Screening for fitness to drive after stroke: A systematic review and meta-analysis

Hannes Devos, Abiodun Emmanuel Akinwuntan, A. Nieuwboer, S. Truijen, M. Tant, W. De Weerdt

Research output: Contribution to journalReview article

74 Citations (Scopus)

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 I 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; I, 58%), Compass (dw 1.06; 95% CI 0.74-1.39; I, 36%), and Trail Making Test B (TMT B; dw 0.81; 95% CI 0.48-1.15; I, 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.

Original languageEnglish (US)
Pages (from-to)747-756
Number of pages10
JournalNeurology
Volume76
Issue number8
DOIs
StatePublished - Feb 22 2011

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Meta-Analysis
Stroke
Confidence Intervals
Trail Making Test
ROC Curve
Accidents
Databases
Drive

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Devos, H., Akinwuntan, A. E., Nieuwboer, A., Truijen, S., Tant, M., & De Weerdt, W. (2011). Screening for fitness to drive after stroke: A systematic review and meta-analysis. Neurology, 76(8), 747-756. https://doi.org/10.1212/WNL.0b013e31820d6300

Screening for fitness to drive after stroke : A systematic review and meta-analysis. / Devos, Hannes; Akinwuntan, Abiodun Emmanuel; Nieuwboer, A.; Truijen, S.; Tant, M.; De Weerdt, W.

In: Neurology, Vol. 76, No. 8, 22.02.2011, p. 747-756.

Research output: Contribution to journalReview article

Devos, H, Akinwuntan, AE, Nieuwboer, A, Truijen, S, Tant, M & De Weerdt, W 2011, 'Screening for fitness to drive after stroke: A systematic review and meta-analysis', Neurology, vol. 76, no. 8, pp. 747-756. https://doi.org/10.1212/WNL.0b013e31820d6300
Devos H, Akinwuntan AE, Nieuwboer A, Truijen S, Tant M, De Weerdt W. Screening for fitness to drive after stroke: A systematic review and meta-analysis. Neurology. 2011 Feb 22;76(8):747-756. https://doi.org/10.1212/WNL.0b013e31820d6300
Devos, Hannes ; Akinwuntan, Abiodun Emmanuel ; Nieuwboer, A. ; Truijen, S. ; Tant, M. ; De Weerdt, W. / Screening for fitness to drive after stroke : A systematic review and meta-analysis. In: Neurology. 2011 ; Vol. 76, No. 8. pp. 747-756.
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