Comprehensive Driving Assessment to Enable Driving Resumption in Adults Recovering From Critical Illness: A Prospective Cohort Study.

Abstract

Primary objective: To determine the driving ability of adult ICU survivors 2 months after hospital discharge. Secondary objectives: Evaluate driving resumption at 3, 6, and 12 months; factors associated with driving resumption; and acceptability of a comprehensive driving assessment. Observational cohort study. Certified driving assessment center in the United Kingdom. Adult ICU survivors who received mechanical ventilation (minimum 72 hr) and/or extracorporeal membrane oxygenation. A Driver Vehicle Licensing Agency-approved, driving ability assessment comprising physical and cognitive evaluation, and practical driving skills using a driving simulator, private track in-car assessment, and on-road in-car assessment. We recruited 40 participants (median age, 53 yr [interquartile range (IQR), 46-64 yr]; 13 [32%] female) from six hospitals. Of these, 33 completed the driving assessment at a median of 12.5 weeks following hospital discharge. Twenty-six participants (79%) were assessed as capable of driving a standard vehicle; however, only 15 (45%) had resumed driving. Seven participants (7/33, 21%) were deemed unable to drive a standard vehicle due to either physical (n = 4/7, 57%), psychological (n = 2/7, 29%), or cognitive impairment (n = 1/7, 14%). Driving resumption following adaptations, retraining, or refresher lessons occurred in four participants (n = 4/7, 57%) in the 12-month study period. Self-reported driving resumption at 3, 6, and 12 months was observed in 21 (62%), 28 (82%), and 30 (91%) participants, respectively. Time to driving resumption ranged from 7 to 274 days following hospital discharge. Median (IQR) driving confidence (10-point Likert scale) increased from 7 (5-8) pre-assessment to 9 (7-10) post assessment (p < 0.05). Driving assessment acceptability was rated very good or excellent by 32 participants (97%). Using a comprehensive driving assessment 3 months following hospital discharge, approximately three quarters of this cohort were deemed able to drive a standard vehicle, yet less than half had resumed driving. Of those with a driving-related impairment, most could resume driving following intervention.