Clinical Determinants of Fitness to Drive in Drivers with Multiple Sclerosis: A Systematic Review
Author(s): Krasniuk
Slidedeck Presentation:
Abstract:
Background:
Drivers with Multiple Sclerosis (MS) may experience visual and cognitive impairment that compromise their fitness to drive. When assessing fitness to drive, 20-40% fail the on-road assessment. Impairment in visual acuity, processing speed, attention, memory, and executive function predict on-road outcomes. However, the clinical assessments that most validly determine at-risk drivers with MS is not fully understood, as the evidence has not been synopsized or critically appraised.
Aims:
Using the 2017 American Academy of Neurology guidelines, this systematic review: classified the evidence (I-IV, highest-lowest) for the clinical determinants of fitness to drive in drivers with MS; and determined the level of confidence (A-highly probable, B-probable, C-possible, U-insufficient) for clinical assessments predicting driving performance of a simulator or fitness to drive of an on-road assessment.
Methods:
A research librarian and research student developed a search strategy with “MS,” “driving,” and “assessment” concepts. They searched seven health-related databases for driving simulator and on-road studies for adult drivers with MS, published in the English language from 1991-2018. Studies included cohort, case-study, or cross-sectional designs that determined relationships between clinical assessments and driving performance of a simulator, or fitness to drive of an on-road assessment. Three reviewers independently completed title and abstract screens before full-text screens. Afterward, they independently extracted data, classified the evidence, and determined the level of confidence for each clinical assessment predicting driving performance or fitness to drive in drivers with MS.
Results:
Without duplicates, database searches yielded 710 articles for screening. The review comprised 6 driving simulator studies (2 Class III, 4 Class IV) with 24 clinical assessments (4 Level C, 20 Level U confidence); and 9 on-road studies (6 Class II, 3 Class IV) with 35 clinical assessments (9 Level B, 22 Level C, 4 Level U confidence). The Paced Auditory Serial Addition Test (PASAT) possibly predicted driving performance (Level C); while the Stroke Driver Screening Assessment (SDSA) and Useful Field of View™ (UFOV) probably predicted fitness to drive in drivers with MS (Level B).
Discussion:
This systematic review identified clinical assessments with mostly insufficient (Level U) to possible (Level C) confidence for the clinical determinants of fitness to drive in drivers with MS. The best available evidence suggests that the SDSA and UFOV, both measures of visual processing speed and attention (SDSA also measures executive function), may probably identify at-risk drivers with MS (Level B).
Conclusions:
Common visual and cognitive impairments may compromise fitness to drive in drivers with MS. This review identified probable confidence that the SDSA and UFOV may identify at-risk drivers with MS (Level B). However, the review did not identify cut-points on either assessment to validly determine at-risk drivers, and most clinical assessments obtained possible (Level C) or insufficient confidence (Level U). Class I studies that compare clinical predictors of fitness to drive with large samples of drivers with and without MS are needed to make highly probable conclusions (Level A).