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

Abstract Objective 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 seven 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—highest to Class IV—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, two Class III and four Class IV driving simulator studies employed twenty-four clinical assessments with Level C ( n =4) or Level U ( n =20) confidence for predicting driving performance. Six Class II and three Class IV on-road studies employed thirty-five clinical assessments with Level B ( n =9), Level C ( n =22), or Level U ( n =4) confidence for predicting fitness to drive. Conclusions 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™ 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.