Citation

Devos H, Ranchet M, Backus D, Abisamra M, Anschutz J, Allison CD, Mathur S, Akinwuntan AE. Arch. Phys. Med. Rehabil. 2016; 98(7): 1332-1338.e2.

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.

Copyright

(Copyright © 2016, Elsevier Publishing)

DOI

10.1016/j.apmr.2016.10.008

PMID

27840131

Abstract

OBJECTIVE: To investigate the cognitive, visual, and motor deficits underlying poor performance on different dimensions of on-road driving in individuals with multiple sclerosis (MS).

DESIGN: Prospective cross-sectional study SETTING: MS Clinic and Driving Simulator Lab PARTICIPANTS: A total of 102 active drivers with various types of MS. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURE: 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 employed to determine the off-road functions influencing performance on the on-road test and each cluster.

RESULTS: Visuospatial function (p=0.002), inhibition (p=0.008), binocular acuity (p=0.04), vertical visual field (p=0.02), and stereopsis (p=0.03) best determined variance in total on-road score (unadjusted R(2)=0.37). Attentional shift (p=0.0004), stereopsis (p=0.007), glare recovery (p=0.047), and use of assistive devices (p=0.03) best predicted the operational cluster (unadjusted R(2)=0.28). Visuospatial function (p=0.002), inhibition (p=0.002), reasoning (p=0.003), binocular acuity (p=0.04), and stereopsis (p=0.005) best determined the tactical cluster (unadjusted R(2)=0.41). The visuo-integrative model (unadjusted R(2)=0.12) comprised binocular acuity (p=0.007) and stereopsis (p=0.045). Inhibition (p=0.0001) and binocular acuity (p=0.001) provided the best model of the mixed cluster (unadjusted R(2)=0.25).

CONCLUSIONS: 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.

Copyright © 2016. Published by Elsevier Inc.

Language: en