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Review
. 2023 Jun 2;11(11):1637.
doi: 10.3390/healthcare11111637.

Driving Rehabilitation for Stroke Patients: A Systematic Review with Meta-Analysis

Sujin Hwang  1 , Chiang-Soon Song  2
Affiliations
Review

Driving Rehabilitation for Stroke Patients: A Systematic Review with Meta-Analysis

Sujin Hwang et al. Healthcare (Basel). .

Abstract

Driving enables stroke survivors to freely participate in social integration. The purpose of this review was to summarize the evidence for the therapeutic effects of driving rehabilitation for patients when they return to driving after stroke and evaluate the predictors of returning to driving to identify the factors impacting their driving rehabilitation. This study employed a systematic review and meta-analysis. PubMed and four other databases were searched until 31 December 2022. Our review included randomized controlled trials (RCT) and non-RCTs that investigated driving rehabilitation for stroke and observational studies. A total of 16 studies (two non-RCT and 14 non-RCT) were reviewed; two RCTs investigated the effect of driving rehabilitation with a simulator system, and eight and six non-RCTS evaluated the predictive factors of driving return post-stroke and compared the effects of driving rehabilitation for stroke, respectively. The National Institute of Health Stroke Scale (NIHSS) and Mini Mental State Examination (MMSE) scores and having paid employment were significant predictors of resuming driving after stroke. The results suggest that NIHSS, MMSE, and paid employment are predictors of returning to driving post-stroke. Future research should investigate the effect of driving rehabilitation on the resumption of driving in patients with stroke.

Keywords: automobile driving; predictors; rehabilitation; stroke.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of studies included in the review.
Figure 2
Figure 2
Risk of bias summary of cohort study and prospective and retrospective study for each included study. The “+” symbol is low risk, the “?” symbol is unclear; and the “-” symbol is high risk [1,2,4,10,11,19,20,21].
Figure 3
Figure 3
Forest plot of clinical predictors of a return to driving post-stroke in the included studies. The size of the square is proportional to the weight of the study in relation to the pooled estimate, and the line in the middle of the square is the confidence interval for each study. The green color of the square means if the data are continuous. The placement of the center of the diamond on the x-axis represents the point estimate, and the width of the diamond represents the 95% CI around the point estimate of the pooled effect [1,2,21].
Figure 4
Figure 4
Forest plot of the common characteristics to predict the return to driving post-stroke in the included studies. The size of the square is proportional to the weight of the study in relation to the pooled estimate, and the line in the middle of the square is the confidence interval for each study. The green color of the square means if the data are continuous and the blue color of the square means if the data are dichotomous. The placement of the center of the diamond on the x-axis represents the point estimate, and the width of the diamond represents the 95% CI around the point estimate of the pooled effect [1,2,4,11,20,21].
Figure 5
Figure 5
Risk of bias summary of case-control study for each included study. The “+” symbol is low risk, the “?” symbol is unclear; and the “−” symbol is high risk [3,7,22,23,24,25].
Figure 6
Figure 6
Risk of bias summary of RCT for each included study. The “+” symbol is low risk, the “?” symbol is unclear; and the “−” symbol is high risk [9,26].
See this image and copyright information in PMC

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