Determinants of Driving After Stroke

Akinwuntan, Abiodun Emmanuel; Feys, Hilde; De Weerdt, Willy; Pauwels, Jan; Baten, Guido; Strypstein, Emmanuel · 2001 · Crossref

DOI: 10.17077/drivingassessment.1044

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Summary

This study investigates the determinants of driving ability in stroke patients, aiming to identify which pre-driving assessment variables best predict the final decision regarding a patient's fitness to drive. The research was motivated by the significant physical and neuropsychological impairments caused by stroke, which can compromise driving safety. The authors sought to determine which specific tests within the Belgian assessment protocol could most accurately forecast the joint decision made by a team of professional assessors. The study analyzed the records of 104 patients who had experienced their first-ever stroke and visited the Center for determination of fitness to drive and car adaptations (CARA) at the Belgian Institute for Road Safety in 1998 and 1999. Participants were required to hold a valid driver’s license and have driven prior to their stroke. The assessment battery included demographic variables (age, sex, side of lesion, driving experience), visual tests (acuity, kinetic vision, stereoscopy, visual scanning), neuropsychological assessments primarily from the Test for Attentional Performance (TAP) battery, and an on-the-road driving test. A multidisciplinary team of neurologists, occupational therapists, and neuropsychologists jointly categorized each patient as suitable, not immediately suitable, or not suitable to drive based on these performance metrics. Statistical analysis revealed that age, time since stroke onset, driving experience, and visual field problems significantly differed across the three decision groups. While neuropsychological tests effectively distinguished patients deemed not suitable from those suitable or not immediately suitable, the on-the-road test differentiated all three groups, with suitable drivers performing markedly better. Logistic regression analysis of 93 complete datasets identified a model comprising side of lesion, kinetic vision, visual scanning, and the on-the-road test as the best predictor of the final decision, explaining 53% of the variance ($R^2=0.53$). The on-the-road test was the single most important determinant ($R^2=0.42$), with an odds ratio indicating that a five-point improvement in this test doubled the likelihood of being deemed suitable to drive. The authors conclude that while the predictive accuracy of the current assessment is moderate, the on-the-road test remains the critical determinant of driving fitness. The findings suggest that patients categorized as "not immediately suitable" often possess adequate neuropsychological skills but lack effective compensatory mechanisms during actual driving. Consequently, the study recommends incorporating neuropsychological tests more closely aligned with real-road situations into pre-driving assessments and highlights the need for training programs focused on teaching compensatory driving techniques for this intermediate group.

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• fitness to drive assessment

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• Methodological Resource: validation psychometrics