To the Editor: Helping patients who have had a stroke return to driving when possible should be an important focus in rehabilitation wards. The National Stroke Foundation supports a three-stage approach to assessing ability to drive, comprising physical and cognitive assessment, an off-road driving test and an on-road driving test.1 Austroads is the association of Australian and New Zealand road transport and traffic authorities, which aims to improve road and road transport outcomes. It provides clear guidelines on criteria for licence and assessment after stroke, but the implementation of these guidelines varies in practice.2

We conducted a review of 53 consecutive patients with a primary diagnosis of stroke admitted to a specialised rehabilitation ward over a 6-month period between January and July 2007. The mean age of the sample population was 77.0 years (SD, 10.7 years), and cognition score (Functional Independence Measure) on discharge was 28.3 (SD, 7.1) (maximum possible score, 35). Each patient completed a survey on driving history. Case notes were reviewed for medical factors associated with admission, any notations about driving, and actions taken regarding driving. Patients were telephoned 6 months after the date of the stroke to determine whether they had resumed driving and, if not, to explore the reasons.

At the time of admission, 26 of the 53 patients held a current drivers licence, a proportion higher than the South Australian state rate of less than 10% for people aged 75 years and over. At the time of discharge, 12 of the 26 patients had their licences cancelled, 11 were referred for medical review after discharge without formal suspension, two were referred for occupational therapy driving assessment, and one was advised not to drive for 6 weeks. At 6 months, only five of the 26 patients (19%) had resumed driving, with one having regained a cancelled licence; six patients cited “lack of confidence” as the reason for not resuming driving.

Reasons for the doctors’ decisions regarding driving were poorly documented in the case notes, and the time frame proposed for medical review ranged from 1 to 4 months. Austroads requires a minimum time of 4 weeks post-stroke before patients can resume driving, but does not specify a time frame for medical or on-road reassessment. Commonly, patients undergoing acute rehabilitation are still within the 4-week period, and assessments regarding return to driving are premature. The low rate of referral to available occupational therapy on-road driving assessment may reflect poor awareness of available hospital resources and online guidelines.

While overseas studies of post-stroke populations indicate a return-to-driving rate between 30% and 58%,3-5 our rate was 19%. This low rate may represent a lack of formal assessment and driver rehabilitation opportunities. The benefits of formal driving assessment and training are supported by recent studies which found that licensed drivers post-stroke did not have an increased incidence of either car accidents or driving violations.6

While most doctors in the rehabilitation ward seemed to have understood the need to address the issue of driving, more formal training in this field is required for doctors.