TY  - JOUR
PY  - 2011//
TI  - Screening for fitness to drive after stroke: A systematic review and meta-analysis
JO  - Neurology
A1  - Devos, H.
A1  - Akinwuntan, Abiodun Emmanuel
A1  - Nieuwboer, A.
A1  - Truijen, S.
A1  - Tant, M.
A1  - De Weerdt, W.
SP  - 747
EP  - 756
VL  - 76
IS  - 8
N2  - 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 (d(w)). Statistical heterogeneity was determined with the I(2) 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 (d(w) 1.22; 95% confidence interval [CI] 1.01-1.44; I(2), 58%), Compass (d(w) 1.06; 95% CI 0.74-1.39; I(2), 36%), and Trail Making Test B (TMT B; d(w) 0.81; 95% CI 0.48-1.15; I(2), 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.<p />  <p>Language: en</p>
LA  - en
SN  - 0028-3878
UR  - http://dx.doi.org/10.1212/WNL.0b013e31820d6300
ID  - ref1
ER  -