title: Screening for fitness to drive after stroke: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To identify the best determinants of fitness to drive after stroke, following a systematic review and meta-analysis.
  
  
  METHODS
  Twenty databases were searched, from inception until May 1, 2010. Potentially relevant studies were reviewed by 2 authors for eligibility. Methodologic quality was assessed by Newcastle-Ottawa scores. The fitness-to-drive outcome was a pass-fail decision following an on-road evaluation. Differences in off-road performance between the pass and fail groups were calculated using weighted mean effect sizes (d(w)). Statistical heterogeneity was determined with the I² statistic. Random-effects models were performed when the assumption of homogeneity was not met. Cutoff scores of accurate determinants were estimated via receiver operating characteristic analyses.
  
  
  RESULTS
  Thirty studies were included in the systematic review and 27 in the meta-analysis. Out of 1,728 participants, 938 (54%) passed the on-road evaluation. The best determinants were Road Sign Recognition (d(w) 1.22; 95% confidence interval [CI] 1.01-1.44; I(2), 58%), Compass (d(w) 1.06; 95% CI 0.74-1.39; I², 36%), and Trail Making Test B (TMT B; d(w) 0.81; 95% CI 0.48-1.15; I(2), 49%). Cutoff values of 8.5 points for Road Sign Recognition, 25 points for Compass, and 90 seconds for TMT B were identified to classify unsafe drivers with accuracies of 84%, 85%, and 80%, respectively. Three out of 4 studies found no increased risk of accident involvement in persons cleared to resume driving after stroke.
  
  
  CONCLUSIONS
  The Road Sign Recognition, Compass, and TMT B are clinically administrable office-based tests that can be used to identify persons with stroke at risk of failing an on-road assessment.
authors.affiliation: Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium. Hannes.Devos@faber.kuleuven.be
authors.forename: H
authors.initials: H
authors.lastname: Devos
authors.forename: A E
authors.initials: AE
authors.lastname: Akinwuntan
authors.forename: A
authors.initials: A
authors.lastname: Nieuwboer
authors.forename: S
authors.initials: S
authors.lastname: Truijen
authors.forename: M
authors.initials: M
authors.lastname: Tant
authors.forename: W
authors.initials: W
authors.lastname: De Weerdt
mesh_terms: D001333:Automobile Driver Examination; D001334:Automobile Driving; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D009483:Neuropsychological Tests; D010809:Physical Fitness / Q000502:physiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011594:Psychometrics; D012372:ROC Curve; D016032:Randomized Controlled Trials as Topic; D021641:Recognition, Psychology / Q000502:physiology; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000503:physiopathology*; D000071939:Stroke Rehabilitation