Department of Transportation vs self-reported data on motor vehicle collisions and driving convictions for stroke survivors: do they agree?

Does aphasia impact on return to driving after stroke? A scoping review

PURPOSE

Stroke can affect driving, an important activity of daily living. Little is known about whether aphasia (language impairment) impacts driving post-stroke. This scoping review explores impacts and perceived impacts of aphasia on driving performance, and the process of returning to driving post-stroke.

MATERIALS AND METHODS

Scoping review using Arksey and O'Malley's framework, reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Bibliographic databases were searched and international clinical practice guidelines were sourced online. Full-text articles were independently assessed by two reviewers. Results were tabulated and summarised using narrative synthesis.

RESULTS

Forty-three literature sources and 17 clinical practice guidelines were identified. Six studies investigated return to driving with aphasia post-stroke; 37 sources from the broader literature contributed to objectives. It remains unclear whether aphasia impacts fitness-to-drive; however, people with aphasia face barriers in returning to driving due to: (1) uncertainty regarding the role of language in driving; (2) poor awareness and knowledge of aphasia, and (3) communication demands in the patient-journey and assessment.

CONCLUSIONS

The current evidence base is limited, inconsistent, and lacking in quality and recency and there is a lack of guidelines to support clinical practice. People with aphasia face barriers in returning to driving; however, it is unclear if aphasia affects fitness-to-drive post-stroke. Implications for rehabilitationPeople with aphasia, their caregivers and clinicians have identified return to driving as a top 10 research priority.We do not know if aphasia affects fitness-to-drive post-stroke, but communication difficulties can make the process of returning to driving more difficult.Speech pathologists have an important role in ensuring that driving is discussed with people with aphasia post-stroke.Speech pathologists should support the multidisciplinary team to understand and meet the communication needs of people with aphasia throughout the driving evaluation process.

An examination of the concordance between self-reported collisions, driver records, and insurance claims in older drivers

Background Previous studies of older drivers have found that there are discrepancies between their retrospective self-reports of collisions and the official jurisdictional record. Objectives The purpose of this study was to examine how older drivers self-report collisions in comparison to what was recorded in their official driver abstract as well as insurance claims, in a prospective study. Methods Participants (n = 125, age ≥ 70 years) in this study were part of the University of Manitoba site of the Candrive longitudinal study of older drivers. During the operation of the Manitoba site (2009 to 2013), participants were periodically asked to report on any collisions (at-fault or not) in which they were involved, while they were enrolled in the study. In addition, driver records (abstracts and insurance claims) from the provincial licensing agency and public insurer (Manitoba Pubic Insurance; MPI) were provided annually. Results In total there were 101 separate instances of collisions (regardless of at-fault status), whether self-reported, or recorded by MPI. There were 20 at-fault collisions that were recorded on the driver abstract. Eighteen of these collisions were self-reported by participants. In total, our participants were involved in 70 insurance claims (42 at-fault) - 61 of these were self-reported to study staff. In addition, there were 31 collisions that were self-reported to study staff, that were not reported to MPI. Conclusions In this prospective study, older drivers were diligent in reporting collisions in which they were involved. While some collisions were not reported that ultimately became a claim or part of their driver abstract, the biggest discrepancy was in the collisions that were reported to study staff but that were not reported to authorities.