Research: driving and disability

R
EpubMarino M et al. Interventions to evaluate fitness to drive among people with chronic conditions: Systematic review of literature.Accid Anal Prev. 2012 May 31.

Background: When a health condition has been identified, the question of whether to continue driving depends not on a medical diagnosis, but on the functional consequences of the illness. The complex nature of physical and mental impairments and their relationship with safe driving make the availability of evidence based tools necessary for health professionals.

Aims: The review aims at identifying and summarizing scientific findings concerning the relationship between neuropsychological and clinical screening tests and fitness to drive among people with chronic conditions.

Methods: Studies were searched for driving ability evaluation by road test or simulator, clinical/neuropsychological examinations of participants with chronic diseases or permanent disablement impairing driving performance, primary outcomes as fatal/non-fatal traffic injuries and secondary outcomes as fitness to drive assessment.

Results: Twenty-seven studies fulfilled the inclusion criteria. Some studies included more than one clinical condition. The illness investigated were Alzheimer Disease (n=6), Parkinson Disease (n=8), Cardiovascular Accident (n=4), Traumatic Brain Injuries (n=3), Sleep Apnea Syndrome (n=2), Narcolepsy (n=1), Multiple Sclerosis (n=1) and Hepatic Encephalopathy (n=1), comorbidities (n=3). No studies match inclusion criteria about Myasthenia Gravis, Diabetes Mellitus, Renal Diseases, Hearing Disorders and Sight Diseases. No studies referred to primary outcomes. The selected studies provided opposite evidences. It would be reasonable to argue that some clinical and neuropsychological tests are effective in predicting fitness to drive even if contrasting results support that driving performance decreases as a function of clinical and neuropsychological decline in some chronic diseases.

Conclusion: Nevertheless we found no evidence that clinical and neuropsychological screening tests would lead to a reduction in motor vehicle crashes involving chronic disabled drivers. It seems necessary to develop tests with proven validity for identifying high-risk drivers so that physicians can provide guidance to their patients in chronic conditions, and also to medical advisory boards working with licensing offices.



“Driving is a difficult issue. It is clear that some MSers can’t drive, whilst other are fine. The difficult group are the ones in the middle. We tend to send them to specialised assessment centres to see if they are capable of driving or not. I have always had reservations about some of the assessments that come back and the findings of this review supports my impressions. We need better assessment tools. Driving safety in MS is a complex issue and when some MSers need to drive to remain employed, or connected socially, taking away their driving license is a massive step.”

“Are there any experiences you would like to share with us?”

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

6 comments

  • i don't drive anymore and it is really depressing! my optician says my eyes are driving standard and she would pass me but she doesn't understand how bright light makes my vision worse by reducung the acuity slightly or how the heat does the same thing.

  • Re: "my optician says my eyes are driving…"

    You need to see an ophthalmologist; you may still be able to drive!

  • I am affected down one side, and don'tt currently drive. However when my motability 'contract' is up on the current car, I'm going to check out having an assessment to enable me to drive. Oh the freedom …

  • Hello,

    I was told to stop driving by my neurologist 'cos my eyes do not move together. Look to the right and right eye moves but left one won't and vice versa. Also I've got double vision. (Are these problems related?) Whilst being told to stop driving was a major blow, inwardly I was quite relieved.

    I'm quite lucky because there is good public transport, I'm still sort-of mobile (I can stagger a few hundred metres) and I have got a very light mobility scooter that I can take anywhere.

    So I'm disapointed that I can not drive but I survive

  • what could an opthalmologist do for me to help me drive again? my optician says the MS could be affecting the pupils and they look too dilated in the light affecting the acuity. she says im 6/6 in one eye and the other is only slightly worse

  • The biggest reason I can't drive is that my proprioception is shot. At first I just couldn't manage a standard transmission (left foot couldn't find or get leverage on the clutch). We bought an automatic, but that only lasted for about a year. I was mostly all right in motion, but I either started too slowly or jackrabbited. Then my knee started locking up when I went to brake. That scared me too much, along with one incident, thankfully in a parking lot, where my foot completely missed the brake several times. I'm just glad I didn't wait too long.

    At the time we lived in a state that required an assessment and special driving lessons before you could have hand controls installed in your car. This would have required a lot of money beyond the cost of the hand controls plus the time off work to drive an hour there and an hour back (for two people since the whole problem was that I couldn't drive). I just couldn't justify the expense, especially for what might be yet another short-term adaptation since my hands are not exactly reliable, either. I am currently working on getting a scooter that I hope will make it easier for me to use public transportation.

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