Driving and Reintegration Into the Community in Patients After Stroke

Objective: To investigate the relationship between driving versus not driving and community integration after stroke. Much research on patients who drive after experiencing a stroke has focused on driving assessment protocols; little attention has been given to the implications of assessment outcomes. Design: Prospective study. Setting: Six driving evaluation centers in Ontario, Canada. Participants: Fifty-three community-dwelling patients who were referred for a driving assessment after they experienced a stroke. Methods: Data on demographics, living circumstances, health status, driving habits, and driving history were gathered via a semistructured interview and various questionnaires administered on 3 occasions: study entry (>= 1 month after stroke; n = 53), 3 months (n = 44), and 1 year (n = 43). Main Outcome Measurement: Reintegration into the community at 1 year, as evaluated with the Reintegration to Normal Living Index (RNLI). Results: The participants had sustained a stroke an average of 12.3 months before study entry. Two subjects were driving at study entry. At 1 year, 28 (65%) of 43 subjects had passed their driving test and had resumed/continued driving. Nondrivers had a significantly lower mean RNLI score than drivers. Subjects who were not driving at study entry but had resumed driving by 1 year had a significant increase in RNLI score (P = .011). Driving was significantly associated with community integration after adjustment for concomitant health status (P < .001). Driving and health status were associated with community integration at 1 year, accounting for 32% of the variance in RNLI score. Conclusions: Driving after stroke was significantly associated with community integration in patients after adjustment for health status (P < .001). Community decision-makers may decide to use the study results when determining the transportation needs of stroke survivors who self-limit their driving because of weather, time of day, or distance concerns. PM R 2010;2:497-503