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Fitness-to-Drive Disagreements in Patients with Dementia
e8 No group differences in cognitive workload were observed. Significant correlations were found between all neuropsychological tests and cRTs of the visual search task in the PD group (p<0.05). By contrast, no significant correlations were found in the control group. Conclusions: This pilot study highlights the major role of cognitive function in visual search in individuals with PD. Larger sample sizes are required to better understand the degree of cognitive workload required to perform an efficient visual search. Key Words: Parkinson disease, Cognition, Vision Disclosures: None disclosed. Oral Presentation 378 Fitness-to-Drive Disagreements in Patients with Dementia Maud Ranchet (Augusta University), Mark Tant, Abiodun Emmanuel Akinwuntan, Hannes Devos Research Objectives: To investigate the agreement between the physicians’ medical and on-road assessors’ practical fitness-to-drive recommendations for individuals with dementia. Design: Retrospective study. Setting: Center for Evaluation of Fitness-to-Drive and Car Adaptations (CARA) of the Belgian Road Safety Institute. Participants: A total of 68 patients with dementia who underwent medical, visual, and road tests. Interventions: Not applicable. Main Outcome Measure(s): Fitness-to-drive recommendations made by on-road assessors. Physicians and on-road assessors used the same three categories (favorable, i.e. fit to drive without or with adaptations; reserved, i.e. fit to drive with restricted use in visibility conditions, distance or speed or unfavorable; i.e. unfit to drive). Agreement between physicians and onroad assessors regarding fitness-to-drive was calculated using the percentage of agreement (p0) and Prevalence and Bias Adjusted Kappa (PABAK). Results: The on-road assessors found 22 (32%) of the individuals fit to drive, 28 (41%) fit to drive with restrictions; and 18 (26%) were unfit to drive. The p0 was 43% and the PABAK was 0.14 (95% confidence interval, 0.03 - 0.25; p Z 0.10). No differences were found in po between specialists (37%) and general practitioners (43%; Chi2 Z 0.22; p Z 0.89). Compared to on-road assessors, physicians overestimated the fitness to drive of 24 patients and underestimated 15 patients. Conclusions: There was low agreement between physicians and on-road assessors regarding fitness-to-drive recommendations in patients with dementia. Future research should investigate whether the appraisal of physician in combination with a set of visual and cognitive tests further reduce the number of misclassified patients. Key Words: Dementia, Outcomes Measures, Automobile Driving, Physicians Disclosures: None disclosed. Oral Presentation 379 Fitness-to-Drive Agreements after Stroke Maud Ranchet (Augusta University), Abiodun Emmanuel Akinwuntan, Mark Tant, Hannes Devos Research Objectives: To investigate the agreement between the physicians’ medical and on-road assessors’ practical fitness-to-drive recommendations for individuals with stroke. Design: Retrospective study. Setting: Center for Evaluation of Fitness-to-Drive and Car Adaptations (CARA) of the Belgian Road Safety Institute. Participants: A total of 735 patients with stroke who underwent medical, visual, and road tests. Interventions: Not applicable. Main Outcome Measure(s): Physicians and on-road assessors used the same three categories (favorable, reserved, or unfavorable) to judge patients’
Oral Research Presentations fitness-to-drive. Agreement between physicians and on-road assessors regarding fitness-to-drive was calculated using the percentage of agreement (p0) and Prevalence and Bias Adjusted Kappa (PABAK). Area Under the Curve (AUC) was used to predict the medical and practical fitness-to-drive recommendations after stepwise logistic regression analyses. Results: The p0 was 73% and the PABAK was 0.60 (p<0.0001). Physicians disagreed on 76/83 (92%) patients classified as unfavorable and 64/80 (80%) of those classified as reserved by the on-road assessor. Previous visits to the driving center and number of comorbidities predicted medical fitness-to-drive recommendations (AUC Z 0.68). Age, previous visits to the driving center, binocular acuity, and driving experience constituted the best model to predict practical fitness-to-drive recommendations (AUC Z 0.70). Conclusions: Physicians find it difficult to rule out stroke drivers who might actually pose a risk on the road. Our results support a joint fitness-todrive decision-making process based on both medical information and practical driving performance. Key Words: Stroke, Physicians, Automobile Driving, Outcome Measures Disclosures: None disclosed. Oral Presentation 387 Predictors of Participation in Supervised Therapy by Post-Stroke Patients in The Singapore Community: A One-Year Cohort Study Gerald Choon-Huat Koh (National University of Singapore), Denise Yan-Yin Lim, Steven Liben Zhang, Cynthia Chen Huijun, Sanjiv Kishore Saxena, Fong Ngan Phoon, David Yong, N.G. Tze-Pin Research Objectives: To determine the relationship between participation in supervised and unsupervised therapy, and predictors of participation in supervised therapy during the first post stroke year. Design: Prospective longitudinal study with interviews at admission, discharge, 1 month, 6 months and one year after discharge. Setting: Two subacute inpatient rehabilitation units and the community after discharge in Singapore. Participants: 215 subacute non-aphasic stroke patients. Interventions: Not Applicable. Main Outcome Measure(s): Participation rate in supervised therapy (at outpatient rehabilitation centers) and unsupervised therapy (at home) as defined as proportion of time spent performing therapy as prescribed by the subacute hospital’s multidisciplinary rehabilitation team at discharge. Results: Patients who participated in supervised therapy (i.e. at an outpatient rehabilitation center) >25% of the time recommended were more likely to participate in unsupervised therapy (i.e. at home) >75% of the time recommended at one, six and twelve months (crude odds ratio, OR Z 4.41 [95%CI:2.09e10.17], 4.45 [95%CI:2.17e9.12], 6.93 [95% CI:2.60e18.48] respectively). Greater participation in supervised therapy at one and six months independently predicted greater participation in supervised therapy at six (adjusted ORZ11.64 [95%CI:4.52-29.97]) and twelve months (adjusted ORZ76.46 [95%CI:12.52-466.98]) respectively. Caregiver availability at six months independently predicted poorer participation in supervised therapy at twelve months. Conclusions: Interventions to increase participation in supervised therapy in the first post-stroke year should focus on transition of care in the first month after discharge. Further studies are needed to understand why caregiver availability was associated with low participation in supervised therapy. Key Words: Stroke, Rehabilitation, Patient compliance, Cohort Studies Disclosures: None disclosed. Oral Presentation 392 Constrained Induced Movement Therapy for Children with Brachial Plexus Injury: Upper and Lower Extremity Immediate and Long Term Changes Tasos Karakostas (Rehabilitation Institute of Chicago), Erik King, Simon Hsiang
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Oral Research Presentations fitness-to-drive. Agreement between physicians and on-road assessors regarding fitness-to-drive was calculated using the percentage of agreement (p0) and Prevalence and Bias Adjusted Kappa (PABAK). Area Under the Curve (AUC) was used to predict the medical and practical fitness-to-drive recommendations after stepwise logistic regression analyses. Results: The p0 was 73% and the PABAK was 0.60 (p<0.0001). Physicians disagreed on 76/83 (92%) patients classified as unfavorable and 64/80 (80%) of those classified as reserved by the on-road assessor. Previous visits to the driving center and number of comorbidities predicted medical fitness-to-drive recommendations (AUC Z 0.68). Age, previous visits to the driving center, binocular acuity, and driving experience constituted the best model to predict practical fitness-to-drive recommendations (AUC Z 0.70). Conclusions: Physicians find it difficult to rule out stroke drivers who might actually pose a risk on the road. Our results support a joint fitness-todrive decision-making process based on both medical information and practical driving performance. Key Words: Stroke, Physicians, Automobile Driving, Outcome Measures Disclosures: None disclosed. Oral Presentation 387 Predictors of Participation in Supervised Therapy by Post-Stroke Patients in The Singapore Community: A One-Year Cohort Study Gerald Choon-Huat Koh (National University of Singapore), Denise Yan-Yin Lim, Steven Liben Zhang, Cynthia Chen Huijun, Sanjiv Kishore Saxena, Fong Ngan Phoon, David Yong, N.G. Tze-Pin Research Objectives: To determine the relationship between participation in supervised and unsupervised therapy, and predictors of participation in supervised therapy during the first post stroke year. Design: Prospective longitudinal study with interviews at admission, discharge, 1 month, 6 months and one year after discharge. Setting: Two subacute inpatient rehabilitation units and the community after discharge in Singapore. Participants: 215 subacute non-aphasic stroke patients. Interventions: Not Applicable. Main Outcome Measure(s): Participation rate in supervised therapy (at outpatient rehabilitation centers) and unsupervised therapy (at home) as defined as proportion of time spent performing therapy as prescribed by the subacute hospital’s multidisciplinary rehabilitation team at discharge. Results: Patients who participated in supervised therapy (i.e. at an outpatient rehabilitation center) >25% of the time recommended were more likely to participate in unsupervised therapy (i.e. at home) >75% of the time recommended at one, six and twelve months (crude odds ratio, OR Z 4.41 [95%CI:2.09e10.17], 4.45 [95%CI:2.17e9.12], 6.93 [95% CI:2.60e18.48] respectively). Greater participation in supervised therapy at one and six months independently predicted greater participation in supervised therapy at six (adjusted ORZ11.64 [95%CI:4.52-29.97]) and twelve months (adjusted ORZ76.46 [95%CI:12.52-466.98]) respectively. Caregiver availability at six months independently predicted poorer participation in supervised therapy at twelve months. Conclusions: Interventions to increase participation in supervised therapy in the first post-stroke year should focus on transition of care in the first month after discharge. Further studies are needed to understand why caregiver availability was associated with low participation in supervised therapy. Key Words: Stroke, Rehabilitation, Patient compliance, Cohort Studies Disclosures: None disclosed. Oral Presentation 392 Constrained Induced Movement Therapy for Children with Brachial Plexus Injury: Upper and Lower Extremity Immediate and Long Term Changes Tasos Karakostas (Rehabilitation Institute of Chicago), Erik King, Simon Hsiang
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