Taking the Wheel: A Comprehensive Investigation of Clinician and Client Needs to Support Driving After Stroke

The purpose of this dissertation was to undertake a comprehensive study of driving restriction after stroke, from both clinical and client perspectives with attention to subgroup representation. This dissertation is comprised of three studies, presented in three manuscripts. Study 1 (Chapter 2) investigated the efficacy of a practice resource to support occupational therapists in addressing driving after stroke in the acute care setting. Study 2 (Chapter 3) examined the published predictive validity of screening tools for fitness to drive after stroke and the representation of demographic subgroups in the extant literature. Study 3 (Chapter 4) explored the driving restriction and community mobility experiences of young women (aged 55 years and younger), an unrepresented group in stroke and driving research. Results from Study 1 provide preliminary experimental evidence that the Practice Resource for Addressing Driving After Stroke (PReDAS) supported clinical practice among occupational therapists. The findings revealed a large treatment effect of the PReDAS for improving clinical reasoning and self-efficacy for addressing driving (Combined Tau-U = 0.70 and 0.90, respectively). In Study 2, the screening tests with the highest level of evidence and consistency of findings for fitness to drive screening were the Stroke Driver’s Screening Assessment and Trail Making Test-B. However, within this body of research, younger women and people from lower income countries are underrepresented (21% women, 61.6± 5 average age, 99% live in high income countries) and few studies reported detailed demographic information to provide context for the findings. Informed by transactional perspectives, Study 3 revealed driving restriction after stroke among young women is a significant disruption due to driving’s instrumental role in enabling participation. Women experienced significant psychological pain from driving restriction, compounded by the sudden and unexpected onset at their age. The women sought out social support, advocated for policy changes, and enacted agency to navigate driving restriction. The unique characteristics of the women and their contexts interacted and deeply shaped experiences of driving restriction. Together, these findings represent a comprehensive investigation to inform how to support both clinicians and clients navigating driving restriction after stroke and will inform further revision and research of the PReDAS.