Determinants of On-road Driving in Multiple Sclerosis

Hannes Devos (1) , Maud Ranchet (2) , Deborah Backus (3) , Matt Abisamra (4) , John Anschutz (3) , Allison Jr. C. Dan (3) , Mathur Sunil (4) , Abiodun Emmanuel Akinwuntan (5)

1 Department of Physical Therapy and Rehabilitation Science
2 IFSTTAR/TS2/LESCOT - Laboratoire Ergonomie et Sciences Cognitives pour les Transports
3 Shepherd Center, Atlanta, GA
4 Biostatistics Department
5 School of Health Professions

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: Active drivers (N=102) with various types of MS. Interventions: Not applicable. Main Outcome Measures: 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 used to determine the off-road functions influencing performance on the on-road test and each cluster. Results: Visuospatial function (P=.002), inhibition (P=.008), binocular acuity (P=.04), vertical visual field (P=.02), and stereopsis (P=.03) best determined variance in total on-road score (unadjusted R2=.37). Attentional shift (P=.0004), stereopsis (P=.007), glare recovery (P=.047), and use of assistive devices (P=.03) best predicted the operational cluster (unadjusted R2=.28). Visuospatial function (P=.002), inhibition (P=.002), reasoning (P=.003), binocular acuity (P=.04), and stereopsis (P=.005) best determined the tactical cluster (unadjusted R2=.41). The visuo-integrative model (unadjusted R2=.12) comprised binocular acuity (P=.007) and stereopsis (P=.045). Inhibition (P=.0001) and binocular acuity (P=.001) provided the best model of the mixed cluster (unadjusted R2=.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.

Mots clés: MULTIPLE SCLEROSIS; NEUROPSYCHOLOGY; DRIVING

Mots clés: REHABILITATION; VISION; SANTE; APTITUDE A LA CONDUITE

Domaines: Neurosciences; Psychologie

Hannes Devos, Maud Ranchet, Deborah Backus, Matt Abisamra, John Anschutz, et al.. Determinants of On-road Driving in Multiple Sclerosis. Archives of Physical Medicine and Rehabilitation, 2017, 98 (7), pp.1332-1338.e2. ⟨10.1016/j.apmr.2016.10.008⟩. ⟨hal-01475850v3⟩