Note: When reviewing the findings, it is important to note that they are always made according to randomized clinical trial (RCT) criteria – specifically as compared to a control group. To clarify, if a treatment is “effective” it implies that it is more effective than the control treatment to which it was compared. Non-randomized studies are no longer included when there is sufficient research to indicate strong evidence (level 1a) for an outcome.
Driving is considered one of the most important activities of daily living and is highly associated with maintaining quality of life post-stroke. Individuals who have had a stroke may experience difficulties that affect their ability to drive such as physical impairments, poor visual scanning, attention, information processing speed and psychomotor skills, which can also be impaired with aging (Crotty et al., 2003). It is therefore important to screen our stroke population who is often at-risk drivers. Driving cessation post-stroke often leads to social isolation and studies have shown higher rates of depression, comorbidities and lower functional independence than individuals who resume driving post-stroke (Devos et al., 2010). Post-stroke assessment of safety to drive is necessary for many patients, with figures showing that only 30% of stroke survivors are able to resume driving following stroke (Finestone et al., 2007). Because of the significant impacts of driving cessation, a growing importance has been developing on interventions to help individuals resume driving following an acute medical condition or prolong the ability to drive in the elderly.
A systematic review by Unsworth & Baker (2014) identified the types of interventions used by Occupational Therapists (OTs) to improve on-road fitness-to-drive and the effectiveness of these interventions. The review included participants with a range of conditions (TBI, older drivers, stroke, ABI, physical and intellectual disability, SCI, and younger drivers with information processing deficits) and included 16 studies*, 2 of which are included in this StrokEngine module. The most commonly-used interventions were bottom-up in nature (computer-based driving simulator training, off-road skill-specific training, off-road education programmes), whereas just one intervention used a top-down approach (car adaptations/modifications). There were inconsistencies in frequency, duration and total number of sessions among studies of each intervention type. The secondary aim of the systematic review was to determine effectiveness of driving interventions: 2 of the 4 types of interventions (computer-based driving simulator training, off-road skill-specific training) showed moderate (level 1b) evidence supporting effectiveness for regaining on-road fitness-to-drive.
* 5 RCTs, 4 pre-post tests, 2 case studies, 2 case control design, 2 cohort studies, and 1 cross-sectional design study.
Petzold et al. (2010) conducted a cross-sectional Canada-wide telephone survey of 480 Occupational Therapists (OTs) working in stroke rehabilitation to examine clinicians’ management of driving-related issues. Participants were recruited from both inpatient and community-based settings over an 18-month period. The survey used a clinical vignette to gather information from clinicians regarding their use of driving-related assessments and interventions. The frequency of use of driving-specific assessments was as low as 11% across the continuum of care with off-road driving screening the most common type of assessment. Non-driving-specific assessments (e.g. MVPT, Cognistat) were used by 59% of inpatient rehabilitation clinicians and 37% of community-based clinicians. In terms of interventions, less than 6% of respondents reported using general interventions in driving rehabilitation and only 3% of respondents used driving-specific intervention. No clinicians reported using computer game/virtual reality interventions in driving rehabilitation. Potential explanations for the lack of attention to driving-related issues post-stroke include the need for best practice standards in driving rehabilitation, clinicians’ need to prioritize post-stroke rehabilitation goals, as well as clinicians’ self-perceived lack of competence regarding driving retraining.
This module reviews evidence regarding interventions used in driving rehabilitation post-stroke and their effectiveness in regaining safe driving skills.
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Acute stage of stroke recovery
No studies have reviewed driving training among patients in acute phase of stroke recovery