
The 13.5-second benchmark for TUG is explained in detail in this article.
▶ Is the 13.5-second TUG a danger line? The origin of the reference value and how to view fall risk
6. Even for the same person, different evaluations reveal different things
Let's consider a hypothetical case here.
Mr. A, 78 years old
Mr. A has recently started feeling anxious when going out.
He can walk indoors, but
crowded places,
turning,
and sitting in a chair
are situations where he says he feels "a little scared."
Mr. A's wish is to
I want to go out with peace of mind
I want to go shopping with friends
That is what it means.
What was revealed by TUG
The total TUG time was 14.2 seconds.
However, looking at the movements rather than just the time,
there was unsteadiness during the turn
there was momentum when sitting down in the chair
were observed.
From the TUG, it is considered better to take a closer look at the turning and sitting-down phases.
What was revealed by SPPB
In the SPPB,
performed 3 standing balance positions
gait speed: 0.6 m/sec
5-time chair stand: 15.8 seconds
were the results.
Rather than determining the cause based on these numbers alone, we will next examine the results of the gait speed and chair stand in more detail.
Things to check next
Physical function
muscle strength
joint range of motion
Presence or absence of pain
How movements are performed
Movement of shifting the center of gravity forward
How the feet are moved
How the body is turned
Environment and daily life situations
Behavior in crowds
Situations involving going out or shopping
At home or along travel routes
Anxiety about falling
Intensity of anxiety
Movements or places being avoided
Whether the range of activity has narrowed
At this point,
"It took time to stand up, so let's do strength training"
"They were unsteady while turning, so let's do balance exercises"
We do not decide immediately like this.
We consider the necessary support by combining the test results, movements, daily life situations, and the individual's goals.
By combining TUG and SPPB,
which movements cause instability
Which tasks are difficult
What to check next
It becomes easier to organize.
7. Supplement for professionals | Do not record only by score and time
Both TUG and SPPB allow you to record results as numbers.
However, if you only record the numbers, when you look back later,
"Why was this the result?"
will become unclear.
What to record for TUG
Total time
Chair height and shape
Use of cane or walker
Walking speed instructions
Parts that took time
Number of steps for turning
Unsteadiness
How they sat down
Anxiety felt by the individual
What to record for SPPB
Score for each item
Total score
Walking distance
Measured walking time
Measured time for 5 chair stands
Reason for inability to perform
Pain or fatigue
Use of assistive devices
Observation of movement
When comparing with previous results, keep measurement conditions such as the chair, walking distance, assistive devices, and speed instructions as consistent as possible.
SPPB is an evaluation with supported reliability and validity.
On the other hand, for people with very high or very low physical function, scores may cluster near the upper or lower limits, making it difficult to capture small changes.
A 2024 systematic review also reported that while SPPB is a valid evaluation, its sensitivity to change has limitations [5].
Therefore, when monitoring progress, it is important to record not only the total score but also the measured times for walking and standing, as well as observations of movement.
Do not end the evaluation results with just
what the score was
how many seconds it took
but also
how they were moving when they achieved that result
should also be recorded.
8. Summary | Decide what you want to know before choosing an evaluation
Here is a summary of the content covered.
TUG looks at the sequence of movement from standing up to sitting down
SPPB looks at balance, walking, and standing up by dividing them into three tasks
Muscle strength, balance, and walking speed also affect TUG
SPPB also includes actual movements
In both cases, the numbers alone do not reveal the underlying causes
TUG is easy to use when you want to observe the flow of movement and turning
SPPB is easy to use when you want to organize and separate the three tasks
If information is insufficient, combine both
Do not determine fall risk based on a single test alone
Connect evaluation results to daily life difficulties and support
Whether to use TUG or SPPB.
The answer is not determined by the name of the test.
First,
"What is the person struggling with?"
"Which movement do I want to examine in detail?"
"What do I want to use the results for?"
Consider these questions.
The goal is not to perform the evaluation.
Where is the person struggling, what should be checked next, and what kind of support will it lead to?
We use TUG and SPPB to think through to that point.
Recommended reading
Basic TUG procedure and how to observe movement
▶ What is the TUG test? How to perform it and interpret results | Don't judge fall risk by time alone
For those who want to know more about the 13.5-second TUG benchmark
For those who want to check the SPPB method and scoring
▶ SPPB procedure and score criteria | Includes clinical evaluation forms