Exploring the relationship between self‐awareness of driving efficacy and that of a proxy when determining fitness to drive after stroke

Abstract

Background ⁄ aim: The inclusion of a driving specific self-awareness measure may assist the clinical screening process to determine fitness to drive after stroke. This article reports on the use of the Adelaide Driving Self-Efficacy Scale (ADSES) and a proxy ADSES for completion by a significant other in assessment of fitness to drive poststroke. Method: A prospective study among a clinical sample of stroke patients was conducted incorporating an off-road occupational therapy assessment, an on-road assessment and a six-month follow-up. Self and proxy driver efficacy ratings were compared with each other at off-road assessment and at six-month follow-up, both ratings were compared with structured on-road ratings of driving performance. Results: Forty-six stroke patients (37 men), mean age 63.5 years, were recruited to the study. Thirty-five participants successfully completed the on-road test. ADSES and proxy ratings were high and a ceiling effect was noted. Self and proxy ratings were significantly correlated with each other and both correlated with the on-road assessment ratings. The ADSES ratings were sensitive to the final driving outcome with scores of the restricted driving group significantly lower than the unrestricted group. Proxy ratings showed a decrease at six-month follow-up. Conclusions:The ADSES is an easy to administer tool that warrants further use in stroke rehabilitation. Scores on the ADSES differentiated between restricted and unrestricted driving recommendations post-stroke. These preliminary findings indicate its potential use as a proxy measure to assist in identifying patient who are not ready for formal driving assessment.

Driving Cessation and Dementia: Results of the Prospective Registry on Dementia in Austria (PRODEM)

“…The study result that the caregivers’ estimate of “unacceptable risk” was the reason to cease driving in more than 90 percent of our patients underscores the pivotal role and key responsibility of caregivers in the decision as to whether demented patients still drive. The reliability of the caregivers’ judgment regarding fitness to drive in old people is supported by a recent study by Stapleton and coworkers [48] who examined the usability of self- and proxy awareness scales for screening post-stroke patients as to their ability to return to driving. The authors showed that patient- and proxy test-scores were highly correlated with each other and with on-road test results [48].…”

“…The reliability of the caregivers’ judgment regarding fitness to drive in old people is supported by a recent study by Stapleton and coworkers [48] who examined the usability of self- and proxy awareness scales for screening post-stroke patients as to their ability to return to driving. The authors showed that patient- and proxy test-scores were highly correlated with each other and with on-road test results [48]. Although in our study the decision for driving cessation depended very much on the caregiver, it was unaffected by any caregiver characteristic per se, including age, sex, relationship to the patient, employment status or strain of care.…”

Is it safe to drive after acute mild stroke? A preliminary report

“…Some studies report less than 35% of patients passing on-road assessments [17,18], and others report over 75% of patients passing on-road assessments [19][20][21][22]. One factor contributing to this variability is the heterogeneous patient samples used across and within studies.…”

Evaluating the effectiveness of on‐road driving remediation following acquired brain injury: A wait‐list feasibility study with follow‐up

“…These components must interact in a rapid, simultaneous manner in order for the task to be completed safely in a dynamic, unpredictable environment (Bohr, 2008). Driving is further complicated by performance patterns such as self‐regulation and self‐awareness, driving context (such as the role of passengers) and activity modifications (for example vehicle modification and compensatory strategies; Gooden et al, 2017; Stapleton, Connolly, & O'Neill, 2012; Swann & Ryder, 2009). A change in any of these factors can impact upon driving safety and competence (Handler & Patterson, 1995).…”