Katholieke Universiteit Leuven DETERMINANTS OF DRIVING AFTER STROKE

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Katholieke Universiteit LeuvenDETERMINANTS OF
DRIVING AFTER STROKE

• Akinwuntan AE1, Feys H1, De Weerdt W1,
  Pauwels J1, Baten G2, Strypstein E2
• 1Department of Rehabilitation Sciences,
  Katholieke Universiteit Leuven, Belgium
  
  2Belgian Institute for Road Safety,
  Brussels, Belgium

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Introduction

• Stroke is a major cause of disability in the
  United States especially in the elderly (Duncan
  et al,1992)
• Primary stroke incidence in Britain about 2 per
  1000 population a year (Bramford et al, 1988)
• Stroke incidence in Belgium estimated at 2.62 per
  1000 population annually (Van Casteren et al,1988)

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• Brain injured persons including stroke patients
  wish to resume driving after the incidence
• Motor, visual, cognitive and perceptual
  difficulties affect driving after stroke (Sundet
  et al, 1995 Mazer et al, 1998 and Lundqvist et
  al, 2000)
• Driving potential of stroke patients can be
  determined following predriving assessments
  (Quigley De Lisa 1983 and Nouri et al,1987)

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• Studies on prediction of driving ability from
  results of the predriving assessments (Galski et
  al, 1990 Mazer et al, 1998 and Schanke Sundet
  2000)
• Purpose of this study
  
  To identify the combination of variables which
  best predict the decision of driving ability in
  stroke patients in Belgium

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Methods

• Design Retrospective study of a two-year
  predriving evaluation
• Setting Belgian Institute for Road Safety,
  Brussels, Belgium
• Subjects History of first stroke, possessed
  valid driving license and driving prior to stroke
  onset

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• Subject number 104 subjects included
• age 56.8 11.9, m/w 82/22, s.o.l 45 (r)
  59 (l) driv. exp. 35yrs, onset-exam. int
  1.5yrs
• Measures
• General medical parameters
• Visual tests
• Neuropsychological tests
• On the road test

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• Main outcome measure
• The suitability to resume driving
• based on a group decision
• Class 1 Suitable to drive
• Class 2 Not immediately suitable to drive
• Class 3 Not suitable to drive

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Results

• Comparison between classes (Chi-square,
  Kruskal Wallis, or ANOVA plt0.05)
• Most general parameters (p 0.05 to 0.0006)
• All tests of visual test battery (p
  0.008 to lt0.0001)
• Most tests of neuropsychological test (p 0.04 to
  lt0.0001)
• The on the road test (p-value 0.0001)

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Further comparison (Tukey/Kramer plt0.05,
Wilcoxon Rank Sum with
Bonferroni correction Plt0.0167)

• Age, driving experience, onset-predriving exam
  and neuropsychological tests 1,2?3
• Most visual tests 1 ? 3
• On the road test 1 ? 2 ? 3

Class 1 Suitable to driveClass 2 Not
immediately suitable to driveClass 3 Not
suitable to drive
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Correlation between variables and group decision
(Spearman rank correlation plt0.05)

• Most parameters and tests had significant
  correlation with group decision
• General parameters -0.24 ? rslt -0.36
• Visual tests 0.29? rslt 0.43
• Neuropsychological tests 0.29? rslt0.43
• The on the road test rs -0.67

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Determination of variable combination with most
accurate prediction (Logistic regression plt0.05)

• Variable p-value Odds ratio
• Side of Lesion 0.02 0.29
• Kinetic vision 0.01 2.25
• Visual scanning 0.04 0.85
• On the road test (5 units) lt0.0001 2.02
• N93, R20.53

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Age, driving experience, onset-predriving exam
and neuropsychological tests 1,2?3
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Determination of variable combination with most
accurate prediction (Logistic regression plt0.05)

• Variable p-value Odds ratio
• Side of Lesion 0.02 0.29
• Kinetic vision 0.01 2.25
• Visual scanning 0.04 0.85
• On the road test (5 units) lt0.0001 2.02
• N93, R20.53

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Discussion

• Visual and neuropsychological abilities are
  important in driving after stroke
• The on the road test accounted for most of the
  variance
• Combination of variables agree with other studies
  on driving after stroke
• Croft and Jones, 1987
  Galski et al, 1990
  Sundet et al, 1995

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Conclusion

• Predictive accuracy of the group decision was
  moderate (R20.53)
• More closely road related test to be included in
  the predriving assessment was suggested

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Reflection

• Poor compensation may have affected driving
  performance
• Levels of cognitive driving heirachy
  (Michon,1979 1989)
• 
  Operational
• Tactical
• Strategic
• A training program for subjects in class 2 (Not
  immediately suitable to drive) could be
  considered

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Thank You

• by
  
  Abiodun Emmanuel Akinwuntan

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