Validation of the triple timed up‐and‐go test in Lambert‐Eaton myasthenia

Abstract

Introduction There are no validated, practical, and quantitative measures of disease severity in Lambert‐Eaton myasthenia (LEM). Methods Data from the Effectiveness of 3,4‐Diaminopyridine in Lambert‐Eaton Myasthenic Syndrome (DAPPER) trial were analyzed to assess triple timed up‐and‐go (3TUG) reproducibility and relationships between 3TUG times and other measures of LEM severity. Results The coverage probability technique showed ≥0.90 probability for an acceptable 3TUG difference of ≤0.2, indicating that it is reproducible in LEM patients. The correlation between 3TUG times and lower extremity function scores was significant in subjects who continued and in those who were withdrawn from 3,4‐diaminopyridine free base. Worsening patient‐reported Weakness Self‐Assessment Scale and Investigator Assessment of Treatment Effect scores corresponded with prolongation of 3TUG times. Discussion The 3TUG is reproducible, demonstrates construct validity for assessment of lower extremity function in LEM patients, and correlates with changes in patient and physician assessments. These findings, along with prior reliability studies, indicate 3TUG is a valid measure of disease severity in LEM.

Presynaptic Paraneoplastic Disorders of the Neuromuscular Junction: An Update

“…The treatment choice is based on the clinical severity of the disease. Recently, a new measure, the Triple Timed-Up-and-Go test, has been established and validated for assessing clinical function and the outcome in patients with LEMS that could be used to guide treatment [87,88].…”

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“…30,31 Of these measures, only the 3TUG test has been shown to be reliable in patients with LEMS and specifically validated as a measure of disease severity. 32,33 The 3TUG test is a simple, noninvasive test that is easily performed in a typical outpatient clinic using a standard-height, armless, straight-backed, hard chair. As shown in FIGURE 2-3, in this test the patient stands up from a seated position, walks approximately 3 meters (10 feet), turns around, walks back to the chair, and sits back down.…”

“…Recent clinical trials have used a variety of measures as primary endpoints, including the Quantitative Myasthenia Gravis (QMG) score, a Subject Global Impression score, and the Triple Timed Up and Go (3TUG) test 30,31 . Of these measures, only the 3TUG test has been shown to be reliable in patients with LEMS and specifically validated as a measure of disease severity 32,33 . The 3TUG test is a simple, noninvasive test that is easily performed in a typical outpatient clinic using a standard-height, armless, straight-backed, hard chair.…”

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“…While several gait metrics are available (Table 3), [24][25][26] the time up and go (TUG) assessment may be best poised to asses gait in CIDP. The TUG assessment can be performed quickly with minimal intrusion on daily clinic flow.…”