Tools to inform general practitioners’ decision making on driving following a stroke

To the Editor: Return to driving following a stroke is a complex issue. Austroads provides general guidelines1 and the National Stroke Foundation recommends a process including off-road and on-road driving tests.2 On-road assessments conducted by occupational therapists are considered the gold standard for decision making on return to driving following a stroke. Limited access is available to off-road and on-road tests across Australia, with few occupational therapists qualified to assess driving ability. Additionally, a range of off-road assessments are used for patients who have had a stroke. General practitioners, who are instrumental in managing return to driving, often base their decisions on limited information regarding functional status, particularly in terms of vision, cognition and perception. Rehabilitation physicians generally have access to more detailed information from allied health staff on which to base their decisions on driving ability.

I investigated whether rehabilitation physicians’ recommendations on driving following a stroke were associated with patients’ performance on two objective tools, which could be used in general practice to assist with decision making. Participants were recruited at two rehabilitation services in Adelaide, South Australia, using the following inclusion criteria: had been diagnosed with stroke; had driven before the stroke; were aged over 18 years; and had provided written informed consent.

I performed two assessments. The first was the Useful Field of View (UFOV) assessment;3 this is a computer-administered assessment that analyses processing speed, divided attention and selective attention, and takes 20 minutes to complete. The second was the Stroke Drivers Screening Assessment (SDSA);4 this consists of three tests conducted at a table — dot cancellation, compass recognition and road sign recognition — and takes 45–60 minutes to complete. Both assessments have been validated in patients who have had a stroke by comparison to on-road assessment.5 Treating rehabilitation physicians, blinded to assessment results, were contacted to obtain their recommendations on driving ability based on their clinical assessment and feedback from allied health staff at a case conference.

A total of 123 participants (98 men [80%]) were recruited, and diagnoses included 53 right hemisphere strokes (43%), 63 left hemisphere strokes (51%) and 7 other strokes (6%). The participants’ mean age was 67.3 years (SD, 13.5 years), median period since injury was 42 days (range, 7–2190 days) and mean amount of driving experience was 48 years (SD, 14.9 years).

Results of the SDSA (n = 120) and UFOV assessment (n = 123) were significantly associated with rehabilitation physicians’ recommendations on driving (Box). This suggests that referring patients who have had a stroke for one of these assessments would provide GPs with objective information to guide decision making on driving.

With the introduction of Medicare Locals, resources that allow GPs to refer patients for standardised off-road driving tests should be considered.