TY - JOUR
T1 - Determinants of On-Road Driving in Multiple Sclerosis
AU - Devos, Hannes
AU - Ranchet, Maud
AU - Backus, Deborah
AU - Abisamra, Matt
AU - Anschutz, John
AU - Allison, C. Dan
AU - Mathur, Sunil
AU - Akinwuntan, Abiodun E.
N1 - Publisher Copyright:
© 2016 American Congress of Rehabilitation Medicine
PY - 2017/7
Y1 - 2017/7
N2 - Objective To investigate the cognitive, visual, and motor deficits underlying poor performance on different dimensions of on-road driving in individuals with multiple sclerosis (MS). Design Prospective cross-sectional study. Setting MS clinic and driving simulator lab. Participants Active drivers (N=102) with various types of MS. Interventions Not applicable. Main Outcome Measures Off-road cognitive, visual, and motor functions, as well as 13 specific driving skills. These skills were categorized into hierarchic clusters of operational, tactical, visuo-integrative, and mixed driving. Stepwise regression analysis was used to determine the off-road functions influencing performance on the on-road test and each cluster. Results Visuospatial function (P=.002), inhibition (P=.008), binocular acuity (P=.04), vertical visual field (P=.02), and stereopsis (P=.03) best determined variance in total on-road score (unadjusted R2=.37). Attentional shift (P=.0004), stereopsis (P=.007), glare recovery (P=.047), and use of assistive devices (P=.03) best predicted the operational cluster (unadjusted R2=.28). Visuospatial function (P=.002), inhibition (P=.002), reasoning (P=.003), binocular acuity (P=.04), and stereopsis (P=.005) best determined the tactical cluster (unadjusted R2=.41). The visuo-integrative model (unadjusted R2=.12) comprised binocular acuity (P=.007) and stereopsis (P=.045). Inhibition (P=.0001) and binocular acuity (P=.001) provided the best model of the mixed cluster (unadjusted R2=.25). Conclusions Our results provide more insights into the specific impairments that influence different dimensions of on-road driving and may be used as a framework for targeted driving intervention programs in MS.
AB - Objective To investigate the cognitive, visual, and motor deficits underlying poor performance on different dimensions of on-road driving in individuals with multiple sclerosis (MS). Design Prospective cross-sectional study. Setting MS clinic and driving simulator lab. Participants Active drivers (N=102) with various types of MS. Interventions Not applicable. Main Outcome Measures Off-road cognitive, visual, and motor functions, as well as 13 specific driving skills. These skills were categorized into hierarchic clusters of operational, tactical, visuo-integrative, and mixed driving. Stepwise regression analysis was used to determine the off-road functions influencing performance on the on-road test and each cluster. Results Visuospatial function (P=.002), inhibition (P=.008), binocular acuity (P=.04), vertical visual field (P=.02), and stereopsis (P=.03) best determined variance in total on-road score (unadjusted R2=.37). Attentional shift (P=.0004), stereopsis (P=.007), glare recovery (P=.047), and use of assistive devices (P=.03) best predicted the operational cluster (unadjusted R2=.28). Visuospatial function (P=.002), inhibition (P=.002), reasoning (P=.003), binocular acuity (P=.04), and stereopsis (P=.005) best determined the tactical cluster (unadjusted R2=.41). The visuo-integrative model (unadjusted R2=.12) comprised binocular acuity (P=.007) and stereopsis (P=.045). Inhibition (P=.0001) and binocular acuity (P=.001) provided the best model of the mixed cluster (unadjusted R2=.25). Conclusions Our results provide more insights into the specific impairments that influence different dimensions of on-road driving and may be used as a framework for targeted driving intervention programs in MS.
KW - Automobile driving
KW - Multiple sclerosis
KW - Neuropsychology
KW - Rehabilitation
KW - Vision, ocular
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U2 - 10.1016/j.apmr.2016.10.008
DO - 10.1016/j.apmr.2016.10.008
M3 - Article
C2 - 27840131
AN - SCOPUS:85009494356
SN - 0003-9993
VL - 98
SP - 1332-1338.e2
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 7
ER -