Mark J Rapoport1,2, Sarah C Plonka3, Hillel Finestone4, Mark Bayley2,5, Justin N Chee1,2, Brenda Vrkljan6, Sjaan Koppel7, Elizabeth Linkewich1,8,9, Judith L Charlton7, Shawn Marshall10, Martin delCampo5, Mark I Boulos1,2,9, Richard H Swartz1,2,9, Jaspreet Bhangu1, Gustavo Saposnik2,11,12, Jessica Comay13, Jamie Dow14, Debbie Ayotte15, Desmond O'Neill16. 1. a Department of Psychiatry , Sunnybrook Health Sciences Center , Toronto , Canada. 2. b Faculty of Medicine , University of Toronto , Toronto , Canada. 3. c Road Safety Research Office , Ontario Ministry of Transportation , Toronto , Canada. 4. d Faculty of Medicine, Division of Physical Medicine and Rehabilitation, Bruyère Continuing Care, The Ottawa Hospital , University of Ottawa , Ottawa , Canada. 5. e Toronto Rehabilitation Institute , University Health Network , Toronto , Canada. 6. f School of Rehabilitation Science , McMaster University , Hamilton , Canada. 7. g Monash University Accident Research Centre , Monash University , Clayton , Australia. 8. h Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences , University of Toronto , Toronto , Canada. 9. i Faculty of Medicine, Department of Medicine (Neurology) , University of Toronto , Toronto , Canada. 10. j Physical Medicine and Rehabilitation , Ottawa Hospital Research Institute , Ottawa , Canada. 11. k Stroke Outcomes and Decision Neuroscience Unit , St. Michael's Hospital , Toronto , Canada. 12. l Department of Economics, Neuroeconomics Lab , University of Zurich , Zurich , Switzerland. 13. m Department of Neurology , Assistive Technology Clinic , Toronto , Canada. 14. n Société de l'assurance automobile du Québec , Québec , QC , Canada. 15. o Library , Canadian Medical Association , Ottawa , Canada. 16. p Trinity College Dublin , The University of Dublin , Dublin 2 , Ireland.
Abstract
BACKGROUND: Returning to driving after stroke is one of the key goals in stroke rehabilitation, and fitness to drive guidelines must be informed by evidence pertaining to risk of motor vehicle collision (MVC) in this population. OBJECTIVES: The purpose of the present study was to determine whether stroke and/or transient ischemic attack (TIA) are associated with an increased MVC risk. METHODS: We searched MEDLINE, CINAHL, EMBASE, PsycINFO, and TRID through December 2016. Pairs of reviewers came to consensus on inclusion, based on an iterative review of abstracts and full-text manuscripts, on data extraction, and on the quality of evidence. RESULTS: Reviewers identified 5,605 citations, and 12 articles met inclusion criteria. Only one of three case-control studies showed an association between stroke and MVC (OR 1.9, 95% CI 1.0-3.9). Of five cohort reports, only one study, limited to self-report, found an increased risk of MVC associated with stroke or TIA (RR 2.71, 95% CI 1.11-6.61). Two of four cross-sectional studies using computerized driving simulators identified a more than two-fold risk of MVCs among participants with stroke compared with controls. The difference in one of the studies was restricted to those with middle cerebral artery stroke. CONCLUSIONS: The evidence does not support a robust increase in risk of MVCs. While stroke clearly prevents some patients from driving at all and impairs driving performance in others, individualized assessment and clinical judgment must continue to be used in assessing and advising those stroke patients who return to driving about their MVC risk.
BACKGROUND: Returning to driving after stroke is one of the key goals in stroke rehabilitation, and fitness to drive guidelines must be informed by evidence pertaining to risk of motor vehicle collision (MVC) in this population. OBJECTIVES: The purpose of the present study was to determine whether stroke and/or transient ischemic attack (TIA) are associated with an increased MVC risk. METHODS: We searched MEDLINE, CINAHL, EMBASE, PsycINFO, and TRID through December 2016. Pairs of reviewers came to consensus on inclusion, based on an iterative review of abstracts and full-text manuscripts, on data extraction, and on the quality of evidence. RESULTS: Reviewers identified 5,605 citations, and 12 articles met inclusion criteria. Only one of three case-control studies showed an association between stroke and MVC (OR 1.9, 95% CI 1.0-3.9). Of five cohort reports, only one study, limited to self-report, found an increased risk of MVC associated with stroke or TIA (RR 2.71, 95% CI 1.11-6.61). Two of four cross-sectional studies using computerized driving simulators identified a more than two-fold risk of MVCs among participants with stroke compared with controls. The difference in one of the studies was restricted to those with middle cerebral artery stroke. CONCLUSIONS: The evidence does not support a robust increase in risk of MVCs. While stroke clearly prevents some patients from driving at all and impairs driving performance in others, individualized assessment and clinical judgment must continue to be used in assessing and advising those strokepatients who return to driving about their MVC risk.