Driving in stroke survivors aged 18-65 years: The Psychosocial Outcomes In StrokE (POISE) Cohort Study

Abstract

Background There is limited information regarding return to driving after stroke. Aims To determine the frequency and predictors of return to driving within 1 month of acute stroke in younger (age 18-65 years) adults. Methods POISE (Psychosocial Outcomes In StrokE) was a cohort study conducted in Australia between October 2008 and June 2010. Consecutive patients (age 18-65 years) with a recent (28 days) acute stroke were recruited. Validated demographic, clinical, mental health, cognitive, and disability measures including return to driving were obtained. Multivariable logistic regression was used to determine factors associated with return to driving within 1 month of stroke. Results Among 359 participants who were legally able to drive before stroke, 96 (26.7%) returned to driving within 1 month. Compared to those without an early return to driving (n=263), drivers were more often male, the main income earner, in paid work before stroke and without symptoms of depression or fatigue. Independence in activities of daily living (odds ratio (OR) 30.05, 95% confidence interval (CI) 3.85-234.45), not recalling receiving advice on driving cessation (OR 5.55, 95% CI 2.86-11.11), and having returned to paid work (OR 3.93, 95% CI 1.94-7.96) were associated with early return to driving. Conclusions One in four young adults resumed driving within a month, contrary to guideline recommendations. These data reinforce the importance of deciding who is responsible for determining fitness to drive after stroke, when, and whether it is reasonable to enforce driving restrictions on those with minimal disability who are fit to return to work. Registration Australian New Zealand Clinical Trials Registry ANZCTRN 12608000459325.