Driving Status and Community Integration After Stroke

Abstract

Background and Purpose: Driving a motor vehicle is an essential activity of daily living for adults; however, few studies have examined the effects of driving cessation on community integration among stroke survivors. The present study investigated this relationship as well as social support and gender as potential moderators of outcome. Method: Ninety pairs of stroke survivors and informants participated. Objective community integration (mobility, occupation, social integration) was assessed via informant ratings, whereas subjective community integration and social support were assessed via self-report. These poststroke outcomes were compared for survivors who did and did not resume driving post stroke. Results: Multivariate analysis of covariance (MANCOVA) indicated that drivers were more mobile and made more productive use of their time than did non-drivers, even after accounting for stroke severity and use of alternative transportation. Two interaction effects were observed: Drivers with high social support showed better community integration than did non-drivers and drivers with low social support. Additionally, among men, non-drivers fared substantially worse than drivers, whereas among women, drivers and non-drivers showed equivalent community integration. Conclusion: Driving status has unique and substantial influence on community integration following stroke. Social support facilitated community integration but did not substantially buffer the effects of driving cessation. Although men and women resumed driving at equal rates, driving cessation showed differential effects for men and women in regard to their community integration. Research is needed to design interventions that promote full engagement in community living among persons who cease driving after stroke.

Keywords:

• community integration
• driving
• gender differences
• social support
• stroke