International Traffic Medicine Association edition:21 location:The Hague date:26-29 April 2009
Background: Several studies have investigated the effect of rehabilitation programs for driving ability in stroke patients, with follow-ups at a maximum of 6 months. The aim of this study was to determine the effect of simulator-based training on driving ability at 5 years post-stroke. A second aim was to investigate the impact of driving cessation on depression 5 years after stroke. Methods: Eighty-three consecutive stroke subjects were randomly allocated to a 15-hour driving training program that consisted either of simulator or cognitive therapy. Off-road and on-road assessments were made before and after intervention, and at 6 months post-stroke. In this study, 61 patients were reassessed at 5 years post-stroke. Driving status (currently driving – stopped driving) and the outcome on an official driving evaluation were used as primary outcome measures. Results: Overall, both groups improved significantly in most of the evaluations from pre-training till 6 months follow-up and remained stable afterwards. Five years after the event, 85% of the simulator group who completed al assessments passed the official fitness to drive assessment compared to 52% of the cognitive group (p = 0.08). At 5 years post-stroke, 34 (56%) subjects were still driving. Subjects who resumed driving were less severely depressed than subjects who gave up driving following the event. Conclusions: Simulator-based training seems to speed up the process of improving driving ability in the first 6 months after stroke and the benefit remains several years after stroke. Driving cessation is associated with severity of depression, even 5 years after stroke.