| OUTCOMES |
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Type of outcome
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Outcome
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Timepoint(s) at which outcome measured
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| Primary Outcome |
DUAL-TASK EFFECTS
Dual-task interference will be the primary outcome measure. Three different tasks of varying levels of difficulty (ie, simple, intermediate, advanced) will be used in the dual-task testing paradigm, namely, forward walking test, sit to stand and pick up an object from the floor, and an obstacle crossing test. For the forward walking test, participants walked along a 15-m walkway and time taken to walk the middle 10 m of the 15-m walkway will be measured For the sit to stand and pick up an object from the floor, participants sits on a chair stands and walks a 3 m, picks an object, turns walks back to the chair and sit down. The time to completion will be recorded by a stopwatch. For the obstacle crossing task, a 10-m walkway will be used and 10 obstacles (length 70 cm, width 4 cm, height 4 cm) will be placed 1 m apart from one another and time taken to walk the 10-m walkway will also be measured. For all 3 tests, participants will be instructed to complete the task as fast as possible while maintaining safety. A shorter walking time will indicate better functional proficiency.
Two cognitive task domains, namely, verbal fluency and mental tracking, will be evaluated. For the verbal fluency task, participants will be asked to name any word start with letter A-J. For the mental tracking task, participants will be asked to performed serial-5-subtractions from a random number between 40 and 80. The number of correct answers generated will be recorded. The sequence of the 3 functional tests will be randomized first, followed by randomization of the sequence of the 2 cognitive tasks. Participants will start with one of the randomized functional tasks in the single-task condition, and then performs the same functional task in the dual-task condition (in conjunction with one of the cognitive tasks, in randomized sequence). Subsequently, the cognitive tasks will be performed in a sitting position (single-task condition). The time given to perform the cognitive task in single-task condition will be matched to the participant’s time taken to complete the cognitive task in the corresponding dual-task condition.
The correct response rate (CRR) of the cognitive tasks will be calculated as follows:
CRR = (number of correct responses ÷ time) ×100
Where a higher CRR value indicated better performance.
When the tasks were performed in the dual-task condition, participants will be instructed to perform both tasks as well as possible. Participants will perform 1 practice trial of each task before data collection. Good reliability of the dual-task assessments has been established (Yang et al, 2016).
The degree of dual-task interference will be represented by the percent dual-task effect (DTE %) of the functional time and CRR and will be calculated as follows (Plummber et al, 2013) :
DTE% in functional time = (dual task functional time – single task functional time) × 100
Single task functional time
DTE% in CRR = (dual task CRR – single task CRR) × 100
Single task CRR
Therefore, a greater positive value for both variables will indicate greater performance deterioration under the dual-task condition compared with the single-task condition (ie, greater dual-task interference) (Plummer-D’Amato et al, 2012).
Other assessment tools include: The Activities-specific Balance Confidence (ABC) Scale; Mini Mental State Examination scales; The Maleka Stroke Community Reintegration Measure; Participation Scale and Dynamic Gait Index.
These assessments will be repeated at the end of the exercise protocol at the end of the twelveth week.
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The assessment will be done before and after the exercise protocol at the end of the twelveth week |
| Secondary Outcome |
DYNAMIC GAIT INDEX
It includes 8 different gait tasks including walking on a level surface, walking while changing gait speeds, walking with vertical or horizontal head turns, walking with pivot turns, stepping over or around obstacles, and walking up and downstairs. Participants’ performance of each test item was rated on a 4-point scale (0−3), with the total score ranging between 0 and 24 (Marchetti et al, 2006) |
The assessment will be taken before and after the exercise protocol |
| Secondary Outcome |
THE ACTIVITIES-SPECIFIC BALANCE CONFIDENCE (ABC) SCALE
It is designed to measure an individual’s confidence in his/her ability to perform daily activities without falling. It is an ordinal scale. The scale has 16 items (score 0-1600 possible). The score is recorded as a percentage (%), with 0% as the lowest level and 100% the highest level of confidence. Max score of 1600 divided by 16 items = 100% (Salbach et al, 2005) |
The assessment test will be done before and after the exercise protocol |
| Secondary Outcome |
MALEKA STROKE COMMUNITY REINTEGRATION MEASURE
The Maleka Stroke Community Reintegration Measure (MSCRIM) will be used to assess community reintegration. It has an urban and rural version, but for the purpose of this study, the urban version will be used. This measure was found to be reliable and valid for stroke survivors in the urban townships of Johannesburg. The urban version has 40 items that are spread over the following six domains: ADLs and self-care, Social interaction and relationship, Home and family responsibilities, Social interaction, Extended family responsibilities and Work and education. The urban version of the MSCRIM is scored out of 112 by the researcher and converted to a percentage with a higher percentage score implying a higher level of community reintegration (Maleka, 2015). The MSCRIM is chosen because of its high reliability coefficient of 0.95 as well as its urban version’s relation to the reality of urban communities (Maleka 2015). It also has elements in it that relate directly to the social circumstances that were faced in the communities in the areas surrounding urban area such as Lagos city which is not found in other questionnaires such as attending traditional events and being able to collect water from a source outside of the participants dwelling.
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The assessment test will be done before and after the exercise protocol |
| Secondary Outcome |
PARTICIPATION SCALE
It is an 18-item interview-based instrument that was designed to assess the participation of individuals with a health condition or disability. The scale was developed in an effort to better describe the participation of people living in middle-income and low-income countries. The items in the scale are closed, structured questions with Crohnbach's α of 0.92, intra-tester stability of 0.83 and inter-tester reliability of 0.80 (Wim t al, 2006; Souza et al, 2017).
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The assessment test will be done before and after the exercise protocol |
| Secondary Outcome |
MINI MENTAL STATE EXAMINATION SCALES
It is a brief 30-point questionnaire test that is used to screen for cognitive impairment. It is also used to estimate the severity of cognitive impairment and to follow the course of cognitive changes in an individual over time, thus making it an effective way to document an individual's response to treatment.
It examines functions including arithmetic, memory and orientation. The test includes simple questions and problems in a number of areas: the time and place of the test, repeating lists of words, arithmetic such as the serial sevens, language use and comprehension, and basic motor skills. Any score greater than or equal to 27 points (out of 30) indicates a normal cognition. Below this, scores can indicate severe (≤9 points), moderate (10–18 points) or mild (19–24 points) cognitive impairment (Espino et al, 2004; Morales et al, 2006; Guerrero-Berroa et al, 2009) |
The assessment test will be done before and after the exercise protocol |