Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
Neurorehabil Neural Repair. 2010 Nov-Dec;24(9):843-50. doi: 10.1177/1545968310368687. Epub 2010 Jul 23.
No long-term studies have been reported on the effect of training programs on driving after stroke.
The authors' primary aim was to determine the effect of simulator versus cognitive rehabilitation therapy on fitness-to-drive at 5 years poststroke. A second aim was to investigate differences in clinical characteristics between stroke survivors who resumed and stopped driving.
In a previously reported randomized controlled trial, 83 stroke survivors received 15 hours of simulator training (n = 42) or cognitive therapy (n = 41). In this 5-year follow-up study, 61 participants were reassessed. Fitness-to-drive decisions were obtained from medical, visual, neuropsychological, and on-road tests; 44 participants (simulator group, n = 21; cognitive group, n = 23) completed all assessments. The primary outcome measures were fitness-to-drive decision and current driving status.
The authors found that 5 years after stroke, 18 of 30 participants (60%) in the simulator group were considered fit to drive, compared with 15 of 31 (48%) in the cognitive group (P = .36); 34 of 61 (56%) participants were driving. Current drivers were younger (P = .04), had higher Barthel scores (P = .008), had less comorbidity (P = .01), and were less severely depressed (P = .02) than those who gave up driving.
The advantage of simulator-based driving training over cognitive rehabilitation therapy, evident at 6 months poststroke, had faded 5 years later. Poststroke drivers were younger and less severely affected and depressed than nondrivers.
目前尚未有研究报道针对脑卒中后驾驶能力训练方案的长期效果。
本研究旨在确定脑卒中后 5 年时，模拟器训练与认知康复疗法对驾驶适宜性的影响，并探讨恢复和停止驾驶的脑卒中幸存者之间的临床特征差异。
在先前报道的一项随机对照试验中，83 例脑卒中幸存者接受了 15 小时的模拟器训练（n = 42）或认知疗法（n = 41）。在本 5 年随访研究中，对 61 例患者进行了重新评估。驾驶适宜性决策来自于医学、视觉、神经心理学和路考测试；44 例患者（模拟器组，n = 21；认知组，n = 23）完成了所有评估。主要结局指标为驾驶适宜性决策和当前驾驶状态。
研究发现，脑卒中后 5 年时，模拟器组 30 例患者中有 18 例（60%）被认为具备驾驶适宜性，而认知组 31 例患者中有 15 例（48%）（P =.36）；61 例患者中有 34 例（56%）仍在驾驶。当前驾驶员更年轻（P =.04）、巴氏量表评分更高（P =.008）、合并症更少（P =.01）、抑郁程度更低（P =.02）。
脑卒中后 6 个月时，基于模拟器的驾驶训练比认知康复疗法具有优势，但 5 年后这种优势已消失。脑卒中后驾驶员比非驾驶员更年轻，受影响程度更轻，抑郁程度更低。
