Patient Factors Associated With Return to Driving Poststroke: Findings From a Multicenter Cohort Study

Objective: To estimate the extent to which body structure, function, activity, and context explain driving resumption at 1 year. Design: Cohort study with relationships modeled in a path analysis. Setting: Three urban Canadian communities. Participants: Patients admitted to hospital with acute stroke who had driven before their stroke (n=290) who participated in a longitudinal study of stroke outcomes. Main Outcome Measures: Driving resumption 1 year after the initial stroke diagnosis. Results: One hundred seventy-seven patients (61%) returned to driving after 1 year. Direct relationships were found between measures of strength and motor activity (Stroke Impact Scale), cognition (Mini-Mental State Examination), type of stroke (hemorrhagic vs ischemic), and driving resumption at 1 year. The effects of stroke severity, fatigue, and sex on driving resumption were mediated through strength and motor activity shown by a model that had excellent fit (comparative fit index=.985, Tucker-Lewis Index=.952, root mean square error of approximation=.046). Conclusions: There are multiple direct and indirect influences on driving resumption at 1 year, from the type of stroke, physical strength and motor activity, cognition, sex, and fatigue measured at 3 months. The paths outlined by this model highlight how stroke sequelae influence community mobility, as well as factors related to driving resumption that are amenable to intervention.