Driving ability in patients with dizziness: a systematic review

Abstract

Introduction-Dizziness is considered one of the most common symptoms in general medical practice. Patients can suffer from a wide range of symptoms that are highly relevant while driving and may affect driving ability. In most countries driving restrictions have been suggested for patients with dizziness or a vestibular disorder. However, these restrictions are not always evidence-based and differ significantly between European countries.Objective-The aim of this systematic review was to identify and evaluate studies dealing with driving performance of dizzy patients or patients with a vestibular disorder. Methods-A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. (1) Data sources: PubMed and the reference list of the included articles. (2) Study selection: articles about driving ability and reported driving difficulties in patients with dizziness, or a diagnosed vestibular disorder, were included.(3) Data extraction was performed by two independent authors using predefined data fields: patient's characteristics, diagnostic criteria, sample size, type of evaluation of driving ability and outcome of the study. The protocol (ID 178086) is available online at PROSPERO. Results-Eight out of 705 articles matched the inclusion criteria but varied widely regarding thestudy population, study design and outcome measures. The majority of studies reported a negative impact of dizziness and/or vestibular disorders on self-reported driving ability and car accidents. Yet several studies could not identify any impairment of driving ability.Conclusions Driving ability was negatively affected by dizziness or a vestibular disorder in the majority of included studies with low risk of bias. This systematic review revealed a significant heterogeneity in reporting driving performance and contradictory results. We were therefore unable to identify a causal relationship between dizziness and driving ability. There is a need for prospective studies in populations with different vestibular disorders using subjective and objective outcome measures that have been validated to evaluate driving performance.

Medical record prompts improve the frequency and documentation of dizziness and driving conversations in the ENT balance clinic

“…Medication, dizziness and drowsiness were discussed with those patients prescribed medication, improving patient awareness and possibly the safety of all road users. 7,8,21,26 Most people with dizziness and imbalance described their symptoms as predictable (e.g. the symptoms only occurred when the individual performed certain movements, or they had a warning sign), controllable (not severe enough to be disabling), or both predictable and controllable, following shared decision-making discussions 32 to explore these parameters.…”

“…19 However, given its importance, the topic of driving and dizziness or vertigo should always be addressed in those presenting with these symptoms, 20 and in patients taking medication that causes dizziness or drowsiness, 20 as data are consistent regarding the effects of medications used for dizziness and vertigo on driving ability. [6][7][8][9][10][21][22][23] Vestibular disorders have been shown to negatively affect driving ability in most studies, with a low risk of bias, 16,17,22 and any associated anxiety or mood disordersprevalent in vestibular disordersmay also affect driving. 16 A systematic review revealed a significant heterogeneity in studies reporting driving performance, with contradictory results, 21 which makes giving accurate, condition-specific advice more challenging.…”

“…[6][7][8][9][10][21][22][23] Vestibular disorders have been shown to negatively affect driving ability in most studies, with a low risk of bias, 16,17,22 and any associated anxiety or mood disordersprevalent in vestibular disordersmay also affect driving. 16 A systematic review revealed a significant heterogeneity in studies reporting driving performance, with contradictory results, 21 which makes giving accurate, condition-specific advice more challenging. [22][23][24] Furthermore, there can be a fear of implications where legislation appears over-cautious.…”

Development and Content Validity of the Bilateral Vestibulopathy Questionnaire

“…This conceptual framework is centered around the full spectrum of BVP symptoms and categorizes them in three different domains: the physical, cognitive, and emotional domain. The burden of these symptoms increases when performing certain activities such as cycling or driving a car, leading to limitations in carrying out these activities ( 47 ). Consequently, patients show altered behavior such as slowing down or paying more attention while performing activities or even avoiding specific activities ( 6 ).…”

Self-Reported Cycling Performance and Impact on Falls in Persons With Bilateral Vestibulopathy

“…For instance, an increase in vestibular symptoms while car driving was reported in 56% of these patients (Lucieer et al 2020). Several studies assessed driving abilities in persons with dizziness and vestibular dysfunction, showing its detrimental effect on self-reported driving ability and the occurrence of car accidents (Uwents et al 2021). Although 94% of persons with BV report an increase of symptoms while cycling, detailed studies about cycling abilities in this population are lacking (Lucieer et al 2020).…”