title: Determinants of On-Road Driving in Multiple Sclerosis.
abstract: To investigate the cognitive, visual, and motor deficits underlying poor performance on different dimensions of on-road driving in individuals with multiple sclerosis (MS).
  
  
  
  Prospective cross-sectional study.
  
  
  
  MS clinic and driving simulator lab.
  
  
  
  Active drivers (N=102) with various types of MS.
  
  
  
  Not applicable.
  
  
  
  Off-road cognitive, visual, and motor functions, as well as 13 specific driving skills. These skills were categorized into hierarchic clusters of operational, tactical, visuo-integrative, and mixed driving. Stepwise regression analysis was used to determine the off-road functions influencing performance on the on-road test and each cluster.
  
  
  
  Visuospatial function (P=.002), inhibition (P=.008), binocular acuity (P=.04), vertical visual field (P=.02), and stereopsis (P=.03) best determined variance in total on-road score (unadjusted R2=.37). Attentional shift (P=.0004), stereopsis (P=.007), glare recovery (P=.047), and use of assistive devices (P=.03) best predicted the operational cluster (unadjusted R2=.28). Visuospatial function (P=.002), inhibition (P=.002), reasoning (P=.003), binocular acuity (P=.04), and stereopsis (P=.005) best determined the tactical cluster (unadjusted R2=.41). The visuo-integrative model (unadjusted R2=.12) comprised binocular acuity (P=.007) and stereopsis (P=.045). Inhibition (P=.0001) and binocular acuity (P=.001) provided the best model of the mixed cluster (unadjusted R2=.25).
  
  
  
  Our results provide more insights into the specific impairments that influence different dimensions of on-road driving and may be used as a framework for targeted driving intervention programs in MS.
authors.affiliation: Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS; Department of Physical Therapy, College of Allied Health Sciences, Augusta University, Augusta, GA. Electronic address: hdevos@kumc.edu.
authors.forename: Hannes
authors.initials: H
authors.lastname: Devos
authors.affiliation: Department of Physical Therapy, College of Allied Health Sciences, Augusta University, Augusta, GA; French Institute of Science and Technology for Transport, Development and Networks (IFSTTAR), Laboratory of Ergonomic and Cognitive Sciences for Transports (TS2-LESCOT), Bron, France.
authors.forename: Maud
authors.initials: M
authors.lastname: Ranchet
authors.affiliation: Shepherd Center, Atlanta, GA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Backus
authors.affiliation: Shepherd Center, Atlanta, GA.
authors.forename: Matt
authors.initials: M
authors.lastname: Abisamra
authors.affiliation: Shepherd Center, Atlanta, GA.
authors.forename: John
authors.initials: J
authors.lastname: Anschutz
authors.affiliation: Shepherd Center, Atlanta, GA.
authors.forename: C Dan
authors.initials: CD
authors.lastname: Allison
authors.affiliation: Biostatistics Department, Medical College of Georgia, Augusta University, Augusta, GA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Mathur
authors.affiliation: Department of Physical Therapy, College of Allied Health Sciences, Augusta University, Augusta, GA; Dean's Office, School of Health Professions, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Abiodun E
authors.initials: AE
authors.lastname: Akinwuntan
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001288:Attention / Q000502:physiology; D001333:Automobile Driver Examination; D001334:Automobile Driving; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology* / Q000534:rehabilitation; D009483:Neuropsychological Tests; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000502:physiology*; D012720:Severity of Illness Index; D012737:Sex Factors; D065855:Spatial Processing / Q000502:physiology; D014787:Vision Tests
keywords: Automobile driving; Multiple sclerosis; Neuropsychology; Rehabilitation; Vision, ocular