多发性硬化症患者道路驾驶的影响因素

Determinants of On-Road Driving in Multiple Sclerosis.

作者信息

Devos Hannes, Ranchet Maud, Backus Deborah, Abisamra Matt, Anschutz John, Allison C Dan, Mathur Sunil, Akinwuntan Abiodun E

机构信息

Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS; Department of Physical Therapy, College of Allied Health Sciences, Augusta University, Augusta, GA.

Department of Physical Therapy, College of Allied Health Sciences, Augusta University, Augusta, GA; French Institute of Science and Technology for Transport, Development and Networks (IFSTTAR), Laboratory of Ergonomic and Cognitive Sciences for Transports (TS2-LESCOT), Bron, France.

出版信息

Arch Phys Med Rehabil. 2017 Jul;98(7):1332-1338.e2. doi: 10.1016/j.apmr.2016.10.008. Epub 2016 Nov 10.

DOI:10.1016/j.apmr.2016.10.008

PMID:27840131

Abstract

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 R=.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 R=.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 R=.41). The visuo-integrative model (unadjusted R=.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 R=.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.

摘要

目的

研究多发性硬化症（MS）患者在道路驾驶不同维度上表现不佳背后的认知、视觉和运动缺陷。

设计

前瞻性横断面研究。

设置

MS诊所和驾驶模拟器实验室。

参与者

患有各种类型MS的活跃驾驶员（N = 102）。

干预措施

不适用。

主要观察指标

越野认知、视觉和运动功能，以及13项特定驾驶技能。这些技能被分类为操作、战术、视觉整合和混合驾驶的层次集群。采用逐步回归分析来确定影响道路测试及每个集群表现的越野功能。

结果

视觉空间功能（P = 0.002）、抑制能力（P = 0.008）、双眼视力（P = 0.04）、垂直视野（P = 0.02）和立体视（P = 0.03）最能确定道路总得分的方差（未调整R = 0.37）。注意力转移（P = 0.0004）、立体视（P = 0.007）、眩光恢复（P = 0.047）和辅助设备的使用（P = 0.03）最能预测操作集群（未调整R = 0.28）。视觉空间功能（P = 0.002）、抑制能力（P = 0.002）、推理能力（P = 0.003）、双眼视力（P = 0.04）和立体视（P = 0.005）最能确定战术集群（未调整R = 0.41）。视觉整合模型（未调整R = 0.12）包括双眼视力（P = 0.007）和立体视（P = 0.045）。抑制能力（P = 0.0001）和双眼视力（P = 0.001）提供了混合集群的最佳模型（未调整R = 0.25）。