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Abstract
Objective: To identify the best determinants of fitness to drive after stroke, following a systematic review and meta-analysis.
Methods: Twenty databases were searched, from inception until May 1, 2010. Potentially relevant studies were reviewed by 2 authors for eligibility. Methodologic quality was assessed by Newcastle-Ottawa scores. The fitness-to-drive outcome was a pass–fail decision following an on-road evaluation. Differences in off-road performance between the pass and fail groups were calculated using weighted mean effect sizes (dw). Statistical heterogeneity was determined with the I2 statistic. Random-effects models were performed when the assumption of homogeneity was not met. Cutoff scores of accurate determinants were estimated via receiver operating characteristic analyses.
Results: Thirty studies were included in the systematic review and 27 in the meta-analysis. Out of 1,728 participants, 938 (54%) passed the on-road evaluation. The best determinants were Road Sign Recognition (dw 1.22; 95% confidence interval [CI] 1.01–1.44; I2, 58%), Compass (dw 1.06; 95% CI 0.74–1.39; I2, 36%), and Trail Making Test B (TMT B; dw 0.81; 95% CI 0.48–1.15; I2, 49%). Cutoff values of 8.5 points for Road Sign Recognition, 25 points for Compass, and 90 seconds for TMT B were identified to classify unsafe drivers with accuracies of 84%, 85%, and 80%, respectively. Three out of 4 studies found no increased risk of accident involvement in persons cleared to resume driving after stroke.
Conclusions: The Road Sign Recognition, Compass, and TMT B are clinically administrable office-based tests that can be used to identify persons with stroke at risk of failing an on-road assessment.
Footnotes
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- CI
- confidence interval
- DMV
- Department of Motor Vehicles
- NOS
- Newcastle-Ottawa Scale
- RCT
- randomized controlled trial
- ROC
- receiver operating characteristic
- SDSA
- Stroke Drivers Screening Assessment
- TMT
- Trail Making Test
- UFOV
- Useful Field of View.
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Supplemental data at www.neurology.org
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References e1 and e2 are available on the Neurology® Web site at www.neurology.org.
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Disclosure: The authors report no disclosures.
- Received September 3, 2010.
- Accepted October 19, 2010.
- Copyright © 2011 by AAN Enterprises, Inc.
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