Volume 87, Issue 9 , Pages 1183-1188, September 2006
Return to Driving After Lower-Extremity Amputation
Article Outline
Abstract
Boulias C, Meikle B, Pauley T, Devlin M. Return to driving after lower-extremity amputation.
Objectives
To study driving behaviors after major lower-extremity amputations and to determine which factors influence return to driving after amputation.
Design
A cross-sectional study.
Setting
Data were collected from patients attending an outpatient amputee and prosthetics clinic between February 2001 and September 2001.
Participants
A convenience sample (N=123). Inclusion criteria were: age greater than 18 years, unilateral or bilateral major lower-extremity amputation, minimum 1 year since prosthetic fitting, and active automobile driver within 6 months prior to amputation. Subjects had an average age of 63.4±12.1 years and were on average 6.8±8.3 years since amputation. Common causes for amputation were peripheral vascular disease (73.2%), trauma (13.8%), and tumor (12.2%).
Interventions
Not applicable.
Main Outcome Measure
Driving habits after lower-extremity amputation.
Results
Overall, 80.5% of participants were able to return to driving an average of 3.8 months after amputation, although the majority reported a decreased driving frequency. Female sex (odds ratio [OR]=.08; 95% confidence interval [CI], .02–.34), age of 60 years or greater (OR=.16; 95% CI, .03–.74), right-sided amputation (OR=.13; 95% CI, .03–.52), and preamputation driving frequency of less than every day (OR=.18; 95% CI, .05–.69) were all significantly related to a reduced likelihood of return to driving postamputation. Items that did not have a statistically significant association with return to driving included level of amputation, reason for amputation, preamputation automobile transmission, and accessibility to public transit. Subjects with left-sided amputation had significantly fewer concerns about driving, while those with a right amputation frequently required vehicle modifications (40.6%) or switch to a left-foot driving style for braking (81.3%) and accelerating (65.6%). Common barriers to return to driving included preference not to drive, fear and/or lack of confidence, and related medical conditions.
Conclusions
The majority of subjects with major lower-extremity amputation were able to return to driving after major lower-extremity amputation. Major automobile modifications are commonly performed by right-sided amputees. Several predictors of return to driving and barriers preventing return to driving were identified.
Key Words: Amputees , Automobile driving , Rehabilitation , Treatment outcome
MAJOR AMPUTATIONS of the lower extremity present both functional impairment and limitation. One of the integral goals in the rehabilitation of patients in this population is the achievement of functional independence. Return to driving a motor vehicle is an important step toward functional independence because it allows the pursuit of vocational and nonvocational activities and preserves self-esteem. In people with mobility limitations due to disability, driving often represents the ultimate freedom.1
It has been reported that 51% to 87% of subjects with major lower-extremity amputation continue to drive after amputation; however, none of these studies examined driving habits in any detail.2, 3, 4, 5 In a study from Spain,6 the driving performance of persons with juvenile-onset amputation was reported. Only people with unilateral amputations were studied, the majority of whom had an amputation due to a traumatic event or a congenital cause. Patients included in this study did not have a driver’s license prior to their amputation. Of those patients with lower-limb amputations, 41.8% took up driving. This study is not generalizable to the majority of amputees in North America who in general are older adults with other medical comorbidities, many of whom drove prior to their amputation.
We were unable to find any studies subsequent to 2000 that addressed the issue of return to driving in people after amputation.
Persons with lower-extremity amputation typically have reduced mobility, and return to driving would likely assist in successful community reintegration and independent functioning. A number of intrinsic and extrinsic factors may influence their return to driving. The intrinsic factors include medical impairments (poor vision, residual limb and phantom pain, cardiovascular disease and cerebrovascular disease) and physical impairments (level of amputation, bilateral vs unilateral amputation, side of amputation). On the other hand, extrinsic factors would include the type of vehicle used (manual or automatic transmission) and access to public transportation or other personal transportation services.
At present, we have little evidence on which to base the advice that we provide to subjects with amputation regarding return to driving after their amputation. There are very few reports of the frequency with which such subjects return to driving, and it is unclear what techniques are used to drive (ie, prosthesis on foot pedals vs left accelerator vs hand controls) and what barriers prevent a return to driving. We as clinicians have no basis other than opinion on which to make recommendations. This cross-sectional study was intended to explore the factors involved in the return to driving as well as the driving habits of those with major lower-extremity amputations.
Methods
Study Design
We performed a cross-sectional study using a convenience sample. Ethics approval was obtained prior to initiation of the study from the research ethics committee at our institution.
Setting
All data were collected from patients attending an outpatient amputee and prosthetics clinic located at a tertiary rehabilitation center in Toronto, ON, Canada.
Participants
We screened patients who attended the outpatient clinic for study inclusion. Inclusion criteria included age greater than 18, unilateral or bilateral major lower-extremity amputation (transtibial or transfemoral), 1 year or more since initial prosthetic fitting, and active automobile driver (ie, licensed) within 6 months prior to amputation. Subjects were excluded if they did not meet all inclusion criteria or if they did not speak or understand English. Data were collected between February 2001 and September 2001. No prospective participant declined to participate on being asked. Recruitment of participants was arbitrarily stopped after September 2001.
Data Collection
We asked all eligible subjects to fill out a brief questionnaire regarding driving status preamputation and postamputation. In addition, questions included relevant medical history, driving history, vehicle modifications, contact with the automobile licensing authorities, concerns about driving, and any barriers preventing return to driving.
Statistical Analysis
We used descriptive statistics to describe the characteristics of the sample subjects. Given the binary nature of the main outcome of interest (eg, postamputation driving vs not driving), univariate binary logistic regression analysis was utilized to produce odds ratios (OR) and 95% confidence intervals (CIs) to identify the variables that were included in the multivariate model. Those variables identified individually as significant predictors of return to driving were entered into the multivariate model. Driving status (eg, postamputation drivers vs nondrivers) was treated as the dependent variable in the multivariate model. Variables suspected to impact driving status (eg, level and type of amputation, previous driving history) were treated as independent variables in the model. For the continuous variable of age, patients were partitioned into clusters (eg, >59y). Chi-square analysis was used to compare vehicle postamputation modification between those with right and left amputations. SPSSa for Windows was used to conduct the analyses.
Results
Patient Sample Characteristics
One hundred twenty-three participants were included. Baseline demographic data are shown in table 1. The mean age ± standard deviation of the participants at the time of assessment was 63.4±12.1 years (range, 24−84y). The mean age at time of amputation was 56.6±15.2 years (range, 10−83y). The mean duration since amputation was 6.8±8.3 years (range, 1−43y). The male to female ratio was approximately 3 to 1 (93 men, 30 women).
Table 1. Sample Characteristics (N=123)
| Characteristics | Values |
|---|---|
| Age (y) | 63.4±12.1 (24–84) |
| Sex | |
| Male | 93(75.6) |
| Female | 30(24.4) |
| Time since amputation (y) | 6.8±8.3(1–43) |
| Amputation type | |
| Transtibial: right | 35(28.5) |
| Transtibial: left | 49(39.8) |
| Transfemoral: right | 9(7.3) |
| Transfemoral: left | 19(15.4) |
| Bilateral transtibial | 8(6.5) |
| Bilateral transfemoral | 2(1.6) |
| Right transfemoral plus left transtibial | 1(0.8) |
| Reason for amputation | |
| Peripheral vascular disease | 90(73.2) |
| Trauma | 17(13.8) |
| Tumor | 15(12.2) |
| Lymphedema | 1(0.8) |
| Diabetes | |
| Yes | 61(49.6) |
| No | 62(50.4) |
| Preamputation driving frequency | |
| Every day | 92(74.8) |
| Several days per week | 19(15.4) |
| Few days per week | 6(4.9) |
| Infrequently | 6(4.9) |
| Preamputation automobile(s) driven | |
| Automatic transmission | 77(62.6) |
| Manual transmission | 7(5.7) |
| Both | 34(27.6) |
| Missing | 5(4.1) |
| Preamputation accelerator foot | |
| Left | 2(1.6) |
| Right | 121(98.4) |
| Preamputation brake foot | |
| Left | 12(9.8) |
| Right | 109(88.6) |
| Both | 1(0.8) |
| Missing | 1(0.8) |
Among the 123 studied, the most common reason for amputation was peripheral vascular disease (73.2%), followed by a traumatic event (13.8%), tumor (12.2%), and lymphedema (0.8%). Diabetes was present in approximately half of all subjects (49.6%). In total, 84 (68.3%) subjects had unilateral transtibial amputations, and 28 (22.7%) had unilateral transfemoral amputations. With respect to side of amputation, 44 (35.8%) subjects had right leg amputations, 68 (55.2%) subjects had unilateral left leg amputations, and 11 (8.9%) subjects had bilateral leg amputations.
Prior to their amputation, the vast majority of participants (90.2%) drove at least several days per week or every day. Most (62.6%) operated a vehicle with automatic transmission prior to their amputation, with 5.7% operating exclusively manual transmission automobiles, and 27.6% operating both manual and automatic transmission automobiles. Prior to their amputation, 98.4% used their right foot exclusively on the accelerator pedal and 88.6% used their right foot exclusively on the brake pedal.
Overall Return to Driving Rates
Of the 123 participants, 99 (80.5%) returned to driving following their amputation and 24 (19.5%) did not. Those who returned to driving did so an average of 3.8±2.9 months (range, 1−18mo) after their amputation. The majority (81.8%) of those who returned to driving after their amputation reported that they currently drive at least several days per week.
Compared with women, men were significantly more likely to return to driving following amputation (P<.01), although this was not due to sex differences in side (P>.05) or level of amputation (P>.05). As a group, 84.9% of the men returned to driving, while only 66.7% of the women chose to do so. Men returned to driving on average 3.4±2.3 months after amputation, while women returned 5.4±4.7 months after amputation. The difference in time to return to driving did not differ significantly between women and men.
Covariates of Return to Driving
Table 2 presents the results of the univariate binary logistic regression for postamputation drivers and nondrivers. Factors related to a reduced likelihood of return to driving following amputation (P<.05) included female sex, age 55 years or older, vascular disease, right-sided amputation (among unilateral amputees), bilateral amputation, and preamputation driving frequency of several days per week or less. In an attempt to determine the earliest point at which an age-dependent difference begins to emerge between those who return to driving versus those who do not, logistic regression was conducted using several cutpoints: 50, 55, 60, and 65 years. At the univariate level, age appears to become a factor in the decision to return to driving as early as 55 years of age.
Table 2. Covariates of Return to Driving
| Characteristic | Drivers (n=99) | Nondrivers (n=24) | OR | 95% CI |
|---|---|---|---|---|
| Sociodemographic | ||||
| Female | 20 | 10 | .35 | .14–.92 |
| Age (y) | ||||
| ≥50 | 66 | 21 | .30 | .08–1.06 |
| ≥55 | 56 | 20 | .27 | .09–.84 |
| ≥60 | 41 | 17 | .30 | .11–.78 |
| ≥65 | 27 | 16 | .19 | .07–.50 |
| Physical health | ||||
| Vascular disease | 68 | 22 | .20 | .04–.90 |
| Amputation | ||||
| Unilateral | ||||
| Below knee | 68 | 16 | .51 | .14–1.90 |
| Right-sided | 32 | 12 | .31 | .11–.85 |
| Bilateral | 6 | 5 | .25 | .07–.89 |
| Preamputation driving frequency | ||||
| Less than every day | 19 | 12 | .24 | .09–.61 |
Predictors of Return to Driving
Those factors identified as significantly related to the decision to return to driving in the univariate regression were included in the multivariate model. The final model is presented in table 3. Female sex (OR=.08; 95% CI, .02−.34), age of 60 years or more (OR=.16; 95% CI, .03−.74), right-sided amputation (OR=.13; 95% CI, .03−.52), and preamputation driving frequency less than every day (OR=.18; 95% CI, .05−.69) all appeared to present the greatest challenges in return to driving after amputation.
Table 3. Predictors of Return to Driving
| Risk Factor | OR | 95% CI |
|---|---|---|
| Sociodemographic | ||
| Female | .08 | .02–.34 |
| Age ≥60y | .16 | .03–.74 |
| Unilateral amputation | ||
| Right-sided | .13 | .03–.52 |
| Preamputation driving frequency | ||
| Less than every day | .18 | .05–.69 |
Car Modifications
Frequencies and types of automobile and driving style modifications in comparison to amputation type are listed in table 4. Of those who returned to driving, 16 (16.2%) required modifications to their vehicles. Left-sided accelerators were required by 12 (12.1%) and hand controls were required by 3 (3.0%) of the participants. In addition, those who previously drove automobiles with manual transmission frequently switched to automatic transmission following amputation. Of the 7 who initially drove standard transmission exclusively, 4 switched to automatic transmission, 3 remained with standard transmission, and 1 began to drive both automatic and manual transmission automobiles. Of the 30 participants who initially drove both standard and automatic transmission vehicles, 23 switched to exclusive driving of automatic transmission and 7 continued to drive both.
Table 4. Car Modifications Among Those Who Returned to Driving
| Modifications | Right Transtibial (n=25) | Right Transfemoral (n=7) | Left Transtibial (n=43) | Left Transfemoral (n=18) | Bilateral (n=6) |
|---|---|---|---|---|---|
| Modifications⁎ | 9(36.0) | 4(57.1) | 1(2.3) | 1(5.6) | 1(16.7) |
| Left-sided accelerator | 9(36.0) | 3(42.9) | 0(0.0) | 0(0.0) | 0(0.0) |
| Hand controls | 0(0.0) | 1(14.2) | 1(2.3) | 0(0.0) | 1(16.7) |
| Other | 0(0.0) | 0(0.0) | 0(0.0) | 1(5.6) | 0(0.0) |
| No modifications | 16(64.0) | 3(42.9) | 42(97.7) | 17(94.4) | 5(83.3) |
| Continued to operate manual transmission | 1/1 | 0/1 | 2/4 | 0/1 | 0/0 |
| Accelerator foot⁎ | |||||
| Right | 10 | 0 | 41 | 18 | 4 |
| Left | 15 | 6 | 1 | 0 | 1 |
| Brake foot⁎ | |||||
| Right | 5 | 0 | 41 | 18 | 3 |
| Left | 20 | 6 | 1 | 0 | 2 |
⁎ P<.001. |
Automobile modifications and driving style modifications were significantly more common in those with right amputations as compared with left amputations (χ3,n=932 test=28.9, P<.001). Overall 13 of 32 (40.6%) with right-sided amputation and 2 of 61 (3.3%) with left-sided amputation elected to have vehicle modifications, while 1 of 6 (17%) with bilateral amputation chose to do so. In addition, among those with unilateral amputation who did not require any car modifications, those with right-sided amputation frequently changed to a left-foot braking style, whereas those with a left-sided amputation did not change driving style (χ2,n=822 test=26.21, P<.001). For this same group, the side of amputation made no difference in terms of accelerator foot preference.
Barriers to Return to Driving
Participants who did not return to driving after their amputation were asked what factors prevented them from returning to driving. Results are presented in table 5. The most common reasons for not returning to drive included, in order of most frequent to least frequent responses: preference not to drive and preference for use of public transportation, lack of confidence and fear of driving, other medical reasons (including poor vision, unstable cardiac disease, stroke, residual limb pain), no license (while having a valid drivers license within 6 months of having the amputation was an inclusion criterion, some subjects would have lost their license at some point after the amputation) or no access to a car or financial difficulties, and told not to drive by family physician or family member.
Table 5. Factors Preventing Return to Driving⁎
| Factors | Total (n=26) |
|---|---|
| Prefer not to drive/prefer public transit | 19 |
| Lack of confidence/fear | 16 |
| Other medical reasons† | 6 |
| No license/no access to car/financial reasons | 7 |
| Told by family member or physician not to drive | 1 |
⁎ Participants were asked to list 1 or more factors that prevented them from returning to driving. |
† Medical reasons include: poor vision, unstable cardiac disease, stroke, and residual limb pain. |
Insurance and Licensing Issues
Only 28 of 123 participants were notified by the automobile licensing authorities that they had to undergo a formal driving assessment if they wished to maintain a valid driver’s license. The jurisdiction in which this study was performed mandates reporting to the authorities of any person who has an impairment that may affect their ability to drive. Whether or not the person is then retested is a decision made by the licensing authorities on an individual basis. Nineteen of the 28 had a right-sided amputation, 4 had left-sided amputation, and 5 had bilateral amputations (χ2,n=1232 test=24.68, P<.001). Twenty of the 28 participants who required a formal driving test went on to perform the test and 19 of 20 passed successfully. Only 2 of 99 who returned to driving reported difficulties obtaining insurance.
Discussion
People with lower-extremity amputation typically have reduced mobility, and return to driving would likely assist in successful community reintegration and independent functioning. A number of factors may potentially influence return to driving, including factors related directly to the physical impairments of amputation and those factors not directly attributable to the amputation.
The driving limitations in people with amputation due strictly to the physical impairments of amputation would likely be secondary to difficulties operating the foot pedals. Proper use of foot pedals is vital for safe automobile driving.7 Examples of potential driving problems in this population include loss of proprioception at the ankle or knee and loss of sensation on foot pedals. This may result in inconsistent pedal pressures, decreased maximum pedal pressures, delayed pedal reaction time, problems secondary to poor positioning in the driver’s seat, and occasional missing of the foot pedals. In addition, unsafe compensatory driving strategies may be used, such as using hands to press or lift the knee in order to operate foot pedals and they may rely on visual cues to switch foot pedals.7 In Ontario and many other Canadian provinces, medical professionals have a legal responsibility to address driving safety in those patients with impairments of function.8 However, several studies that have evaluated the driving safety in those with physical disabilities (including amputation) have demonstrated that driving safety is not compromised provided that the correct vehicle adaptations are made.9, 10, 11
Driving limitations may also occur that are not directly attributable to the amputation. Amputation in western society commonly is associated with other medical conditions such as diabetes and atherosclerosis that may result in secondary impairments (ie, diabetic retinopathy, peripheral neuropathy, stroke, cardiovascular disease) that may negatively influence driving ability. In addition people with amputation often are unable to return to work12 after amputation and may have financial restrictions that may limit driving.
Previous studies2, 3, 4, 5 have shown that 51% to 87% of people with major lower-extremity amputation return to driving after amputation but, apart from reporting this, they did not examine driving habits in any detail. The factors that influence the return to driving following amputation were not addressed by any of these studies. Fernandez et al6 reported in detail the driving performance of juvenile onset amputees living in Spain. Only people with unilateral amputations were studied and the majority had an amputation due to a traumatic event or a congenital cause. Participants included in the Fernandez study did not have their driver’s license prior to their amputation. Of the 189 people with lower-limb amputations, only 41.8% drove. Interestingly, the side of amputation did not affect the capacity to drive. About half (48.1%) of these drivers had a right amputation. Regarding the level of amputation, approximately a third (34.2%) of the drivers had a transfemoral amputation. The population studied required a number of vehicle modifications. The major adaptation was the shift from a manual gearbox to an automatic one. There were no specific comments about other vehicle modifications. A number of key issues were not addressed by this study. These include the frequency of driving and reasons for not driving among the nondrivers. This study is not generalizable to the majority of people with lower-extremity amputation in North America, who in general are older adults with other medical comorbidities,13, 14, 15 and the norm in North America is to have automatic transmissions.
We were unable to identify any recent publications with respect to return to driving after amputation.
In our cross-sectional study, the majority of participants required an amputation due to peripheral vascular disease. Our sample is likely a fairly typical representation of major lower-extremity amputees who are prosthetic users in western society.13, 14, 15 Because participants were recruited for this study from a clinic that specializes in prosthetic management, this study was unable to evaluate those who were not prosthetic users.
Despite the potential difficulties of operating an automobile while wearing a prosthesis, the majority of the participants seemed to return to driving after amputation. Overall, 80.5% returned to automobile driving, on average 3.8 months after their amputation. The retained ability to drive likely represents considerable increase in independence and autonomy.
Factors identified to be positive predictors of return to driving include younger current age, younger age at the time of amputation, male sex, increased preamputation driving frequency, and left-sided amputation. These findings were not surprising, because increased age is generally associated with increased disability, those who drive more frequently prior to their amputation are likely more motivated to drive after amputation, and the right foot is traditionally used to operate the foot pedals. It is not clear to us why men are more likely to return to driving after amputation.
Interestingly, there is no statistically significant association between amputation level and return to driving. It was expected that those with transfemoral amputation would have decreased return to driving rates as compared to those with a transtibial amputation because they tend to have increased illness severity,16 decreased functional ability,15, 17, 18 and decreased life expectancy.15, 16, 19 However, the lack of association between amputation level and return to driving may be explained by the finding that most resume driving using the intact foot on the pedals, thus making the amputation level irrelevant. In addition, the lack of association in this study may also be influenced by a selection bias. As compared with subjects with a transtibial amputation, those with a transfemoral amputation are less likely to continue with prosthetic ambulation,18, 20, 21, 22 and because this study involved only prosthetic users, the lower functioning transfemoral group may not be well represented.
A trend was detected toward decreased return to driving rates in those participants with peripheral vascular disease (vs trauma or tumor), and diabetics (vs nondiabetics). These differences did not reach statistical significance.
Due to the typical driving style of operating foot pedals with the right foot only, it is not surprising to note that those with right-sided amputation have more difficulties returning to driving than left-sided. They returned to driving less frequently (72.2% vs 89.7%) and required vehicle modifications more often (40.6% vs 3.3%) than the participants with left-sided amputation.
A small number of participants reported that they had not used their right foot exclusively for operating the brake and accelerator prior to their amputation; the reasons for this were not addressed in this study.
Vehicle modifications, as expected, were generally unnecessary with left-sided amputation (unless their vehicles had a standard transmission). Despite the typical preamputation right-foot driving style, 59.4% of those with right amputation (19/32) did not elect to have foot pedal modifications when they returned to driving. Of those with right-sided amputation who did not modify their foot pedals, 60.0% (15/25) chose to adopt a left foot driving style and 40.0% (10/25) learned to control the foot pedals with their prosthesis. It was also noted that no one with right transfemoral amputation continued to drive with a right foot accelerator style.
Because this study did not look at the type of prosthesis that the participants had been using, no comments can be made with respect to prosthetic componentry and return to driving.
Those who do return to driving report a decrease in driving frequency after their amputation. It is unclear how much of this can be attributed to lack of desire to drive, lack of desire to perform community activities, and/or allowing others (ie, family members) to drive them. The majority of participants in our study had full access to public transportation. This may also play a role in the decreased frequency of driving postamputation.
Twenty percent (24/123) of the participants in our study did not return to driving. A number of barriers were identified by these subjects, as shown in table 5. The majority preferred not to return to driving after their amputation or preferred to use public transportation (19 responses). Lack of confidence and fear were also common. Other factors included medical conditions such as poor vision, unstable cardiac disease, stroke, and residual limb pain. Interestingly 1 person was told by their family physician not to return to driving and 1 person was prevented from driving by their family. Therefore it seems that most common barriers preventing a return to driving are not directly related to their amputation but are psychologic and medical in nature.
The Canadian Medical Association guidelines state “People who have an amputation below the knee of one or both legs are usually able to drive any class of motor vehicle safely…. These patients must demonstrate their ability to drive to the satisfaction of the driver examiner.”23(p64) Despite our policy of notifying the licensing authorities of all subjects with right-sided amputation, only 22.8% were instructed to take a formal driving test by the Ontario Ministry of Transportation. Nineteen of 20 participants who went on to take the test passed successfully. Obtaining insurance did not appear to be a significant issue because only 2 of 99 drivers reported difficulty obtaining insurance following their amputation.
As illustrated by this study, the majority of subjects with amputation, with demographic characteristics described in this study, return to driving without performing modifications to their vehicles. This study was not designed to determine the safety of driving postamputation, what type(s) of vehicle they should be allowed to drive, what vehicle modifications should be recommended (if any), and what (if any) restrictions should be imposed. Further research is needed in this area before specific recommendations can be made. Until further research is available it seems appropriate that evaluation is performed on an individual basis and if any concerns exist about driving safety a formal driving evaluation should be recommended.
This study was conducted at 1 institution and there would be a degree of selection bias, with respect both to which subjects with amputation were accepted into the rehabilitation program and, second, to selection bias that may occur when a convenience sample is being recruited. As such, the results of this study may not be generalizable to other populations with amputation, if the patient characteristics are not similar to the group described in this study. The jurisdiction in which one lives, and the laws or regulations that exist in any particular jurisdiction, may also limit the generalizability of these results.
Conclusions
The majority of prosthetic users with major lower-extremity amputations (80.5%) are able to return to automobile driving an average of 3.8 months after amputation. Predictors that negatively influence return to driving include current age, age at time of amputation, years since amputation, female sex, right-sided amputation, and decreased preamputation driving frequency. Those that do not return to driving cite preference not to drive, lack of confidence or fear, and related medical reasons (poor vision, cardiac disease, stroke, pain) as common barriers. Those with left-sided amputation have significantly less concerns regarding driving, while those with right-sided amputation frequently require vehicle modifications (40.6%) or switch to a left-foot driving style for braking (81.3%) and accelerating (65.6%).
Suppliers
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- a Version 12.0; SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.Reprints are not available from the author.
PII: S0003-9993(06)00521-1
doi:10.1016/j.apmr.2006.06.001
© 2006 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Volume 87, Issue 9 , Pages 1183-1188, September 2006
