UK Stroke Forum Conference location:Glasgow date:30 November - 2 December
Introduction. The goal of this systematic review and meta-analysis was to identify the best screening tools for fitness-to-drive after stroke.
Methods. Eleven electronic databases, 5 abstract databases and 4 current trials registries were searched, from inception of database until May 1, 2010. The search identified 3264 citations. Original studies were scanned in duplicate for eligibility. The fitness-to-drive outcome was a pass – fail decision on an on-road test. Methodological quality was assessed by Newcastle-Ottawa scores. Weighted mean effect sizes (Dw) of determinants were calculated using fixed-effects models. Statistical heterogeneity was estimated with the I² statistic. Random-effects models were performed when the assumption of homogeneity was not met. Cut-off scores of valid determinants were determined via receiver operating characteristic curves (ROC).
Results. Thirty studies were included in the systematic review and 27 in the meta-analysis. Out of 1728 stroke patients, 938 (54%) passed the on-road evaluation. The most valid determinants were road sign recognition test (Dw, 1.22; 95% Confidence Interval [CI], 1.01-1.44; I², 72%), compass test (Dw, 1.06; 95% CI, 0.74-1.39; I², 82%), and Trail Making Test, part B (TMT B; Dw, 0.81; 95% CI, 0.48-1.15; I², 0%). Cut-off values of 8.5 points for road sign recognition, 25 points for compass, and 90 seconds for TMT B were identified to correctly classify unsafe drivers with an accuracy of 84%, 85% and 80%, respectively.
Conclusion. The road sign recognition, compass and TMT B are clinically administrable office-based tests that could be used to determine at-risk stroke survivors to be referred for further on-road assessment.