PM&R
Volume 2, Issue 6 , Pages 497-503, June 2010

Driving and Reintegration Into the Community in Patients After Stroke

  • Hillel M. Finestone, MD

      Affiliations

    • Candrive Research Program, Canadian Institutes of Health Research; Ottawa Hospital Rehabilitation Centre; Division of Physical Medicine and Rehabilitation, University of Ottawa; and Élisabeth Bruyère Hospital, Bruyère Continuing Care, 43 Bruyère Street, Ottawa, ON K1N 5C8, Canada‡
    • Corresponding Author InformationAddress correspondence to: H.M.F.
    • ,
  • Meiqi Guo, BSc

      Affiliations

    • Queen's University Medical School, Kingston, ON, Canada§
    • ,
  • Paddi O'Hara, PhD

      Affiliations

    • O'Hara Consulting, Ottawa, ON, Canada
    • ,
  • Linda Greene-Finestone, PhD

      Affiliations

    • Division of Physical Medicine and Rehabilitation, University of Ottawa; and the Public Health Agency of Canada, Ottawa, ON, Canada∥
    • ,
  • Shawn C. Marshall, MD

      Affiliations

    • Candrive Research Program, Canadian Institutes of Health Research; Ottawa Hospital Rehabilitation Centre; and Division of Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON, Canada#
    • ,
  • Lynn Hunt, MSc

      Affiliations

    • The Ottawa Hospital Rehabilitation Centre, Ottawa, ON, Canada⁎⁎
    • ,
  • Jennifer Biggs, RN

      Affiliations

    • Candrive Research Program, Canadian Institutes of Health Research, Ottawa, ON, Canada‡‡
    • ,
  • Anita Jessup, RN

      Affiliations

    • Candrive Research Program, Canadian Institutes of Health Research, Ottawa, ON, Canada§§

Received 27 October 2009; accepted 29 March 2010.

Objective

To investigate the relationship between driving versus not driving and community integration after stroke. Much research on patients who drive after experiencing a stroke has focused on driving assessment protocols; little attention has been given to the implications of assessment outcomes.

Design

Prospective study.

Setting

Six driving evaluation centers in Ontario, Canada.

Participants

Fifty-three community-dwelling patients who were referred for a driving assessment after they experienced a stroke.

Methods

Data on demographics, living circumstances, health status, driving habits, and driving history were gathered via a semistructured interview and various questionnaires administered on 3 occasions: study entry (≥1 month after stroke; n = 53), 3 months (n = 44), and 1 year (n = 43).

Main Outcome Measurement

Reintegration into the community at 1 year, as evaluated with the Reintegration to Normal Living Index (RNLI).

Results

The participants had sustained a stroke an average of 12.3 months before study entry. Two subjects were driving at study entry. At 1 year, 28 (65%) of 43 subjects had passed their driving test and had resumed/continued driving. Nondrivers had a significantly lower mean RNLI score than drivers. Subjects who were not driving at study entry but had resumed driving by 1 year had a significant increase in RNLI score (P = .011). Driving was significantly associated with community integration after adjustment for concomitant health status (P < .001). Driving and health status were associated with community integration at 1 year, accounting for 32% of the variance in RNLI score.

Conclusions

Driving after stroke was significantly associated with community integration in patients after adjustment for health status (P < .001). Community decision-makers may decide to use the study results when determining the transportation needs of stroke survivors who self-limit their driving because of weather, time of day, or distance concerns.

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  • ‡ Disclosure: nothing to disclose
  • § Disclosure: nothing to disclose
  •  Disclosure: nothing to disclose
  • ∥ Disclosure: nothing to disclose
  • # Disclosure: nothing to disclose
  • ⁎⁎ Disclosure: nothing to disclose
  • ‡‡ Disclosure: nothing to disclose
  • §§ Disclosure: nothing to disclose

 This work was supported by grants NA5529 and T6193 from the Heart and Stroke Foundation of Ontario.

 Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org

 This CME activity is designated for 1.0 AMA PRA Category 1 Credit™ and can be completed online at me.aapmr.org. Log on to www.me.aapmr.org, go to Lifelong Learning (CME) and select Journal-based CME from the drop down menu. This activity is FREE to AAPM&R members and $25 for non-members.

PII: S1934-1482(10)00299-6

doi:10.1016/j.pmrj.2010.03.030

PM&R
Volume 2, Issue 6 , Pages 497-503, June 2010

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