Screening Fitness to Drive After Stroke Across Demographic Subgroups: A Systematic Review.

The review only included studies that used a pass/fail outcome on a driving test, so research that measured driving performance on a scale was left out. The authors note this may be why some tests were graded C rather than higher. No meta-analysis was done and safe-driving cut-off points could not be updated; the best cut-point data still come from an earlier review (Devos et al., 2011). Studies with mixed diagnostic groups were excluded unless stroke results were reported separately, so relevant work with other conditions such as dementia was not considered. Most participants were assessed about 12 months after their stroke, so the review says little about screening in the first year, when return-to-drive decisions are often made on leaving acute care or rehabilitation. Google Translate was used for some non-English studies, which can distort the detail extracted from them. Most included studies did not report cut points, and demographic reporting was too sparse to apply frameworks like ECLECTIC to clinical practice.

The authors declared no potential conflicts of interest with respect to the research, authorship or publication of the article, and received no financial support for it.

Do not read the Grade A rating for the SDSA as proof it works for the patient in front of you. The grade reflects how consistent the studies were, not who they included: the samples were over 80% men, mostly over 58, and almost all from high-income countries, and most studies did not report their participants' race, language or education. That evidence has not been shown to hold for women, younger patients, or people from racialized communities.