MONDAY, Feb. 21 (HealthDay News) -- A new review of existing
research contends that three brief tests could help doctors figure
out whether recovering stroke patients are well enough to
"A quick and objective screening in the doctor's office can help them to make more accurate decisions," said review author Hannes Devos, a research assistant at Katholieke Universiteit Leuven in Belgium.
However, several U.S. stroke experts said they weren't ready to
accept the new study's findings.
The American Heart Association estimates that 6.4 million stroke
survivors are alive in the United States today. While some patients
are able to recover with few permanent disabilities, strokes can
cause some people to permanently lose memory and the ability to
properly move their bodies.
In some cases, patients with serious motor-skill problems can
still drive a car as long as they're able to get proper equipment,
such as an automatic transmission, a left-sided accelerator pedal
for patients who have trouble moving their right side, and steering
knobs that allow one-handed driving, Devos said.
Stroke patients may need to get approval from a physician before
they can legally begin driving again, but evaluation processes in
the office can sometimes be a challenge. "Some physicians do not
feel confident to screen for fitness to drive because they lack
standardized tools that can be administered in the doctor's
office," Devos said.
With that in mind, Devos and colleagues reviewed 30 surveys and
included 27 in an overall statistical analysis. In total, the
studies evaluated various screening tests before patients took
on-road driving tests; 54 percent of 1,728 patients (average age
61) passed the driving tests.
The researchers found that three screening tests had accuracy
levels of 80 percent to 85 percent for determining how patients
would fare on an on-road driving test. One of the tests asks
patients to match road signs to driving situations. Another
requires patients to match cue cards in a mockup of a driving
roundabout or rotary. The third test asks patients to connect 25
circles while alternating between numbers and letters in
consecutive order, Devos said.
The tests only take about 15 minutes and doctors can easily
administer them during a routine visit, Devos said.
So should the tests be administered?
Dr. Larry B. Goldstein, professor of medicine and director of
the Duke Stroke Center at Duke University Medical Center, is
skeptical, pointing out that the tests didn't correctly identify 15
percent to 20 percent of unsafe drivers, and they may also fail to
identify safe drivers.
"I am not sure whether it is practical to include a formal driving assessment as part of the routine post-stroke follow-up visit or whether the cost would be reimbursed," he said, adding that patients can choose to be tested in a driving simulator before hitting the road as part of a test.
Dr. Jeffrey L. Saver, a professor of neurology and director of
the University of California, Los Angeles Stroke Center, said the
office tests might be helpful if patients and families aren't sure
whether to spend money on on-road driving tests.
"However, on-road assessment will remain the gold standard and likely will continue as the approach generally pursued by physicians for patients with deficits that could potentially impair driving," he said.
The study appears in the Feb. 22 issue of the journal
For more about
stroke, visit the U.S. National Library of Medicine.