Clinical evaluation of fitness to drive in patients with brain metastases

Cristina Valencia-Sanchez, Vanessa C. Gorelkin, Maciej M. Mrugala, Akanksha Sharma, Sujay A. Vora, Jonathan Ben Ashman, Thomas B. Daniels, Michele Y Halyard, William Rule, Nan Zhang, Richard J. Butterfield, Steven Eric Schild, Alyx B. Porter

Research output: Contribution to journalArticle

Abstract

Background. Guidelines to provide recommendations about driving restrictions for patients with brain metastases are lacking. We aim to determine whether clinical neurologic examination is sufficient to predict suitability to drive in these patients by comparison with an occupational therapy driving assessment (OTDA). Methods. We prospectively evaluated the concordance between neurology assessment of suitability to drive (pass/fail) and OTDA in 41 individuals with brain metastases. Neuro-oncology evaluation included an interview and neurological examination. Participants subsequently underwent OTDA during which a battery of objective measures of visual, cognitive, and motor skills related to driving was administered. Results. The mean age of patients who failed OTDA was age 68.9 years vs 59.3 years in the group members who passed (P = .0046). The sensitivity of the neurology assessment to predict driving fitness compared with OTDA was 16.1% and the specificity 90%. The 31 patients who failed OTDA were more likely to fail Vision Coach, Montreal Cognitive Assessment, and Trail Making B tests. Conclusions. There was poor association between the assessment of suitability to drive by neurologists and the outcome of the OTDA in patients with brain metastases. Subtle deficits that may impair the ability to drive safely may not be evident on neurologic examination. The positive predictive value was high to predict OTDA failure. Age could be a factor affecting OTDA performance. The results raise questions about the choice of assessments in making recommendations about driving fitness in people with brain metastases. OTDA should be strongly considered in patients with brain metastases who wish to continue driving.

Original languageEnglish (US)
Pages (from-to)484-489
Number of pages6
JournalNeuro-Oncology Practice
Volume6
Issue number6
DOIs
StatePublished - Dec 1 2019

Keywords

  • Brain metastases
  • Fitness to drive

ASJC Scopus subject areas

  • Medicine (miscellaneous)

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  • Cite this

    Valencia-Sanchez, C., Gorelkin, V. C., Mrugala, M. M., Sharma, A., Vora, S. A., Ashman, J. B., Daniels, T. B., Halyard, M. Y., Rule, W., Zhang, N., Butterfield, R. J., Schild, S. E., & Porter, A. B. (2019). Clinical evaluation of fitness to drive in patients with brain metastases. Neuro-Oncology Practice, 6(6), 484-489. https://doi.org/10.1093/nop/npz027