title: Effect of simulator training on fitness-to-drive after stroke: a 5-year follow-up of a randomized controlled trial.
abstract: BACKGROUND
  No long-term studies have been reported on the effect of training programs on driving after stroke.
  
  
  OBJECTIVE
  The authors' primary aim was to determine the effect of simulator versus cognitive rehabilitation therapy on fitness-to-drive at 5 years poststroke. A second aim was to investigate differences in clinical characteristics between stroke survivors who resumed and stopped driving.
  
  
  METHODS
  In a previously reported randomized controlled trial, 83 stroke survivors received 15 hours of simulator training (n = 42) or cognitive therapy (n = 41). In this 5-year follow-up study, 61 participants were reassessed. Fitness-to-drive decisions were obtained from medical, visual, neuropsychological, and on-road tests; 44 participants (simulator group, n = 21; cognitive group, n = 23) completed all assessments. The primary outcome measures were fitness-to-drive decision and current driving status.
  
  
  RESULTS
  The authors found that 5 years after stroke, 18 of 30 participants (60%) in the simulator group were considered fit to drive, compared with 15 of 31 (48%) in the cognitive group (P = .36); 34 of 61 (56%) participants were driving. Current drivers were younger (P = .04), had higher Barthel scores (P = .008), had less comorbidity (P = .01), and were less severely depressed (P = .02) than those who gave up driving.
  
  
  CONCLUSIONS
  The advantage of simulator-based driving training over cognitive rehabilitation therapy, evident at 6 months poststroke, had faded 5 years later. Poststroke drivers were younger and less severely affected and depressed than nondrivers.
authors.affiliation: Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium. Hannes.Devos@faber.kuleuven.be
authors.forename: Hannes
authors.initials: H
authors.lastname: Devos
authors.forename: Abiodun Emmanuel
authors.initials: AE
authors.lastname: Akinwuntan
authors.forename: Alice
authors.initials: A
authors.lastname: Nieuwboer
authors.forename: Isabelle
authors.initials: I
authors.lastname: Ringoot
authors.forename: Karen
authors.initials: K
authors.lastname: Van Berghen
authors.forename: Mark
authors.initials: M
authors.lastname: Tant
authors.forename: Carlotte
authors.initials: C
authors.lastname: Kiekens
authors.forename: Willy
authors.initials: W
authors.lastname: De Weerdt
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D001334:Automobile Driving / Q000523:psychology* / Q000592:standards*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D020521:Stroke / Q000150:complications / Q000523:psychology; D000071939:Stroke Rehabilitation; D013663:Teaching / Q000379:methods*; D014584:User-Computer Interface