Citation

Krasniuk S, Classen S, Morrow SA, Tippett M, Knott M, Akinwuntan A. Arch. Phys. Med. Rehabil. 2019; 100(8): 1534-1555.

Affiliation

Professor and Dean. Department of Physical Therapy and Rehabilitation Science, School of Health Professions, Kansas University Medical Center, Kansas City, Kansas, United States.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.apmr.2018.12.029

PMID

30690007

Abstract

OBJECTIVE: To critically appraise the evidence for the clinical determinants of fitness to drive in adults with Multiple Sclerosis (MS). DATA SOURCES: The research librarian and lead author searched seven databases for driving simulator and on-road studies for adults with MS published in the English language from 1991 to 2018. STUDY SELECTION: Three reviewers independently screened titles/abstracts and full-texts for studies with: cohort, case-control, or cross-sectional designs; participants, 18 years or older, with relapsing or progressive MS; visual, cognitive, or motor clinical assessments as predictors; and driving performance through simulator or fitness to drive through on-road assessment as outcomes. DATA EXTRACTION: Using the 2017 American Academy of Neurology guidelines, reviewers independently classified each study from Class I-highest to Class IV-lowest amount of rigor. For each clinical assessment, reviewers independently rated the level of confidence for predicting driving performance or fitness to drive from Level A-highly probable, B-probable, C-possible, to Level U-insufficient conclusions. DATA SYNTHESIS: Through qualitative synthesis, two Class III and four Class IV driving simulator studies employed twenty-four clinical assessments with Level C (n=4) or Level U (n=20) confidence for predicting driving performance. Six Class II and three Class IV on-road studies employed thirty-five clinical assessments with Level B (n=9), Level C (n=22), or Level U (n=4) confidence for predicting fitness to drive.

CONCLUSIONS: This systematic review identified mostly insufficient conclusions for predicting driving performance in driving simulator studies, and possible conclusions for predicting fitness to drive in on-road studies. The best available evidence suggests that the Stroke Driver Screening Assessment and Useful Field of View™ probably predict fitness to drive in adults with MS (Level B). Class I studies that compare predictors of fitness to drive with large prospective samples of adults with and without MS are necessary for highly probable conclusions.

Copyright © 2019. Published by Elsevier Inc.

Language: en

Keywords

Automobile Driving; Evidence-Based Practice; Multiple Sclerosis; Risk Factors; Simulators