Returning to driving post-stroke: Identifying key factors for best practice decision making over the recovery trajectory

Author: Annabel McNamara

McNamara, Annabel, 2016 Returning to driving post-stroke: Identifying key factors for best practice decision making over the recovery trajectory, Flinders University, School of Health Sciences

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The purpose of this thesis is to examine the process of returning to driving post-stroke in order to contribute to best practice decision making. A decision tree is suggested to build patient-centred procedures for returning to driving along the post-stroke recovery trajectory.

Part one reviews literature on the return to driving process post-stroke and identifies gaps in knowledge. The stroke recovery trajectory’s three main phases of recovery (acute, rehabilitation and community care) are outlined and act as a framework for the thesis structure. Part two of the thesis describes five separate but related studies carried out to address the research gaps identified.

The first study is a qualitative study that examines attitudes and perceptions of stroke survivors from one to 16 weeks post-stroke. Independence was found to be the primary motivator in stroke survivors’ decisions about fitness to drive. However, during the acute phase stroke survivors were focused on their physical recovery, not returning to driving. Study participants had little knowledge of return to driving procedures or legislation, despite information being available. Gender differences were apparent in factors affecting the return to driving decision making.

The second study examines the psychometric property of practice effect on the Useful Field of View (UFOV, Ball & Owsley, 1993) a pre-driving screening assessment. UFOV scores have been found to be associated with on-road driving assessment scores (George & Crotty, 2010) and used in medical recommendations. Study participants were all stroke survivors with a control group performing the UFOV at three months and assessment group at one, two and three months post-stroke. Findings suggest there was no practice effect in relation to a single three month post-stroke time point. Timing of reassessment was also examined.

The third study examined self-perceived driving confidence measured by the Adelaide Driving Self Efficacy Scale (ADSES, George et al., 2007; George & Crotty, 2010) and driving habits. Results indicated there was a significant statistical association between low self-perceived driving confidence and lower kilometres driven per week, reduce driving scope, driving closer to home and avoiding challenging driving situations.

The fourth study explored self-perceived driving confidence of post-stroke drivers and their non-stroke, aged-matched driving peers measured by the ADSES. No difference was found, suggesting once stroke survivors have returned to driving they have the same levels of self-perceived driving confidence and potential driving scope as their non-stroke driving peers.

The final study focused on decisions to relinquish a driver’s licence among the older Australian general population and used a novel Discrete Choice Experiment (DCE) methodological approach. A general population was used to establish a norm with which future research on specific chronic conditions such as stroke could make comparison. Recommendation of General Practitioners’ (GPs), participants’ local doctors was found to be the primary influencing factor in the decision of older Australians to relinquish their driver’s licence. Advice from family and friends, age and crash risk in the next year were also influencing factors. The costs and availability of public transport options were not influencing factors.

The last chapter of this thesis is the Discussion section which identifies the common themes emerging along with limitations and recommendations for future research directions.

Keywords: Driving, Stroke, CVA, Best practice, Decision making, Post-stroke recovery trajectory

Subject: Rehabilitation thesis

Thesis type: Doctor of Philosophy
Completed: 2016
School: School of Health Sciences
Supervisor: Dr Stacey George