Community Integration Research: Stroke Survivors & Driving

Driving and reintegration into the community in patients after stroke.

Finestone HM, Guo M, O’Hara P, Greene-Finestone L, Marshall SC, Hunt L, Biggs J, Jessup A.  Candrive Research Program, Canadian Institutes of Health Research, Ottawa, ON K1N 5C8, Canada.  PM R. 2010 Jun;2(6):497-503.

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 (> or =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.

Driving status and community integration after stroke.

Griffen JA, Rapport LJ, Bryer RC, Scott CA.  Department of Psychology, Wayne State University, Detroit, Michigan, USA.  Top Stroke Rehabil. 2009 May-Jun;16(3):212-21.

BACKGROUND AND PURPOSE: Driving a motor vehicle is an essential activity of daily living for adults; however, few studies have examined the effects of driving cessation on community integration among stroke survivors. The present study investigated this relationship as well as social support and gender as potential moderators of outcome.

METHOD: Ninety pairs of stroke survivors and informants participated. Objective community integration (mobility, occupation, social integration) was assessed via informant ratings, whereas subjective community integration and social support were assessed via self-report. These poststroke outcomes were compared for survivors who did and did not resume driving post stroke.

RESULTS: Multivariate analysis of covariance (MANCOVA) indicated that drivers were more mobile and made more productive use of their time than did non-drivers, even after accounting for stroke severity and use of alternative transportation. Two interaction effects were observed: Drivers with high social support showed better community integration than did non-drivers and drivers with low social support. Additionally, among men, non-drivers fared substantially worse than drivers, whereas among women, drivers and non-drivers showed equivalent community integration.

CONCLUSION: Driving status has unique and substantial influence on community integration following stroke. Social support facilitated community integration but did not substantially buffer the effects of driving cessation. Although men and women resumed driving at equal rates, driving cessation showed differential effects for men and women in regard to their community integration. Research is needed to design interventions that promote full engagement in community living among persons who cease driving after stroke.