Does aphasia impact on return to driving after stroke? A scoping review

Figures & data

Figure 1. PRISMA flowchart [70]: Source selection processes and reasons for exclusion.

A flowchart showing the source selection processes. Sources are separated into those identified via databases and registers and those identified via other methods. Information is displayed across the following phases: identification, screening and included.

Table 1. Source characteristics.

Reference	Country	Type of evidence	Type of publication	Research design	Aim	Participants	MMAT	Obj. 1 n = 38	Obj. 2 n = 21
Research specifically investigating return to driving with aphasia (n = 6)
Donovan et al. [71]	USA	Primary	Government research report	Quantitative non-randomized	To investigate aphasia’s effect on road sign interpretation accuracy and response time	n = 20 (a) + (b) 10 post-stroke with aphasia; (c) 10 neurologically normal controls	✓	✓	✓
Golper et al. [72]	USA	Primary	Full-text article	Quantitative non-randomized	(1) To analyse the self-judgement of driving competency in PWA; (2) to determine which tasks were most predictive of the overall team recommendation regarding returning to driving.	n = 20 (a) + (b) 20 post-stroke with aphasia	✓	✓	✓
Hartje et al. [73]	Germany	Primary	Full-text article	Quantitative non-randomized	To compare performance in a practical driving examination with performance in standardised neuropsychological tests for people with and without aphasia after acute neurological impairment.	n = 65 post-stroke/TBI (a) 53 post-stroke; (b) 34 PWA post-stroke; 2 PWA post-TBI.	✓	✓	✓
Lebrun et al. [74]	The Netherlands	Primary	Book chapter	Quantitative non-randomized	To determine the road sign interpretation skills of PWA.	n = 25 (a) 21 post-stroke; (b) 14 PWA; (c) 4 neurologically normal controls	✓	✓	✓
Mackenzie and Paton [76]	UK	Primary	Full-text article	Mixed methods	(1) To determine views and practice of medical practitioners and aphasia therapists on return to driving with aphasia post-stroke and the experience and effects for aphasic people of resuming or not resuming driving. (2) To compare the road sign recognition ability of PWA with a comparable non-stroke population.	n = 65 (a) + (b) 18 post-stroke with aphasia; (c) 18 neurologically normal controls; (d) 11 medical practitioners, 18 SLTs	✓	✓	✓
Matsko et al. [75]	USA	Primary	Conference poster abstract	Quantitative non-randomized	To explore the use of a numerical communication scoring system and simulated driving exercise as predictors of driving skill in an adult communication impaired stroke population.	n = 25 (a) 25 post-stroke with communication impairments; (b) PWA included but number not specified	✓	✓
Incidental findings/research evidence from the broader literature (n = 29)
Akinwuntan et al. [105]	Belgium	Primary	Full-text article	Quantitative non-randomized	To identify variables that best predict a team’s decision of driving ability in stroke patients from a pre-driving assessment.	n = 104 (a) 104 post-stroke; (b) 16 PWA	✓	✓
Aslaksen et al. [85]	Norway	Primary	Full-text article	Quantitative non-randomized	To examine the predictive value of standardized neuropsychological tests to predict on-road driving performance in patients with cerebral stroke or TBI, and to provide cut-off values.	n = 78 (a) 55 post-stroke; (b) LHD included but PWA not specified	✓	✓
Berger and Mensh [94]	USA	Primary	Full-text article	Qualitative	To use the experiences of a PWA to provide a guide for rehabilitation professionals.	n = 1 post-stroke with aphasia	✓	✓
Bliokas et al. [86]	Australia	Primary	Full-text article	Quantitative non-randomized	To evaluate the ability of a neuropsychological assessment battery to predict on-road outcome measures and explore relationships between individual neuropsychological tests and driving performance in individuals with acquired cognitive impairment.	n = 104 (a) 61 post-stroke; (b) PWA not specified	✓	✓	✓
Breen [92]	USA	Primary	Conference poster abstract	Quantitative descriptive	To investigate the characteristics and rehabilitation outcomes of stroke survivors who return to work.	n = 190 (a) 190 post-stroke; (b) PWA included but number not specified	✓	✓
Breen et al. [91]	USA	Primary	Conference poster abstract	Quantitative descriptive	To investigate the cost, length of treatment and characteristics of stroke survivors returning to work.	n = 96 (a) 96 post-stroke; (b) PWA included but number not specified	✓	✓
Breen et al. [90]	USA	Primary	Conference poster abstract	Quantitative descriptive	To investigate the frequency and characteristics of stroke survivors returning to work.	n = 96 (a) 96 post-stroke; (b) PWA included but number not specified	✓	✓
Fields and Unsworth [17]	Australia	Secondary	Full-text article	Systematic review	To identify the evidence base for including assessment of cognitive and perceptual skills within fitness-to-drive evaluations.	N/A		✓
Franklin et al. [18]	Ireland	Primary	Full-text article	Qualitative	To derive the shared top 10 research priorities of PWA, their carers and SLTs.	Survey n = 46 (a) + (b) 21 PWA; (d)18 SLTs; (e) 7 carers Consensus meeting n = 22 (a) + (b) 10 PWA; (d) 9 SLTs; (e) 3 carers	✓		✓
Howe et al. [95]	Australia	Primary	Full-text article	Qualitative	To explore the environmental factors that hinder or support the community participation of adults with aphasia.	n = 25 (a) + (b) 25 post-stroke with aphasia	✓	✓	✓
Kato et al. [93]	Unknown	Primary	Conference poster abstract	Quantitative descriptive	To introduce a drive recorder system as an evaluation tool for driving ability in real-life situations for stroke patients.	n = 3 (a) 3 post-stroke; (b) 1 PWA	✓	✓
Kerr et al. [116]	UK	Primary	Full-text article	Qualitative	To determine information needs and structure for a website about living with stroke.	n = 12 (a) 12 post-stroke; (b) 5 PWA	✓		✓
Lundqvist et al. [117]	Sweden	Primary	Full-text article	Quantitative non-randomized	To describe a model and clinical guidelines for determining driving fitness for patients with cognitive dysfunction in a rehabilitation setting.	n = 43 (a) 18 post-stroke; (b) PWA included but number not specified	✓		✓
Marino et al. [81]	Italy	Secondary	Full-text article	Systematic review	To identify and summarize scientific findings concerning the relationship between neuropsychological and clinical screening tests and fitness to drive in chronic conditions.	N/A		✓
Marshall et al. [3]	Canada	Secondary	Full-text article	Systematic review	To identify the most consistent predictors of driving ability post stroke.	N/A		✓
McCabe et al. [80]	Canada	Secondary	Full-text article	Systematic review	To evaluate interventions and strategies for community reintegration following brain injury.	N/A		✓
McKevitt et al. [96]	UK	Primary	Full-text article	Quantitative descriptive	To estimate the prevalence of self-reported need in community-dwelling stroke survivors across the UK.	n = 799 (a) 799 post-stroke (b) PWA not specified, but people with self-reported communication problems included.	✓	✓	✓
Nouri and Lincoln [83]	UK	Primary	Full-text article	Quantitative non-randomized	To validate a cognitive test battery, previously found to be predictive of on-road driving performance.	n = 40 (a) 40 post-stroke; (b) LHD damage included but PWA not specified	✓	✓
Nouri [104]	UK	Primary	Full-text article	Quantitative descriptive	To examine the knowledge and opinions of GPs on fitness to drive after a stroke.	n = 155 (d) 155 GPs	✓	✓	✓
Nouri et al. [82]	UK	Primary	Full-text article	Quantitative non-randomized	To produce a cognitive screening assessment to identify which post-stroke drivers would be safe to be assessed on the road.	n = 39 (a) 39 post-stroke; (b) LHD damage included but PWA not specified	✓	✓	✓
Perumparaichallai et al. [84]	USA	Primary	Full-text article	Quantitative non-randomized	To evaluate the cognitive and driving outcomes of a neurorehabilitation program and to examine the relationship between neuropsychological variables and driving outcomes.	n = 128 (a) 36 post-stroke; (b) PWA not specified	✓	✓
Phan et al. [107]	Australia	Primary	Conference poster abstract	Quantitative non-randomized	To discover patterns which lead clinicians to request driving tests after stroke.	n = 82 (a) 82 post-stroke; (b) 27 PWA	✓	✓
Radford and Lincoln [89]	UK	Primary	Full-text article	Quantitative non-randomized	To determine the concurrent validity of the Stroke Drivers Screening Assessment (SDSA).	n = 93 (a) 93 post-stroke; (b) PWA included but number not specified	✓	✓	✓
Rohde et al. [115]	Australia	Primary	Full-text article	Qualitative	To identify similarities and differences between client and therapist goals in rehabilitation for people with aphasia and explore reasons for any differences.	n = 7 (a) + (b) 4 post-stroke with aphasia; (d) 3 SLTs	✓		✓
Sagar et al. [88]	Australia	Primary	Conference poster abstract	Quantitative non-randomized	Exploration of the relationship between a patient’s initial stroke severity score (National Institute of Health Stroke Score/NIHSS) and passing driving test.	n = 81 (a) 81 post-stroke (b) PWA included but number not specified	✓	✓
Schanke and Sundet [87]	Norway	Primary	Full-text article	Quantitative non-randomized	To investigate the correspondence between neuropsychological test results and on-road driving performance among patients with a CT-verified brain damage or documented neurological disorder.	n = 55 (a) 43 post-stroke; (b) 18 PWA	✓	✓
Sjöqvist Nätterlund [114]	Sweden	Primary	Full-text article	Qualitative	To describe aphasic individuals’ experiences of everyday activities and social support in daily life.	n = 20 (a) + (b) 20 post-stroke with aphasia	✓		✓
Stack et al. [50]	Ireland	Primary	Full-text article	Quantitative descriptive	To investigate occupational therapy evaluation practices for fitness to drive after stroke in Ireland.	n = 47 (d) 47 OTs	✓	✓
Sundet et al. [106]	Norway	Primary	Full-text article	Quantitative non-randomized	To identify which neuropsychological measures are prioritised in the decision-making process regarding fitness to drive and to establish cut-off scores for sensitive tests.	n = 72 (a) 72 post-stroke; (b) 20 PWA	✓	✓
Commentary or statement of opinion (n = 8)
Bryer et al. [98]	USA	Commentary/review	Book chapter	N/A	Clinical text on “Driver rehabilitation and community mobility”.	N/A		✓	✓
Finestone and Gershkoff [99]	USA	Commentary/review	Book chapter	N/A	Clinical text on “Driving after stroke”.	N/A		✓	✓
Gershkoff and Finestone [100]	USA	Commentary/review	Book chapter	N/A	Clinical text on “Driving after stroke”.	N/A		✓	✓
Marx et al. [102]	Germany	Commentary/review	Full-text article	N/A	To provide a guideline for the assessment of driving ability after a diagnosis of cerebrovascular disease.	N/A		✓
Pellerito [101]	USA	Commentary/review	Book chapter	N/A	Clinical text on “Driver rehabilitation”	N/A		✓	✓
Taylor [97]	UK	Commentary/review	Clinical guideline	N/A	Historical clinical guideline	N/A		✓
van Zomeren et al. [103]	The Netherlands	Commentary/review	Full-text article	N/A	To evaluate whether anatomical structures in the brain can be related to aspects of the driving task.	N/A		✓	✓
Wolfe and Lehockey [23]	USA	Commentary/review	Full-text article	N/A	To provide a review of relevant research related to neuropsychological assessment of driving capacity and practical guidelines for clinicians.	N/A		✓

Participant key: (a) participants post-stroke; (b) participants with aphasia post-stroke (if known); (c) neurologically normal controls; (d) health professionals; (e) carers.

Table 2. International fitness to drive and stroke clinical practice guidelines (n = 17).

Country	Guideline	Aphasia/communication discussed	Summary of discussion
Australia	Austroads. Assessing fitness to drive for commercial and private vehicle drivers: medical standards for licensing and clinical management guidelines [4]	Yes	Specific comment that aphasia (comprehension of written and spoken language) may impact on fitness to drive (p. 155).^a Further commentary regarding the need for intact comprehension for safe driving (p. 8, 120, 152, 163).^a
	Clinical guidelines for stroke management. Stroke Foundation [131]	No
	Australian Competency Standards for Occupational Therapy Driver Assessors [113]	Yes	Discussion regarding screening communication skills as required for the driving task (Standard 2.11, p. 16).^a Details expectations for the assessment process including the need to follow instructions and obey all road signs and signals (Standard 3.5, p. 21).^b
UK	Driver & Vehicle Licensing Agency. Assessing fitness to drive: A guide for medical professionals [128]	No
	Royal College of Physicians. National clinical guideline for stroke, 5th ed. [109]	Yes	Specifies that persisting language impairment requires referral for on-road screening and evaluation (p. 56).^a Advice that many cognitive tests are not valid for PWA, and on-road assessment may be needed (p. 55).^b
NZ	Waka Kotahi NZ Transport Agency. Medical aspects of fitness to drive. A guide for health professionals [130]	No
	Clinical guidelines for stroke management. Stroke Foundation [131]	No
Canada	Canadian Council of Motor Transport Administrators. Determining driver fitness in Canada [118]	Yes	Specifies that the Mini Mental State Examination and similar tests are sensitive to language ability and education (p. 35).^b
	Canadian Medical Association. Determining medical fitness to operate motor vehicles: CMA driver’s guide ed., 9.1 [108]	Yes	Notes that although aphasia is not an absolute contradiction to safe driving, it requires attention and further evaluation (p. 87).^a
	Canadian stroke best practice recommendations: Rehabilitation, recovery, and community participation following stroke. Part two: Transitions and community participation following stroke [110].	Yes	Specifies that cognitive assessment should include a focus on reading/symbol comprehension (p. 800).^a
Ireland	National Office for Traffic Medicine. Slainte agus Tiomaint: Medical fitness to drive guidelines 10th ed. [129]	No
	Irish Heart Foundation. National clinical guidelines and recommendations for the care of people with stroke and transient ischaemic attack [132]	No
South Africa	South African-Contextualised Stroke Rehabilitation Guideline (SA-CSRG) [111]	Yes	Notes the requirement for sensory assessment, including reading comprehension (p. 105).^a Advises against assessing driving eligibility with cognitive tests if the person’s language impairment would invalidate their results (p. 105).^b
	South African Society of Occupational Medicine. Medical requirements for fitness to drive [133]	No
US	Guidelines for Adult Stroke Rehabilitation and Recovery: A guideline for healthcare professionals from the American Heart Association/American Stroke Association [134]	No
	National Highway Traffic Safety Administration. Driver fitness medical guidelines [135]	No
	Clinician’s Guide to Assessing and Counselling Older Drivers. 4th ed. [112]	Yes	Notes that a Driving Rehabilitation Specialist may be able to determine whether the person has an expressive aphasia, and can therefore interpret written stimuli, such as traffic signs (p. 126).^a Notes that traffic signs may be interpreted based on colour, shape, and symbol recognition (p. 126).^a Notes that PWA who demonstrate safe driving ability may fail to renew their license due to difficulties with the written examination. Advises that the clinician should urge the licensing authority to make reasonable accommodations. (p. 126)^b

^a Discussion regarding the role of language/communication in the driving task.

^b Considerations regarding language/communication in evaluation process.

Table

Part A: Research specifically investigating return to driving with aphasia (n = 6)
Quantitative non-randomized studies (n = 5)
Reference	Aim	Participants	Screening question 1: research question	Screening question 2: data address research question	3.1. Participants representative of target population	3.2. Appropriate measurements	3.3. Complete outcome data	3.4. Confounders accounted for	3.5. Intervention/exposure as intended	MMAT score/5
Donovan et al. [71]	To investigate aphasia’s effect on road sign interpretation accuracy and response time.	n = 20 (a) + (b) 10 post-stroke with aphasia; (c) 10 neurologically normal controls	Yes	Yes	Yes	Yes	Can’t tell	No	Yes	3/5
Golper et al. [72]	(1) To analyse the self-judgement of driving competency in PWA; (2) to determine which tasks were most predictive of the overall team recommendation regarding returning to driving.	n = 20 (a) + (b) 20 post-stroke with aphasia	Yes	Yes	Yes	Yes	Yes	Yes	Yes	5/5
Hartje et al. [73]	To compare performance in a practical driving examination with performance in standardised neuropsychological tests for people with and without aphasia after acute neurological impairment.	n = 65 post-stroke/TBI (a) 53 post-stroke; (b) 34 PWA post-stroke; 2 PWA post-TBI.	Yes	Yes	Yes	Yes	Can’t tell	No	Yes	3/5
Lebrun et al. [74]	To determine the road sign interpretation skills of PWA.	n = 25 (a) 21 post-stroke; (b) 14 PWA; (c) 4 neurologically normal controls	No	Can’t tell	Yes	Yes	Yes	No	No	N/A (3/5)
Matsko et al. [75]	To explore the use of a numerical communication scoring system and simulated driving exercise as predictors of driving skill in an adult communication impaired stroke population.	n = 25 (a) 25 post-stroke with communication impairments; (b) PWA included but number not specified	Yes	Yes	Can’t tell	Can’t tell	Can’t tell	No	Can’t tell	0/5

Table

Mixed methods (n = 1)
Reference	Aim	Participants	Screening question 1: research question	Screening question 2: data address research question	5.1. Adequate rationale for mixed methods design	5.2. Components effectively integrated	5.3. Outputs of integrated components adequately interpreted	5.4. Divergences and inconsistencies adequately addressed	5.5. Components adhere to quality criteria	MMAT score/5
Mackenzie and Paton [76]	(1) To determine the views and practice of medical practitioners and aphasia therapists on return to driving with aphasia caused by stroke and the experience and effects for aphasic people of resuming or not resuming driving. (2) To compare the road sign recognition ability of PWA with a comparable non-stroke population.	n = 65 (a) + (b) 18 post-stroke with aphasia; (c) 18 neurologically normal controls; (d) 11 medical practitioners, 18 SLTs	Yes	Yes	No	No	Yes	Yes	No	2/5

Table

Qualitative component of Mackenzie (2003) study
Reference	Aim	Participants	Screening question 1: research question	Screening question 2: data address research question	1.1. Qualitative approach appropriate for RQ	1.2. Data collection methods	1.3. Findings derived from data	1.4. Interpretation of results substantiated by data	1.5. Coherence between data sources, collection, analysis, and interpretation	MMAT score/5
Mackenzie and Paton [76]	To determine the views and practice of medical practitioners and aphasia therapists on return to driving with aphasia caused by stroke and the experience and effects for aphasic people of resuming or not resuming driving.	(a) + (b) 18 post-stroke with aphasia; (d) 11 medical practitioners, 18 SLTs	Yes	Yes	Yes	Yes	Yes	No	No	3/5

Table

Quantitative non-randomized component of Mackenzie (2003) study
Reference	Aim	Participants	Screening question 1: research question	Screening question 2: data address research question	3.1. Participants representative of target population	3.2. Appropriate measurements	3.3. Complete outcome data	3.4. Confounders accounted for	3.5. Intervention/exposure as intended	MMAT score/5
Mackenzie and Paton [76]	To compare the road sign recognition ability of PWA with a comparable non-stroke population.	(a) + (b) 18 post-stroke with aphasia; (c) 18 neurologically normal controls	Yes	Yes	Yes	Yes	Yes	No	Yes	4/5

Table

Part B: Contributions from the broader literature (n = 25).
Quantitative non-randomized studies (n = 12)
Reference	Aim	Participants	Screening question 1: research question	Screening question 2: data address research question	3.1. Participants representative of target population	3.2. Appropriate measurements	3.3. Complete outcome data	3.4. Confounders accounted for	3.5. Intervention/exposure as intended	MMAT score/5
Akinwuntan et al. [105]	To identify variables that best predict a team’s decision of driving ability in stroke patients from a pre-driving assessment.	n = 104 (a) 104 post-stroke; (b) 16 PWA	Yes	Yes	Yes	Yes	No	Yes	Can’t tell	3/5
Aslaksen et al. [85]	To examine the predictive value and provide cut-off values for standardized neuropsychological tests to predict on-road driving performance.	n = 78 (a) 55 post-stroke; (b) LHD included but PWA not specified	Yes	Yes	Yes	Yes	Can’t tell	Yes	Yes	4/5
Bliokas et al. [86]	To evaluate the ability of a neuropsychological assessment battery to predict on-road outcome measures and explore relationships between individual neuropsychological tests and driving performance.	n = 104 (a) 61 post-stroke; (b) PWA not specified	Yes	Yes	Can’t tell	Yes	Yes	No	Yes	3/5
Lundqvist et al. [117]	To describe a model and clinical guidelines for determining driving fitness for patients with cognitive dysfunction in a rehabilitation setting.	n = 43 (a) 18 post-stroke; (b) PWA included but number not specified	No	Can’t tell	Yes	Yes	Yes	No	No	N/A (3/5)
Nouri et al. [82]	To produce a cognitive screening assessment to identify which post-stroke drivers would be safe to be assessed on the road.	n = 39 (a) 39 post-stroke; (b) LHD included but PWA not specified	Yes	Yes	Yes	Yes	Yes	No	Yes	4/5
Nouri and Lincoln [83]	To validate a cognitive test battery, previously found to be predictive of on-road driving performance.	n = 40 (a) 40 post-stroke; (b) LHD included but PWA not specified	Yes	Yes	Yes	Yes	Can’t tell	No	Yes	3/5
Perumparaichallai et al. [84]	To evaluate the cognitive and driving outcomes of a neurorehabilitation program and to examine the relationship between neuropsychological variables and driving outcomes.	n = 128 (a) 36 post-stroke; (b) PWA not specified	Yes	Yes	Yes	Yes	Can’t tell	No	Yes	3/5
Phan et al. [107]	To discover patterns which lead clinicians to request driving tests after stroke.	n = 82 (a) 82 post-stroke; (b) 27 PWA	Yes	Yes	Yes	Yes	Can’t tell.	Can’t tell.	Can’t tell.	2/5
Radford and Lincoln [89]	To determine the concurrent validity of the Stroke Drivers Screening Assessment (SDSA).	n = 93 (a) 93 post-stroke; (b) PWA included but number not specified	Yes	Yes	Yes	Yes	Yes	Yes	Yes	5/5
Sagar et al. [88]	Exploration of the relationship between a patient’s initial stroke severity score (National Institute of Health Stroke Score/NIHSS) and passing driving test.	n = 81 (a) 81 post-stroke (b) PWA included but number not specified	Yes	Yes	Yes	Yes	Can’t tell	Can’t tell	Can’t tell.	2/5
Schanke and Sundet [87]	To investigate the correspondence between neuropsychological test results and on-road driving performance among patients with a CT-verified brain damage or documented neurological disorder.	n = 55 (a) 43 post-stroke; (b) 18 PWA	Yes	Yes	Yes	Yes	Can’t tell	Yes	Yes	4/5
Sundet et al. [106]	To identify which neuropsychological measures are prioritised in the decision-making process regarding fitness to drive and to establish cut-off scores for sensitive tests.	n = 72 (a) 72 post-stroke; (b) 20 PWA	Yes	Yes	Yes	Yes	Can’t tell.	Yes	Yes	4/5

Table

Quantitative descriptive studies (n = 7)
Reference	Aim	Participants	Screening question 1: research question	Screening question 2: data address research question	4.1. Sampling strategy	4.2. Sample representative	4.3. Measurements appropriate	4.4. Risk of nonresponse bias low	4.5. Statistical analysis	MMAT score/5
Breen [92]	To investigate the characteristics and rehabilitation outcomes of stroke survivors who return to work.	n = 190 (a) 190 post-stroke; (b) PWA included but number not specified	Yes	Yes	Yes	Can’t tell	Yes	Yes	Yes	4/5
Breen et al. [91]	To investigate the cost, length of treatment and characteristics of stroke survivors returning to work.	n = 96 (a) 96 post-stroke; (b) PWA included but number not specified	Yes	Yes	Yes	Can’t tell	Yes	Yes	Yes	4/5
Breen et al. [90]	To investigate the frequency and characteristics of stroke survivors returning to work.	n = 96 (a) 96 post-stroke; (b) PWA included but number not specified	Yes	Yes	Yes	Can’t tell	Yes	Yes	Yes	4/5
Kato et al. [93]	To introduce a drive recorder system as an evaluation tool for driving ability in real-life situations for stroke patients.	n = 3 (a) 3 post-stroke; (b) 1 PWA	No	Can’t tell.	Can’t tell	Can’t tell	No	Can’t tell	No	0/5
McKevitt et al. [96]	To estimate the prevalence of self-reported need in community-dwelling stroke survivors across the UK.	n = 799 (a) 799 post-stroke (b) PWA not specified, but people with self-reported communication problems included.	Yes	Yes	Yes	Yes	Yes	Yes	Yes	5/5
Nouri [104]	To examine the knowledge and opinions of GPs on fitness to drive after a stroke.	n = 155 (d) 155 GPs	Yes	Yes	Yes	Yes	Yes	No	Yes	4/5
Stack et al. [50]	To investigate occupational therapy evaluation practices for fitness to drive after stroke in Ireland	n = 47 (d) 47 OTs	Yes	Yes	Yes	Yes	Yes	Can’t tell	Yes	4/5

Table

Qualitative studies (n = 6)
Reference	Aim	Participants	Screening question 1: research question	Screening question 2: data address research question	1.1. Qualitative approach appropriate for RQ	1.2. Data collection methods	1.3. Findings derived from data	1.4. Interpretation of results substantiated by data	1.5. Coherence between data sources, collection, analysis, and interpretation	MMAT score/5
Berger and Mensh [94]	To use the experiences of a PWA to provide a guide for rehabilitation professionals.	n = 1 (a) + (b) post-stroke with aphasia	No	Yes	Yes	Can’t tell	No	No	No	1/5
Franklin et al. [18]	To derive the shared top 10 research priorities of PWA, their carers and SLTs.	Survey n = 46 (a) + (b) 21 PWA; d)18 SLTs; (e) 7 carers Consensus meeting n = 22 (a) + (b) 10 PWA; (d) 9 SLTs; (e) 3 carers	Yes	Yes	Yes	Yes	Yes	Yes	Yes	5/5
Howe et al. [95]	To explore the environmental factors that hinder or support the community participation of adults with aphasia.	n = 25 (a) + (b) 25 post-stroke with aphasia	Yes	Yes	Yes	Yes	Yes	Yes	Yes	5/5
Kerr et al. [116]	To determine information needs and structure for a website about living with stroke.	n = 12 (a) 12 post-stroke; (b) 5 PWA	Yes	Yes	Yes	Yes	Yes	Yes	Yes	5/5
Rohde et al. [115]	To identify similarities and differences between client and therapist goals in rehabilitation for people with aphasia and explore reasons for any differences.	n = 7 (a) + (b) 4 post-stroke with aphasia; (d) 3 SLTs	Yes	Yes	Yes	Yes	Yes	Yes	Yes	5/5
Sjöqvist Nätterlund [114]	To describe aphasic individuals’ experiences of everyday activities and social support in daily life.	n = 20 (a) + (b) 20 post-stroke with aphasia	Yes	Yes	Yes	Yes	Yes	Can’t tell.	Yes	4/5

Participant key: (a) participants post-stroke; (b) participants with aphasia post-stroke (if known); (c) neurologically normal controls; (d) health professionals; (e) carers.

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