title: Dual tasking with the timed "up & go" test improves detection of risk of falls in people with Parkinson disease.
abstract: BACKGROUND
  Falls are a common and disabling feature of Parkinson disease (PD). Early identification of patients at greatest risk of falling is a key goal of physical therapy assessment. The Timed "Up & Go" Test (TUG), a frequently used mobility assessment tool, has moderate sensitivity and specificity for identifying fall risk.
  
  
  OBJECTIVE
  The study objective was to investigate whether adding a task (cognitive or manual) to the TUG (TUG-cognitive or TUG-manual, respectively) increases the utility of the test for identifying fall risk in people with PD.
  
  
  METHODS
  This was a retrospective cohort study of people with PD (N=36).
  
  
  METHODS
  Participants were compared on the basis of self-reported fall exposure in the preceding 6 months (those who had experienced falls ["fallers"] versus those who had not ["nonfallers"]). The time taken to complete the TUG, TUG-cognitive, and TUG-manual was measured for both groups. Between-group differences were calculated with the Mann-Whitney U test. The discriminative performance of the test at various cutoff values was examined, and estimates of sensitivity and specificity were based on receiver operating characteristic curve plots.
  
  
  RESULTS
  Fallers took significantly longer than nonfallers (n=19) to complete the TUG under all 3 conditions. The TUG-cognitive showed optimal discriminative performance (receiver operating characteristic area under the curve=0.82; 95% confidence interval [CI]=0.64, 0.92) at a cutoff of 14.7 seconds. The TUG-cognitive was more likely to correctly classify participants with a low risk of falling (positive likelihood ratio=2.9) (<14.7 seconds) and had higher estimates of sensitivity (0.76; 95% CI=0.52, 0.90) than of specificity (0.73; 95% CI=0.51, 0.88) at this threshold (negative likelihood ratio=0.32).
  
  
  CONCLUSIONS
  Retrospective classification of fallers and nonfallers was used.
  
  
  CONCLUSIONS
  The addition of a cognitive task to the TUG enhanced the identification of fall risk in people with PD. The TUG-cognitive should be considered a component of a multifaceted fall risk assessment in people with PD.
authors.affiliation: R.C. Vance, PT, MSc, Physiotherapy Department, Beaumont Hospital, Beaumont Road, Dublin 9, Leinster, Ireland, and School of Physiotherapy, Royal College of Surgeons, 123 St Stephen's Green, Dublin 2, Dublin, Leinster, Ireland. roisinmoloney@beaumont.ie.
authors.forename: Roisin C
authors.initials: RC
authors.lastname: Vance
authors.affiliation: D.G. Healy, MD, PhD, Neurology Department, Beaumont Hospital.
authors.forename: Dan G
authors.initials: DG
authors.lastname: Healy
authors.affiliation: R. Galvin, PT, PhD, School of Physiotherapy, Royal College of Surgeons.
authors.forename: Rose
authors.initials: R
authors.lastname: Galvin
authors.affiliation: H.P. French, PT, PhD, School of Physiotherapy, Royal College of Surgeons.
authors.forename: Helen P
authors.initials: HP
authors.lastname: French
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology; D015331:Cohort Studies; D005080:Exercise Test; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000503:physiopathology*; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity