Abstract
Objective
Describe who is able to return to driving (RTD) after moderate-to-severe traumatic
brain injury (TBI), when this occurs, who maintains that activity, and the association
with outcome.
Design
Cross-sectional descriptive study.
Setting
Eight follow-up sites of the TBI Model Systems (TBIMS) program.
Participants
618 participants enrolled in the TBIMS and 88 caregivers (N=706).
Interventions
Not applicable.
Main Outcome Measures
A survey was completed from 1-30 years postinjury focusing on RTD. Descriptors included
demographic information, injury severity, and current employment status. Outcome was
assessed at the time of the interview, including depression, quality of life, functional
status, and community participation.
Results
Of 706 respondents, 78% (N = 552) RTD, but 14% (N = 77) of these did not maintain
that activity. Of those who RTD, 43% (N = 192) did so within 6 months of the injury
and 92% did so within 24 months postinjury. The percentage of people driving after
TBI did not differ significantly based on age at time of injury or follow-up. There
were significant differences between drivers and nondrivers with respect to severity
of injury, seizures, race, education, employment, rural vs urban setting, marital
status, and family income. We performed a multivariate logistic regression to examine
the association between driving status and demographic variables, adjusting for other
variables in the model. The strongest associations were with current employment, family
income, race, seizures, and severity of injury. Driving was associated with greater
community participation, better functional outcomes, fewer symptoms of depression,
and greater life satisfaction.
Conclusions
Over a span of 30 years, three-quarters of people experiencing moderate-to-severe
TBI return to driving a personal vehicle, although not everyone maintains this activity.
Employment, race, family income, and seizures are strongly associated with RTD.
Keywords
List of abbreviations:
GOS-E (Glasgow Outcome Scale-Extended), IRF (inpatient rehabilitation facility), PART-O (Participation Assessment with Recombined Tools-Objective Scale), PHQ-9 (Patient Health Questionnaire-9), RTD (return to driving), SWLS (Satisfaction With Life Scale), TBI (traumatic brain injury), TBIMS (TBI Model Systems), TFC (time to follow commands)To read this article in full you will need to make a payment
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References
- Barriers to driving and community integration after traumatic brain injury.J Head Trauma Rehabil. 2006; 21: 34-44
- Driving and community integration after traumatic brain injury.Arch Phys Med Rehabil. 2008; 89: 922-930
- Examining driving and participation 5 years after traumatic brain injury.OTJR (Thorofare N J). 2018; 38: 143-150
- Return to driving within 5 years of moderate-severe traumatic brain injury.Brain Inj. 2010; 24: 464-471
- Driving following traumatic brain injury: prevalence, exposure, advice and evaluations.Brain Inj. 1998; 12: 683-695
- Acquired brain damage and driving: a review.Arch Phys Med Rehabil. 1987; 68: 697-705
- Predictors of on-road driver performance following traumatic brain injury.Arch Phys Med Rehabil. 2015; 96: 440-446
- Predictors of the on-road driving assessment after traumatic brain injury: comparing cognitive tests, injury factors, and demographics.J Head Trauma Rehabil. 2016; 31: E44-E52
- UFOV performance and driving ability following traumatic brain injury.Brain Inj. 2006; 20: 455-461
- Factors influencing driving 10 years after brain injury.Brain Inj. 2008; 22: 295-304
- Cognitive and personality determinants of post-injury driving fitness.Arch Clin Neuropsychol. 2010; 25: 99-117
- Predictors of driving outcome after traumatic brain injury.Arch Phys Med Rehabil. 2002; 83: 1415-1422
- Evaluating fitness to drive after cerebral injury: basic issues and recommendations for medical and legal communities.J Head Trauma Rehabil. 2000; 15: 895-908
- Traumtic brain injury and driving assessment: an evidence-based literature review.Am J Occup Ther. 2009; 63: 580-591
- Predictors of driving avoidance and exposure following traumatic brain injury.J Head Trauma Rehabil. 2014; 29: 185-192
- Older drivers and cataract: driving habits and crash risk.J Gerontol A Biol Sci Med Sci. 1999; 54: M203-M211
- Development of the Adelaide Driving Self-Efficacy Scale.Clin Rehabil. 2007; 21: 56-61
- Return to driving after severe traumatic brain injury: increased risk of traffic accidents and personal responsibility.J Head Trauma Rehabil. 2012; 27: 210-215
- Summary of travel trends: 2009 National Household Travel Survey.Washington, D.C.: Federal Highway Administration, 2011
- Prediction of functional outcomes after traumatic brain injury: a comparison of 2 measures of duration of unconsciousness.Arch Phys Med Rehabil. 2001; 82: 1355-1359
- Validity of the Patient Health Questionnaire-9 in assessing depression following traumatic brain injury.J Head Trauma Rehabil. 2005; 20: 501-511
- The Satisfaction With Life Scale.J Pers Assess. 1985; 49: 71-75
- Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use.J Neurotrauma. 1998; 15: 573-585
- Another look at the PART-O using the Traumatic Brain Injury Model Systems National Database: scoring to optimize psychometrics.Arch Phys Med Rehabil. 2016; 97: 211-217
- Summary of travel trends: 2017 National Household Travel Survey.Federal Highway Administration, Washington, D.C.2018
- Nonparametric estimations from incomplete observations.J Am Stat Assoc. 1958; 53: 457-481
- Multiple imputation after 18+ years.J Am Stat Assoc. 1996; 91: 473-489
R Core Team. R: a language and environment for statistical computing. Available at:https://www.R-project.org/. Accessed March 17, 2021.
- Modeling survival data: exending the Cox model.Springer, New York2000
Therneau TM. A package for survival analysis in S. version 2.38. Available at:https://CRAN.R-project.org/package=survival/. Accessed March 17, 2021.
- mice: multivariate imputation by chained equations in R.J Stat Softw. 2011; 45: 1-67
- Return to driving after head injury.J Neurol Neurosurg Psychiatry. 2001; 70: 761-766
- Race and insurance disparities in discharge to rehabilitation for patients with traumatic brain injury.J Neurotrauma. 2013; 30: 2057-2065
- Predictors of follow-up completeness in longitudinal research on traumatic brain injury: findings from the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Program.Arch Phys Med Rehabil. 2014; 95: 633-641
Article info
Publication history
Published online: March 07, 2021
Accepted:
February 4,
2021
Received in revised form:
February 2,
2021
Received:
September 27,
2020
Footnotes
Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research, Administration of Community Living (grant nos. 90DPTB0015, 90DPTB0006, 90DPTB0004, 90DPTB00070, 90DPTB0014, 90DPTB0008, 90DPTB0005, 90DPTB0012).
Disclosures: None
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
