@article{ref1,
title="Driving impairment and crash risk in Parkinson disease: a systematic review and meta-analysis",
journal="Neurology",
year="2018",
author="Thompson, Trevor and Poulter, Damian and Miles, Clare and Solmi, Marco and Veronese, Nicola and Carvalho, André F. and Stubbs, Brendon and Uc, Ergun Y.",
volume="91",
number="10",
pages="e906-e916",
abstract="OBJECTIVES: To provide the best possible evidence base for guiding driving decisions in Parkinson disease (PD), we performed a meta-analysis comparing patients with PD to healthy controls (HCs) on naturalistic, on-the-road, and simulator driving outcomes. <br><br>METHODS: Seven major databases were systematically searched (to January 2018) for studies comparing patients with PD to HCs on overall driving performance, with data analyzed using random-effects meta-analysis. <br><br>RESULTS: Fifty studies comprising 5,410 participants (PD = 1,955, HC = 3,455) met eligibility criteria. Analysis found the odds of on-the-road test failure were 6.16 (95% confidence interval [CI] 3.79-10.03) times higher and the odds of simulator crashes 2.63 (95% CI 1.64-4.22) times higher for people with PD, with poorer overall driving ratings also observed (standardized mean differences from 0.50 to 0.67). However, self-reported real-life crash involvement did not differ between people with PD and HCs (odds ratio = 0.84, 95% CI 0.57-1.23, <i>p</i> = 0.38). <br><br>FINDINGS remained unchanged after accounting for any differences in age, sex, and driving exposure, and no moderating influence of disease severity was found. <br><br>CONCLUSIONS: Our findings provide persuasive evidence for substantive driving impairment in PD, but offer little support for mandated PD-specific relicensure based on self-reported crash data alone, and highlight the need for objective measures of crash involvement.<br><br>© 2018 American Academy of Neurology.<p /> <p>Language: en</p>",
language="en",
issn="0028-3878",
doi="10.1212/WNL.0000000000006132",
url="http://dx.doi.org/10.1212/WNL.0000000000006132"
}