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Driving Simulation in the Clinic: Testing Visual Exploratory Behavior in Daily Life Activities in Patients with Visual Field Defects
Published on: September 18, 2012
Comprehensive Driving Assessment to Enable Driving Resumption in Adults Recovering From Critical Illness: A
Chloe Apps1,2, Kate Brooks1, Gillian Radcliffe1
1Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
Objectives:
Primary objective: To determine the driving ability of adult ICU survivors 2 months after hospital discharge. Secondary objectives: Evaluate driving resumption at 3, 6, and 12 months; factors associated with driving resumption; and acceptability of a comprehensive driving assessment.
Design:
Observational cohort study.
Setting:
Certified driving assessment center in the United Kingdom.
Patients:
Adult ICU survivors who received mechanical ventilation (minimum 72 hr) and/or extracorporeal membrane oxygenation.
Interventions:
A Driver Vehicle Licensing Agency-approved, driving ability assessment comprising physical and cognitive evaluation, and practical driving skills using a driving simulator, private track in-car assessment, and on-road in-car assessment.
Measurements And Main Results:
We recruited 40 participants (median age, 53 yr [interquartile range (IQR), 46-64 yr]; 13 [32%] female) from six hospitals. Of these, 33 completed the driving assessment at a median of 12.5 weeks following hospital discharge. Twenty-six participants (79%) were assessed as capable of driving a standard vehicle; however, only 15 (45%) had resumed driving. Seven participants (7/33, 21%) were deemed unable to drive a standard vehicle due to either physical (n = 4/7, 57%), psychological (n = 2/7, 29%), or cognitive impairment (n = 1/7, 14%). Driving resumption following adaptations, retraining, or refresher lessons occurred in four participants (n = 4/7, 57%) in the 12-month study period. Self-reported driving resumption at 3, 6, and 12 months was observed in 21 (62%), 28 (82%), and 30 (91%) participants, respectively. Time to driving resumption ranged from 7 to 274 days following hospital discharge. Median (IQR) driving confidence (10-point Likert scale) increased from 7 (5-8) pre-assessment to 9 (7-10) post assessment (p < 0.05). Driving assessment acceptability was rated very good or excellent by 32 participants (97%).
Conclusions:
Using a comprehensive driving assessment 3 months following hospital discharge, approximately three quarters of this cohort were deemed able to drive a standard vehicle, yet less than half had resumed driving. Of those with a driving-related impairment, most could resume driving following intervention.
