Stroke Recurrence among Stroke Patients Referred for Driving Assessment and Rehabilitation: A Cohort Study

Abstract

Returning to driving is one of the priorities for stroke survivors. However, the fear of the risk of recurrent stroke has led to concern about allowing driving post-stroke. This study was performed to study the impact of various vascular risk factors on stroke recurrence among drivers referred to our national referral center for Driving Assessment and Rehabilitation Program (DARP). Medical records of subjects who were diagnosed to have a stroke and were referred to DARP were retrospectively reviewed. Data on demographics (age and gender) and vascular risk factors (hypertension—HT, diabetes mellitus—DM, hyperlipidemia—HL, cigarette smoking—SM, previous stroke—PS, and heart disease—HD) were collected. Subjects were contacted and records scrutinized for a report of recurrent stroke. A total of 133 subjects were recruited, median 54 years (range 20–77 years), 95.5% male, 59.4% had HT, 32.3% DM, 65.4% HL, 43.6% SM, 3.8% PS, and 8.3% HD. Over a median follow-up of 30 months (range 1–78 months), the recurrence rate of stroke was 11.3%, 3.69/100 patient-years. On uni-variable analysis, the risk of stroke recurrence rose with age (HR 1.08, 95%CI 1.02–1.15, p = 0.01) and heart disease (HR 5.77, 95%CI 1.46–22.83, p = 0.01). On multivariable analysis, only age remained significant (HR 1.07, 95%CI 1.00–1.13, p = 0.045). Among those aged >60 years, the HR was 3.88 (95%CI 1.35–11.20, p = 0.012). The risk of stroke recurrence is higher among older drivers and is not influenced by other vascular factors.

The relationship between Rating of Everyday Arm‐use in the Community and Home (REACH) scale affected arm‐use assessment, activity and participation after stroke

“…A third of our participants had resumed driving after at least 1 year of living with the effects of a stroke. This is consistent with findings in previous studies, which showed that 33 to 61% return to driving after a stroke (Aufman et al., 2013; Perrier et al., 2010; Venketasubramanian & Chan, 2023). Our simple measure of arm use explained 34% of the variability in return to driving, which is large given that various impairments that present in stroke such as motor, visual, cognitive, perceptual, and sensory deficits can affect the ability to drive (Akinwuntan et al., 2012; Bolognini et al., 2016; Hazelton et al., 2022).…”

Driving Rehabilitation for Stroke Patients: A Systematic Review with Meta-Analysis

“…Driving requires balancing patient safety and autonomy. Many nations have policies requiring health professionals to identify people at risk of driving for health-related reasons [5,[12][13][14].…”