Table 2 Description of primary and secondary outcomes and time points of assessments
S/N | Outcome measure | Description/administration | Psychometrics | Assessment point |
|---|---|---|---|---|
Primary outcomes | ||||
1 | Step length | It will be measured as the distance from the heel strike of one foot to the heel strike on the next successive step of the opposite foot, using the midpoint of the heel square as the reference point (distance CD measured in cm) See Fig. 3 | The measure is easy and has adequate test–retest reliability (r = 0.97) [50] and concurrent validity with strobe-light photography [51] | Baseline 4th week 8th week 20th week |
2 | Gait speed | It will be measured as the distance covered in meters per time taken in seconds to walk a specified distance on a level surface. In this study, it will be calculated as the ratio of 10 m distance per unit time covered during the gait training | The measure has excellent test–retest reliability (ICC = 0.94–0.99) [49, 52] and concurrent validity (r = 0.95) with GAITRite system [53] | Baseline 4th week 8th week 20th week |
Secondary outcomes | ||||
3 | Step length symmetry ratio | It will be calculated by dividing the step length of the paretic limb to that of the non-paretic limb | The calculation has been recommended in determining gait symmetry [28] | Baseline 4th week 8th week 20th week |
4 | Stride length | It will be measured by taking the midpoint of the heel square as a reference point for measurement, and then measuring the linear distance from the heel strike of one foot to the heel strike of the next successive step of the same foot (distance AB measured in cm). See Fig. 3 | The measure is easy and has excellent test–retest reliability (r = 0.925) [50] and concurrent validity (r = 0.85) with GAITRite system [53] | Baseline 4th week 8th week 20th week |
5 | Stride length symmetry ratio | It will be calculated by dividing the stride length of the paretic limb to that of the non-paretic limb | Baseline 4th week 8th week 20th week | |
6 | Stride width | It will be measured as the transverse linear distance between points on 2 successive feet. Heel-to-heel step width will be calculated as the difference between distance G and F, measured from the midpoint of 2 successive heel squares of the opposite feet to the edge of the walking path. See Fig. 3 | The measure has adequate test–retest reliability (r = 0.782) [50] and concurrent validity with strobe-light photography [51] | Baseline 4th week 8th week 20th week |
7 | Cadence | It will be measured as the number of steps taken per unit time. The value will be calculated by dividing the total number of steps taken on the paper by the total time needed to walk across the length of the floor (measured in steps per minute) | The measure is easy and has excellent test–retest reliability (r = 0.905) [50] and good concurrent validity reliability (r = 0.75) with GAITRite system [53] | Baseline 4th week 8th week 20th week |
8 | Motor function (lower limb) | It will be measured with the use of the Motricity Index by assessing hip flexion, knee extension and dorsiflexion in sitting position. The strength of the lower limb will be rated as 0 (no movement); 9 (palpable contraction in muscle, but no movement); 14 (visible movement, but not full range and not against gravity); 19 (full-range movement against gravity, but not resistance); 25 (full movement against gravity, but weaker than the other side); and 33 (normal power) For the hip flexion test, while sitting on a chair, with the paretic hip bent at 90°, the participants will be asked to move the knee towards the chin and the examiner then monitors the contraction of iliopsoas/rectus femoris (anterior thigh). (14 points will be given if there is less than a full range of passive motion; 19 points will be given if the hip is fully flexed yet it can be easily pushed down). For the knee extension test, participants will be asked to sit on a chair with their foot unsupported and the knee at 90°. The examiner will then monitor the contraction of the quadriceps (14 points will be given for less than 50% of full extension; 19 points will be given for full extension yet it can be easily pushed down). For the ankle dorsiflexion test, it will be tested with the foot relaxed in a plantarflexed position. The participant will be asked to dorsiflex the foot and the examiner monitors the tibialis anterior (14 points will be given if there is less than a full range of dorsiflexion) | It is easy to administer and has high inter-rater reliability (r = 0.87) and validity (r = 0.81 vs Rivermead Motor Assessment) for measuring leg impairment in chronic stroke patients [54] | Baseline 4th week 8th week 20th week |