Objective: To identify the best determinants of fitness-to-drive after stroke, following a systematic review and meta-analysis.
Methods: Twenty databases were searched, from inception until May 1, 2010. Potentially relevant studies were reviewed by two authors for eligibility. Methodological quality was assessed by Newcastle-Ottawa scores. The fitness-to-drive outcome was a pass – fail decision following an on-road evaluation. Differences in off-road performance between the pass and fail groups were calculated using weighted mean effect sizes (dw). Statistical heterogeneity was determined with the I² statistic. Random-effects models were performed when the assumption of homogeneity was not met. Cut-off scores of accurate determinants were estimated via receiver operating characteristic analyses.
Results: Thirty studies were included in the systematic review and 27 in the meta-analysis. Out of 1728 participants, 938 (54%) passed the on-road evaluation. The best determinants were Road Sign Recognition (dw, 1.22; 95% Confidence Interval [CI], 1.01−1.44; I², 58%), Compass (dw, 1.06; 95% CI, 0.74−1.39; I², 36%), and Trail Making Test B (TMT B; dw, 0.81; 95% CI, 0.48−1.15; I², 49%). Cut-off values of 8.5 points for Road Sign Recognition, 25 points for Compass, and 90 seconds for TMT B were identified to classify unsafe drivers with accuracies of 84%, 85% and 80%, respectively. Three out of four studies found no increased risk of accident involvement in persons cleared to resume driving after stroke.
Conclusions: The Road Sign Recognition, Compass and TMT B are clinically administrable office-based tests that can be used to identify persons with stroke at-risk of failing an on-road assessment.