Screening for fitness to drive after stroke: A systematic review and meta-analysis

H. Devos, A. E. Akinwuntan, A. Nieuwboer, S. Truijen, M. Tant, W. De Weerdt

Research output: Contribution to journalReview articlepeer-review

101 Scopus citations


OBJECTIVE: To identify the best determinants of fitness to drive after stroke, following a systematic review and meta-analysis. METHODS: Twenty databases were searched, from inception until May 1, 2010. Potentially relevant studies were reviewed by 2 authors for eligibility. Methodologic quality was assessed by Newcastle-Ottawa scores. The fitness-to-drive outcome was a pass-fail decision following an on-road evaluation. Differences in off-road performance between the pass and fail groups were calculated using weighted mean effect sizes (dw). Statistical heterogeneity was determined with the I statistic. Random-effects models were performed when the assumption of homogeneity was not met. Cutoff scores of accurate determinants were estimated via receiver operating characteristic analyses. RESULTS: Thirty studies were included in the systematic review and 27 in the meta-analysis. Out of 1,728 participants, 938 (54%) passed the on-road evaluation. The best determinants were Road Sign Recognition (dw 1.22; 95% confidence interval [CI] 1.01-1.44; I, 58%), Compass (dw 1.06; 95% CI 0.74-1.39; I, 36%), and Trail Making Test B (TMT B; dw 0.81; 95% CI 0.48-1.15; I, 49%). Cutoff values of 8.5 points for Road Sign Recognition, 25 points for Compass, and 90 seconds for TMT B were identified to classify unsafe drivers with accuracies of 84%, 85%, and 80%, respectively. Three out of 4 studies found no increased risk of accident involvement in persons cleared to resume driving after stroke. CONCLUSIONS: The Road Sign Recognition, Compass, and TMT B are clinically administrable office-based tests that can be used to identify persons with stroke at risk of failing an on-road assessment.

Original languageEnglish (US)
Pages (from-to)747-756
Number of pages10
Issue number8
StatePublished - Feb 22 2011

ASJC Scopus subject areas

  • Clinical Neurology


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