Portrait of driving practice following a mild stroke: a secondary analysis of a chart audit

Association of Age and Neurological Severity at Intensive Care Unit Admission With Driving Resumption Within 30 Days of Stroke: A Single-Center Historical Cohort Study

Objectives Guidelines in several countries recommend against driving soon after a stroke; however, some patients resume driving within one month after onset. This study aimed to examine the relationship between neurological and social background factors at intensive care unit (ICU) admission and resumption of motor vehicle driving within 30 days of the first acute stroke/cerebral hemorrhage. Materials and methods Data were extracted from medical records of a single center linked to the National Cerebral and Cardiovascular Center Administration Office for Stroke Data Bank in Japan. The data included age, sex, Japan Coma Scale (JCS), National Institutes of Health Stroke Scale (NIHSS), employment status, family situation, and outcomes of driving resumption in patients with a valid driving license transported to the ICU within 24 hours of stroke onset. Time-to-event analysis was used to explore the associations between these factors and driving resumption, with data censored 30 days from onset. Results In total, 239 patients had complete medical records, of whom 66 resumed driving. A multivariate Cox proportional hazards analysis showed that fewer patients aged ≥65 years resumed driving than those aged <65 years (hazard ratio 0.46; 95% confidence interval: 0.25-0.84; p=0.009). Patients with NIHSS scores ≥5 and JCS scores ≥1 were also less likely to resume driving compared with those with scores <5 (0.22; 0.08-0.56; p=0.008) and 0 (0.13; 0.04-0.37; p<0.001), respectively. Conclusions Age, NIHSS score, and JCS score at ICU admission are independently associated with the likelihood of resuming driving within 30 days of stroke onset. These findings may aid with the provision of support and education to facilitate the efficient resumption of driving after an acute event.

Australian health professionals' perceptions about the management of return to driving early after stroke: A mixed methods study

BACKGROUND

Stroke can affect a person's ability to drive a motor vehicle. In Australia, there is a 4-week restriction in driving after stroke and a 2-week restriction after transient ischemic attack. Concerns exist as to whether people discharged home from the acute setting receive education about these driving restrictions.

OBJECTIVES

This study sought to investigate health professionals' knowledge about, and responsibilities for patients return-to-driving (RTD) education after stroke and TIA.

METHODS

A cross-sectional online survey was designed and included questions about health professional demographic characteristics and knowledge and opinions of RTD guidelines. An open-ended question at the end of the survey enabled respondents to provide additional, free text information. Descriptive analyses were used to describe respondents' demography and characteristics. Chi-square analysis was used to compare responses across the different professional groups. Significance was tested using a p-value of 0.05. Data obtained from the free text question were analyzed through an inductive thematic approach.

RESULTS

A total of 455 health professionals responded to the survey, with 45% being occupational therapists. Only 22% of health professionals correctly selected the 4-week restriction period after stroke and 27% selected the 2-week restriction period for those with TIA. Occupational therapists were identified by 85% of respondents as the profession responsible for providing RTD education, followed by doctors (72%). Health professionals lack clarity in RTD guidelines and often defer the responsibility of managing RTD to others.

CONCLUSIONS

Education of health professionals in RTD guidelines is recommended to improve the processes of care after stroke.