Title: Short and long term effects of two driving retraining programmes after stroke: a randomised controlled trial
Authors: Devos, Hannes ×
Akinwuntan, Abiodun Emmanuel
Nieuwboer, Alice
Tant, Mark
Kiekens, Carlotte
De Weerdt, Willy #
Issue Date: 20-Jun-2011
Host Document: Physiotherapy vol:97 issue:S1 pages:283-284
Conference: World Physical Therapy 2011 location:Amsterdam date:20-23 June
Abstract: Purpose
Very few rehabilitation programmes exist to retrain driving skills commonly affected after stroke. The purpose of this randomised controlled trial (RCT) was to investigate the short and long term effect of two driving retraining programmes on fitness-to-drive after stroke.

This RCT helps us to gain insight into the carryover effect of two distinct rehabilitation concepts on fitness-to-drive. The simulator programme focuses on the contextual training of driving skills, while the cognitive rehabilitation programme addresses the training of cognitive components of driving in a non-contextual setting.

Throughout a 20-month recruitment period, 83 participants (65 men, 18 women) consented to partake. Participants presented with mild to moderate functional impairments and were all independently ambulant. They were 6 to 9 weeks after stroke and on average 54 ± 12 years old, had 33 ± 11 years of driving experience, and had a Barthel score of 74 ± 26.

Participants were randomly allocated into either a simulator group or a cognitive group. Both groups received 15 hours of driving therapy. Participants in the simulator group were trained on lane tracking, speed control, anticipation, road sign recognition, hazard perception, and overtaking maneuvers. The driving simulator was a Ford Fiesta 1.8 with automatic gear transmission. STISIM Drive software was used to develop tailor-made scenarios. Participants in the cognitive group were trained on visuospatial skills, problem-solving skills, road sign recognition, and route finding using off-the-shelf games. Fitness-to-drive decisions were derived from medical, visual, neuropsychological, and on-road tests before training, immediately after training, at 6 months and at 60 months post-stroke. The assessors were blind to the allocation of the participants in the two treatment groups.

A Generalized Estimating Equation model was fitted with main effects of Group (simulator versus cognitive) and of Time (before training, after training, 6 month follow-up, 60 month follow-up), and the interaction effect of Group by Time. The fitness-to-drive decision (pass – fail) was the main outcome measure.

Both groups significantly improved in a visual and many perceptual tests and in the on-road test immediately after training. At 6 months follow-up, significantly more participants in the simulator (73%) compared to the cognitive group (42%) passed the driving evaluation and were safe to resume driving (p = 0.03). The advantage of the simulator training over the cognitive program had however faded at the 60 months evaluation.

Contextual training in a driving simulator speeds up the restoration of driving skills after stroke, with apparent effects observed at 6 months post-stroke. However, the beneficial effect disappears after 5 years.

The results of this RCT favour the implementation of simulator therapy in the conventional rehabilitation programme of stroke survivors with mild to moderate deficits. Future studies should investigate whether driving simulator therapy can partly replace on-road training in terms of fitness-to-drive success rates, cost- and time effectiveness.
Publication status: published
KU Leuven publication type: IMa
Appears in Collections:Research Group for Neuromotor Rehabilitation
Physical Medicine and Revalidation Section (-)
× corresponding author
# (joint) last author

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