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. 2022 Nov 30:13:1056411.
doi: 10.3389/fneur.2022.1056411. eCollection 2022.

Driving ability and predictors for driving performance in Multiple Sclerosis: A systematic review

Susan Seddiq Zai  1 , Christoph Heesen  1 , Carsten Buhmann  2 , Roshan das Nair  3   4 , Jana Pöttgen  1
Affiliations

Driving ability and predictors for driving performance in Multiple Sclerosis: A systematic review

Susan Seddiq Zai et al. Front Neurol. .

Abstract

Objective: To provide an overview of the evidence on driving ability in persons with multiple sclerosis (PwMS), specifically to (i) study the impact of MS impairment on driving ability and (ii) evaluate predictors for driving performance in MS.

Methods: To identify relevant studies, different electronic databases were screened in accordance with PRISMA guidelines; this includes reference lists of review articles, primary studies, and trial registers for protocols. Furthermore, experts in the field were contacted. Two reviewers independently screened titles, abstracts, and full-texts to identify relevant articles targeting driving in people with MS that investigated driving-related issues with a formal driving assessment (defined as either an on-road driving assessment; or naturalistic driving in a car equipped with video cameras to record the driving; or a driving simulator with a steering wheel, a brake pedal, and an accelerator).

Results: Twenty-four publications, with 15 unique samples (n = 806 PwMS), were identified. To assess driving ability, on-road tests (14 papers) and driving simulators (10 papers) were used. All studies showed moderate to high study quality in the CASP assessment. About 6 to 38% of PwMS failed the on-road tests, showing difficulties in different areas of driving. Similarly, PwMS showed several problems in driving simulations. Cognitive and visual impairment appeared to most impact driving ability, but the evidence was insufficient and inconsistent.

Conclusion: There is an urgent need for more research and standardized guidelines for clinicians as one in five PwMS might not be able to drive safely. On-road tests may be the gold standard in assessing driving ability, but on-road protocols are heterogeneous and not infallible. Driving simulators assess driving ability in a standardized way, but without standardized routes and driving outcomes, comparability between studies is difficult. Different aspects, such as cognitive impairment or vision problems, impact driving ability negatively and should be taken into consideration when making decisions about recommending driving cessation.

Systematic review registration: Identifier [10.17605/OSF.IO/WTG9J].

Keywords: cognition; driving; driving simulator; multiple sclerosis (MS); on-road driving.

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Conflict of interest statement

CB has received fees for advisory board participation from UCB Pharma and Zambon, as well as lecture fees from AbbVie Pharma, BIAL Pharma, TAD Pharma, UCB Pharma, and Zambon Pharma. CH received research grants from Merck, Novartis, and speaker honoraria from Merck and Roche. JP has received funding to present lectures on fatigue from GAIA AG, for investigator-initiated studies from Merck and Celgene. RdN has received funding to present lectures on cognitive screening and rehabilitation in MS (speakers' bureau) from Merck, Novartis, and Biogen. SSZ declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of all included studies.
Figure 2
Figure 2
Impact of disease-related abilities on driving. EDSS, Expanded disability status scale; 25-FW, 25-foot walk-test; 9-HPT, 9 Hole peg test, GPT, Grooved pegboard test; MSFC, Multiple sclerosis functional composite; PASAT, The paced auditory serial addition test; SDMT, Symbol digit modalities test; DS, Digit symbol; TMT-A, Trail making test-A; TMT-B, Trail making test-B; CVLT, California verbal learning test; HVLT, Hopkins verbal learning test; BVMT, Brief visuospatial memory test; ROCF, Rey osterreith complex figure; BD, Block design; SDSA, Stroke driver screening assessment; DC, dot cancellation; SMD, Square matrices directions; RSR, Road sign recognition; UFOV, Useful field of view; SOP, Speed of processing; DA, Divided attention; SA, Selective attention; R/G CP, Red & green color perception; B/V CP, Blue & violet color perception.
See this image and copyright information in PMC

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