Establishing an evidence-base framework for driving rehabilitation in Parkinson's disease: A systematic review of on-road driving studies

Abstract

BACKGROUND: Individuals with Parkinson's disease (PD) experience problems with on-road driving that can be targeted in driving rehabilitation programs. OBJECTIVE: To provide a framework for driving rehabilitation in PD by identifying the critical on-road driving impairments and their associated visual, cognitive, and motor deficits. METHODS: We conducted a systematic review of the literature on on-road driving and naturalistic driving practices in PD. Relevant databases including Pubmed, Medline, PsychINFO, ISI Web of Science, Cochrane library, and ClinicalTrials.gov, were reviewed using the key words Parkinson's disease, on-road driving, naturalistic driving, and their related entry words. On-road driving skills were mapped onto an existing theoretic model of operational, tactical, and strategic levels. The on-road and off-road cognitive, motor, and visual predictors of global on-road driving were summarized. RESULTS: Twenty-seven studies were included. All but one study were prospective and Class II studies according to the American Academy of Neurology Classification Criteria. Participants were on average 68 years old and in the mild to moderate stages of PD. Drivers with PD were more likely to fail a driving assessment compared to age- and gender-matched controls. Compared with controls, drivers with PD experienced difficulties on all levels of driving skill. However, the compensation strategies on the strategic level showed that drivers with PD were aware of their diminished driving skills on the operational and strategic levels. Operational and tactical on-road driving skills best predicted global on-road driving. A combination of visual, cognitive, and motor deficits underlie impaired on-road driving performance in PD. CONCLUSION: Driving rehabilitation strategies for individuals with PD should include training of operational and tactical driving skills or indirect comprehensive training program of visual, cognitive, and motor skills.