Clinical Determinants of Fitness to Drive in Persons With Multiple Sclerosis: Systematic Review

Published:January 25, 2019DOI:



      To critically appraise the evidence for the clinical determinants of fitness to drive in adults with multiple sclerosis (MS).

      Data Sources

      The research librarian and lead author searched 7 databases for driving simulator and on-road studies for adults with MS published in the English language from 1991 to 2018.

      Study Selection

      Three reviewers independently screened titles, abstracts, and full-texts for studies with: cohort, case-control, or cross-sectional designs; participants, 18 years or older, with relapsing or progressive MS; visual, cognitive, or motor clinical assessments as predictors; and driving performance through simulator or fitness to drive through on-road assessment as outcomes.

      Data Extraction

      Using the 2017 American Academy of Neurology guidelines, reviewers independently classified each study from class I to class IV, or highest to lowest amount of rigor. For each clinical assessment, reviewers independently rated the level of confidence for predicting driving performance or fitness to drive from level A, highly probable; B, probable; C, possible; to level U, insufficient conclusions.

      Data Synthesis

      Through qualitative synthesis, 2 class III and 4 class IV driving simulator studies employed 24 clinical assessments with level C (n=4) or level U (n=20) confidence for predicting driving performance. Six class II and 3 class IV on-road studies employed 35 clinical assessments with level B (n=9), level C (n=22), or level U (n=4) confidence for predicting fitness to drive.


      This systematic review identified mostly insufficient conclusions for predicting driving performance in driving simulator studies, and possible conclusions for predicting fitness to drive in on-road studies. The best available evidence suggests that the Stroke Driver Screening Assessment and Useful Field of View test probably predict fitness to drive in adults with MS (level B). Class I studies that compare predictors of fitness to drive with large prospective samples of adults with and without MS are necessary for highly probable conclusions.


      List of abbreviations:

      AAN (American Academy of Neurology), EDSS (Expanded Disability Status Scale), MS (multiple sclerosis), 9HPT (Nine-Hole Peg Test), PASAT (Paced Auditory Serial Addition Test), SDSA (Stroke Driver Screening Assessment), SPIDER (Systematic Process for Investigating and Describing Evidence-Based Research tool), T25W (Timed 25-Foot Walk Test), UFOV (Useful Field of View test)
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