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Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Supervisor

Alvarez, Liliana

Abstract

The purpose of this dissertation was to undertake a comprehensive study of driving restriction after stroke, from both clinical and client perspectives with attention to subgroup representation. This dissertation is comprised of three studies, presented in three manuscripts. Study 1 (Chapter 2) investigated the efficacy of a practice resource to support occupational therapists in addressing driving after stroke in the acute care setting. Study 2 (Chapter 3) examined the published predictive validity of screening tools for fitness to drive after stroke and the representation of demographic subgroups in the extant literature. Study 3 (Chapter 4) explored the driving restriction and community mobility experiences of young women (aged 55 years and younger), an unrepresented group in stroke and driving research.

Results from Study 1 provide preliminary experimental evidence that the Practice Resource for Addressing Driving After Stroke (PReDAS) supported clinical practice among occupational therapists. The findings revealed a large treatment effect of the PReDAS for improving clinical reasoning and self-efficacy for addressing driving (Combined Tau-U = 0.70 and 0.90, respectively).

In Study 2, the screening tests with the highest level of evidence and consistency of findings for fitness to drive screening were the Stroke Driver’s Screening Assessment and Trail Making Test-B. However, within this body of research, younger women and people from lower income countries are underrepresented (21% women, 61.6± 5 average age, 99% live in high income countries) and few studies reported detailed demographic information to provide context for the findings.

Informed by transactional perspectives, Study 3 revealed driving restriction after stroke among young women is a significant disruption due to driving’s instrumental role in enabling participation. Women experienced significant psychological pain from driving restriction, compounded by the sudden and unexpected onset at their age. The women sought out social support, advocated for policy changes, and enacted agency to navigate driving restriction. The unique characteristics of the women and their contexts interacted and deeply shaped experiences of driving restriction.

Together, these findings represent a comprehensive investigation to inform how to support both clinicians and clients navigating driving restriction after stroke and will inform further revision and research of the PReDAS.

Summary for Lay Audience

After experiencing a stroke, a person is not allowed to drive a car for a period of time. The purpose of this research is to understand driving restriction for the people who experience it, and the health care providers who help them, like occupational therapists.

In Study 1, we tested a practice resource (The PReDAS) to help occupational therapists test driving skills and make recommendations for driving and getting around in the community after stroke. We found that the therapists had increased reasoning skills and confidence in their ability to address driving after using the PReDAS.

In Study 2, we searched the literature for tests that are good at predicting if a person would pass or fail a driving test after a stroke. We also identified which groups of people are included in those studies (and which are not) to see if the research applies to diverse groups, such as people of different gender, age, income, etc. We found many tests that are useful to predict pass or failing a driving test, the most useful tests were the Stroke Driver’s Screening Assessment and Trail Making Test-B. However, the research in this area largely neglected women, young people (years), and people who live in low-income countries. Also, researchers did not provide a lot of information about their participants (such as their education, gender, cultural identity, etc.), so it is difficult for therapists to know how the research will apply to their clients.

In Study 3, we asked young women (aged 55 years and younger) about their experiences and perspectives of driving restriction after stroke. We found that young women have unique experiences of driving restriction that impact how they can participate in their lives. Young women also have unique needs and supports must be tailored to those needs.

Together, these three studies will help to improve the practice resource to support occupational therapists and people who have stroke navigate the difficulties of driving restriction.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

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