Does the brake response time of the right leg change after left total knee arthroplasty? A prospective study. The effect of immobilization devices and left-foot adapter on brake-response time. Brake response time after total knee arthroplasty: when is it safe for patients to drive? Driving reaction time before and after anterior cervical fusion for disc herniation: a preliminary study When Is It Safe to Return to Driving After Spinal Surgery? Age of first intoxication, heavy drinking, driving after drinking and risk of unintentional injury among U.S. college students. Effects of upper-limb immobilisation on driving safety. A Randomized Trial of a Physical Conditioning Program to Enhance the Driving Performance of Older Persons Effect of community-based interventions on high-risk drinking and alcohol-related injuries. Reducing alcohol-impaired driving in Massachusetts: the Saving Lives Program. Worker's compensation and return-to-work following orthopaedic injury to extremities. Efficacy of surgical wound drainage in orthopaedic trauma patients: a randomized prospective trial. Driving reaction time before and after surgery for lumbar disc herniation in patients with radiculopathy Utility of Spine Surgery: A Comparison of Common Elective Orthopaedic Surgical Procedures Driving rehabilitation for military personnel recovering from traumatic brain injury using virtual reality driving simulation: a feasibility study. The effect of shoulder immobilization on driving performance. Influence of left- and right-side total hip arthroplasty on the ability to perform an emergency stop while driving a car. Driving Reaction Time Before and After Primary Fusion of the Lumbar Spine Using driving simulators to assess driving safety. When is it safe for patients to drive after right total hip arthroplasty? Beliefs and attitudes of members of the American Academy of Orthopaedic Surgeons regarding the treatment of anterior cruciate ligament injury. Effect of Simulator Training on Fitness-to-Drive After Stroke: A 5-Year Follow-up of a Randomized Controlled Trial Single-Level Degenerative Cervical Disc Disease and Driving Disability: Results from a Prospective, Randomized Trial
Patients undergoing total knee arthroplasty often ask when they can safely resume car driving . There is little evidence available on which physicians can rely when advising patients on this issue . In a prospect i ve study we assessed the brake response time of 24 patients admitted to the clinic for left total knee arthroplasty preoperatively and then 10 days after surgery . On each measurement day the patients performed two tasks , a simple and a complex brake response time task in a car simulator . Ten days after left TKA the brake response time for the simple task had decreased by 3.6 % ( p=0.24 ) , the reaction time by 3.1 % ( p=0.34 ) and the movement time by 6.6 % ( p=0.07 ) . However , the performance improvement was not statistically significant . Task complexity increased brake response time at both time points . A 5.8 % increase was significant ( p=0.01 ) at 10 days after surgery . Based on our results , we suggest that patients who have undergone left total knee arthroplasty may resume car driving 10 days after surgery as long as they drive a car with automatic transmission BACKGROUND The ability to perform an emergency stop is essential for safe driving and can be represented by total brake-response time , reaction time , and braking time . Immobilization of the lower extremities is routinely performed for a variety of musculoskeletal conditions . This study sought to investigate the effect of immobilization with a left-foot driving adapter , a controlled-ankle-motion device , and a short leg cast on braking times . Our hypothesis was that there would be a significant difference in braking-time values between individuals utilizing a left-foot driving adapter or immobilization device  and control individuals wearing normal footwear . METHODS A prospect i ve , observational study was conducted to assess the effect of the immobilization devices on braking times . A driving simulator was used to assess total brake-response time , reaction time , and braking time in thirty-five volunteers . Volunteers were assessed while ( 1 )  wearing normal footwear ( control group  )  , ( 2 ) wearing a controlled-ankle-motion boot , ( 3 ) wearing a removable short leg cast , and ( 4 ) employing a left-foot driving adapter . RESULTS The mean total brake-response time was significantly increased as compared with that of the control group in all three study groups . The mean reaction time was significantly increased for the short leg cast and controlled-ankle-motion groups as compared with reaction time in the control group . The mean braking time was significantly increased in the controlled-ankle-motion and left-foot driving-adapter groups as compared with braking time in the control group . CONCLUSIONS Total brake-response time while wearing a controlled-ankle-motion boot or a short leg cast or while utilizing a left-foot driving adapter is significantly increased , or worsened , as compared with the response time while wearing normal footwear . This information may prove valuable to physicians when counseling patients on when it may be safe to return to driving Total knee arthroplasty ( TKA ) dramatically decreases pain and improves mobility and quality of life . However , little has been reported on its effect on driving ability in the early postoperative period . This prospect i ve study was conducted to compare preoperative and postoperative brake response times ( BRTs ) in patients undergoing TKA for osteoarthritis . The results showed that patients returned to preoperative BRT as early as 3 weeks after surgery , and at 9 weeks after surgery , BRTs were significantly improved over baseline . Based on BRT analysis patients undergoing TKA  may be allowed to return to driving 6 weeks after surgery Purpose Reduced driving reaction time ( DRT ) has already been studied in context with lumbar disc surgeries . Data on whether cervical spine pathologies impair driving abilities are still lacking . In addition , no return-to-driving recommendations after anterior cervical fusion procedures have been published . Therefore , we assessed DRT before and after anterior cervical discectomy and fusion . Methods We performed a prospect i ve study with 12 patients ( mean age 47.2 years ; female 7 , male 5 ) . DRT as well as arm and neck pain were evaluated before surgery , on the day before discharge from hospital and at the 4–6-week follow-up examinations . 31 healthy subjects were tested for DRT  as a control group . Results All patients showed significant improvement in DRT in the longitudinal course ( p < 0.05 ) . DRT was 601 ms ( median , IQR : 63 ) before surgery , which was reduced to 580 ms ( median , IQR : 112 ) on the day before discharge from hospital and to 532 ms ( median , IQR : 48 ) at follow-up examination . Control subjects had a driving reaction time of 487 ms ( median , IQR : 116 ) , which differed significantly from that of patients at all three testing times ( p < 0.05 ) . VAS for arm and neck pain showed significant improvement ( p < 0.05 ) . Conclusion The present results show a positive effect of anterior cervical discectomy and fusion on driving safety . Based on our data we state that it appears to be safe to resume driving after discharge from hospital . However , patients scheduled to undergo anterior cervical discectomy and fusion  should be informed about increased DRT as compared to healthy individuals Study Design Prospect i ve study . Objective Surgeons ’ recommendations for a safe return to driving following cervical and lumbar surgery vary and are based on empirical data . Driver reaction time ( DRT ) is an objective measure of the ability to drive safely . There are limited data about the effect of cervical and lumbar surgery on DRT . The purpose of our study was to use the DRT to determine when the patients undergoing a spinal surgery  may safely return to driving . Methods We tested 37 patients ’ DRT using computer software . Twenty-three patients ( mean 50.5 ± 17.7 years ) received lumbar surgery , and 14 patients had cervical surgery ( mean 56.7 ± 10.9 years ) . Patients were compared with 14 healthy male controls ( mean 32 ± 5.19 years ) . The patients having cervical surgery were subdivided into the anterior versus posterior approach and myelopathic versus nonmyelopathic groups . Patients having lumbar spinal surgery were subdivided by decompression versus fusion with or without decompression and single-level versus multilevel surgery . The patients were tested preoperatively and at 2 to 3 , 6 , and 12 weeks following the surgery . The use of opioids was noted . Results Overall , the patients having cervical and lumbar surgery showed no significant differences between pre- and postoperative DRT ( cervical p = 0.49 , lumbar p = 0.196 ) . Only the patients having single-level procedures had a significant improvement from a preoperative DRT of 0.951 seconds ( st and ard deviation 0.255 ) to 0.794 seconds ( st and ard deviation 0.152 ) at 2 to 3 weeks ( p = 0.012 ) . None of the other subgroups had a difference in the DRT . Conclusions Based on these findings , it may be acceptable to allow patients having a single-level lumbar fusion who are not taking opioids to return to driving as early as 2 weeks following the spinal surgery OBJECTIVES This study explored whether college students who were first intoxicated by alcohol at ages younger than 19 are more likely to become alcohol dependent and frequent heavy drinkers , drive after drinking , ride with intoxicated drivers and be injured after drinking . It also investigated whether these results occur because these students believe they can drink more and still drive legally and safely . METHOD In 1999 , 14,138 of 23,751 full-time 4-year students from a r and om sample of 119 college and universities nationwide completed self-administered question naires ( response rate : 60 % ) . This analysis focused on 12,550 who were aged 19 or older . Respondents were asked the age at which they first got drunk , as well as questions about recent alcohol-related behaviors and consequences . RESULTS Compared with respondents first drunk at age 19 or older , those first drunk prior to age 19 were significantly more likely to be alcohol dependent and frequent heavy drinkers , to report driving after any drinking , driving after five or more drinks , riding with a driver who was high or drunk and , after drinking , sustaining injuries that required medical attention . Respondents first intoxicated at younger ages believed they could consume more drinks and still drive safely and legally ; this contributed to their greater likelihood of driving after drinking and riding with high or drunk drivers . CONCLUSIONS Educational , clinical , environmental and legal interventions are needed to delay age of first intoxication and to correct misperceptions among adolescents first drunk at an early age about how much they can drink and still drive safely and legally Doctors are frequently asked by patients whether it is safe to drive with an upper limb immobilised in a cast . In the literature there are no objective measurements of the effects of upper-limb immobilisation upon driving performance .  Eight healthy volunteers performed four 20-min driving circuits in a driving simulator ( STISIM 400W ) , circuits 1 and 4 without immobilisation and circuits 2 and 3 with immobilisation . Immobilisation involved a lightweight below-elbow cast with the thumb left free . Volunteers were r and omised to right or left immobilisation for circuit 2 , and the contralateral wrist was immobilised for circuit 3 . Circuits included urban and rural environments and specific hazards ( pedestrians crossing , vehicles emerging from a concealed entrance , traffic lights changing suddenly , avoidance of an oncoming vehicle in the driver 's carriageway ) . Limb immobilisation led to more cautious rural and urban driving , with less adjustment of speed and lateral road position than when unrestricted . However when responding to hazards immobilisation caused less safe driving , with higher speeds , a greater proximity to the hazard before action was taken and less steering adjustment . The effects of restriction upon performance were more prevalent and severe with right-arm immobilisation . Upper-limb immobilisation appears to have little effect on the ability to drive a car unchallenged , but to adversely affect responses to routine hazards . Advice on ability to drive safely should be cautious , as the impact of immobilisation appears to be more subtle and wide ranging than previously thought Background As the number of older drivers increases , concern has been raised about the potential safety implication s. Flexibility , coordination , and speed of movement have been associated with older drivers ’ on road performance . Objective To determine whether a multicomponent physical conditioning program targeted to axial and extremity flexibility , coordination , and speed of movement could improve driving performance among older drivers . Design R and omized controlled trial with blinded assignment and end point assessment . Participants r and omized to intervention underwent graduated exercises ; controls received home , environment safety modules . Participants Drivers , 178 , age ≥ 70 years with physical , but without substantial visual ( acuity 20/40 or better ) or cognitive ( Mini Mental State Examination score ≥24 ) impairments were recruited from clinics and community sources . Measurements On-road driving performance assessed by experienced evaluators in dual-brake equipped vehicle in urban , residential , and highway traffic . Performance rated three ways : ( 1 ) 36-item scale evaluating driving maneuvers and traffic situations ; ( 2 ) evaluator ’s overall rating ; and ( 3 ) critical errors committed . Driving performance reassessed at 3 months by evaluator blinded to treatment group . Results Least squares mean change in road test scores at 3 months compared to baseline was 2.43 points higher in intervention than control participants ( P = .03 ) . Intervention drivers committed 37 % fewer critical errors ( P = .08 ) ; there were no significant differences in evaluator ’s overall ratings ( P = .29 ) . No injuries were reported , and complaints of pain were rare . Conclusions This safe , well-tolerated intervention maintained driving performance , while controls declined during the study period . Having interventions that can maintain or enhance driving performance may allow clinician – patient discussion s about driving to adopt a more positive tone , rather than focusing on driving limitation or cessation CONTEXT High-risk alcohol consumption patterns , such as binge drinking and drinking before driving , and underage drinking may be linked to traffic crashes and violent assaults in community setting s. OBJECTIVES To determine the effect of community-based environmental interventions in reducing the rate of high-risk drinking and alcohol-related motor vehicle injuries and assaults . DESIGN AND SETTING A longitudinal multiple time series of 3 matched intervention communities ( northern California , southern California , and South Carolina ) conducted from April 1992 to December 1996 . Outcomes were assessed by 120 general population telephone surveys per month of r and omly selected individuals in the intervention and comparison sites , traffic data on motor vehicle crashes , and emergency department surveys in 1 intervention-comparison pair and 1 additional intervention site . INTERVENTIONS Mobilize the community ; encourage responsible beverage service ; reduce underage drinking by limiting access to alcohol ; increase local enforcement of drinking and driving laws ; and limit access to alcohol by using zoning . MAIN OUTCOME MEASURES Self-reported alcohol consumption and driving after drinking ; rates of alcohol-related crashes and assault injuries observed in emergency departments and admitted to hospitals . RESULTS Population surveys revealed that the self-reported amount of alcohol consumed per drinking occasion declined 6 % from 1.37 to 1 . 29 drinks . Self-reported rate of " having had too much to drink " declined 49 % from 0.43 to 0.22 times per 6-month period . Self-reported driving when " over the legal limit " was 51 % lower ( 0 . 77 vs 0.38 times ) per 6-month period in the intervention communities relative to the comparison communities . Traffic data revealed that , in the intervention vs comparison communities , nighttime injury crashes declined by 10 % and crashes in which the driver had been drinking declined by 6 % . Assault injuries observed in emergency departments declined by 43 % in the intervention communities vs the comparison communities , and all hospitalized assault injuries declined by 2 % . CONCLUSION A coordinated , comprehensive , community-based intervention can reduce high-risk alcohol consumption and alcohol-related injuries result ing from motor vehicle crashes and assaults . JAMA . 2000;284:2341 - 2347 OBJECTIVES The purpose of this study ws to assess whether a community program begun in March 1988 that organized multiple city departments and private citizens could reduce  alcohol-impaired driving , related driving risks  , and  traffic deaths and injuries . METHODS Trends in fatal crashes and injuries per 100 crashes were compared in Saving Lives Program cities and the rest of Massachusetts from March 1984 through February 1993 . In annual roadside surveys conducted at r and omly selected locations , safety belt use among occupants of 54577 vehicles and travel speeds of 118442 vehicles were observed . Four statewide telephone surveys ( n = 15188 ) monitored self-reported driving after drinking . RESULTS In program cities relative to the rest of Massachusetts during the 5 program years in comparison with the previous 5 years , fatal crashes declined 25 % , from 178 to 120 , and fatal crashes involving alcohol decreased 42 % , from 69 to 36 . Visible injuries per 100 crashes declined 5 % , from 21.1 to 16.6 . The proportions of vehicles observed speeding and teenagers who drove after drinking were cut in half . CONCLUSIONS Interventions organized by multiple city departments and private citizens can reduce driving after drinking , related driving risks , and traffic deaths and injuries OBJECTIVE To explore the influence of  workers ' compensation coverage  on injury patterns and return-to-work outcome in orthopaedic injuries of the extremities . DESIGN Prospect i ve and follow-up study . SUBJECTS A total of 154 subjects were recruited and 37.7 % of the injuries were covered by workers ' compensation .  METHODS Baseline data were obtained by question naire and chart review . The main outcome variable was time of first return to work . Subjects were followed up at 1 , 3 and 6 months after initial interview . Cox proportional hazards model was used to analyse associations between potential predictors and return-to-work . RESULTS The workers ' compensation group were most likely to be men employed in labour occupations and were most likely to sustain crushing injuries , or injuries from being struck by objects . The 6-month return-to-work rates for the workers ' compensation and non-workers ' compensation groups were 70.7 % and 71.9 % . Early return-to-work was associated with more years in higher education , and increased self-efficacy in both groups . Moreover , age older than 45 years and hospitalization less than 14 days were associated with early return-to-work in the non-workers ' compensation group . CONCLUSION The injury patterns of workers ' compensation and non-workers ' compensation groups differed , but the likelihood of return-to-work at 6-month follow-up was similar . More years of education and self-efficacy were positive predictors of return-to-work OBJECTIVE To study the efficacy of closed suction drainage in clean nonemergent surgical fracture fixation or bone grafting on the extremities or pelvis . DESIGN A prospect i ve r and omized trial . SETTING The orthopaedic trauma service of a Level I trauma hospital . PATIENTS Patients were older than age eighteen years and undergoing clean nonemergent surgical fracture fixation or bone grafting procedures on the extremities ( excluding h and s and feet ) or pelvis . INTERVENTION The application of a surgical drain . MAIN OUTCOME MEASUREMENTS Wound drainage , edema , hematoma and erythema , dehiscence , infection , and need for surgery or readmission were followed for six weeks . A univariate analysis with Student 's t test for continuous variables and chi-squared analysis for all categorical data were used , with a p value of < or = 0.05 considered statistically significant . RESULTS A total of 202 patients were r and omized to 102 patients with no drain and 100 patients with a drain .  There was no significant difference between the groups with regard to injury severity , systemic disease , age , body weight , physical status , or estimated blood loss . There was no significant difference between the drain and no-drain groups in any of the parameters evaluated . CONCLUSION There is no significant difference between drained and nondrained wounds in clean , nonurgent orthopaedic trauma surgery . It appears that drainage systems can be safely eliminated in this group Purpose Although patients scheduled to undergo lumbar disc surgery  often ask when they are allowed to drive a motor vehicle again , there are no published recommendations on this subject . Methods We conducted a prospect i ve study in 46 consecutive patients ( mean age 48.9 years ) to determine driving reaction time ( DRT ) before and after surgery in patients with lumbar disc herniation . Of the patients 23 had left-side radiculopathy and 23 right-side radiculopathy .  Driving reaction time as well as back and leg pain were evaluated preoperatively , on the day of discharge from hospital and at the 5-week follow-up examination ( FU ) . 31 healthy subjects were tested as controls . Results Significant improvement in DRT was seen for both patient sample s ( p < 0.05 ) . For patients with a right-side radiculopathy preoperative DRT was 664 ms ( median , IQR : 241 ) , which was reduced to 605 ms ( median , IQR : 189 ) immediately postoperatively and to 593 ms ( median , IQR : 115 ) at FU . For patients with a left-side radiculopathy DRT was 675 ms ( median , IQR : 247 ) preoperatively , 638 ms ( median , IQR : 242 ) postoperatively and 619 ms ( median , IQR : 162 ) at FU . Pain was moderately correlated to DRT . Control subjects had a driving reaction time of 487 ( median , IQR : 116 ) , which differed significantly from patients at all three testing times ( p < 0.001 ) . Conclusion Our data indicate a positive effect of the surgery on driving ability . Therefore , we would suggest that for both patient sample s it is safe to continue driving after hospital discharge . However , patients have to be informed about increased DRT caused by radiculopathy already before surgery Study Design . A 1-year prospect i ve observational cohort study . Objective . To compare the utility before and 1 year after  elective spine surgery with some other common  orthopaedic surgical procedures .  Summary of Background Data . By using global measures like EQ-5D and SF-36 for the determination of the utility , the changes in quality of life , quality of life ( QoL ) after an intervention different diagnoses , and treatments can be compared . Total hip replacement ( THR ) has become almost golden st and ard in this respect . Methods . Seven hundred seventy-seven subjects with different common orthopaedic diagnoses scheduled for elective surgery were just before surgery and 1 year after surgery answering both EQ-5D and SF-36 .  Four groups with different spine diagnoses and procedures were formed and compared with 8 other diagnoses and treatment groups . Results . Before surgery , subjects with spine diagnoses reported the lowest QoL of all diagnoses compared . Surgery for spinal stenosis , spondylolisthesis , and instability meant the largest improvement of all surgical interventions . Surgery for NHP gave a moderately good improvement , whereas surgery for CLBP only marginally improved those operated . Particularly THR but also TKR more or less completely normalized QoL but made it from a relatively high preoperative level . The greatest improvements after spine surgery , other surgical procedures , and different diagnoses were in the pain/discomfort domain . Conclusion . Spinal surgery in spinal stenosis , spondylolisthesis , and instability had in comparison to other types of elective orthopaedic surgery an outst and ing better ability to improve the operated subject ’s health-related quality of life than other types of elective orthopaedic surgery . The utility of HNP surgery  was somewhat lower and was rather marginal for those operated for nonspecific CLBP OBJECTIVE To investigate the feasibility of virtual reality driving simulation rehabilitation training ( VRDSRT ) with military personnel recovering from traumatic brain injury ( TBI ) . METHODS Eleven men with TBI were r and omly assigned as controls ( n = 5 ) receiving residential rehabilitation only or the VRDSRT group ( n = 6 ) receiving residential rehabilitation and VRDSRT . All subjects underwent pre- and post- assessment s including simulator driving , and completing road rage and risky driving question naires . Between assessment s , VRDSRT subjects received 4 - 6 , 60- to 90-min rehabilitation training sessions involving practicing progressively more complex driving skills ( lane position , speed control , etc . ) through progressively more dem and ing traffic . RESULTS VRDSRT was well received , considered realistic and effective , with no reported simulation sickness . Driving performance improved significantly in the VRDSRT group only ( p < 0.01 ) . They also demonstrated a reduction in road rage ( p = 0.01 ) and risky driving ( p = 0.04 ) at post- assessment . CONCLUSION VRDSRT showed promising results with respect to retraining driving performance and behavior among military personnel recovering from TBI BACKGROUND The purpose of this study was to evaluate the effect of sling immobilization on driving performance with use of a driving simulator . METHODS This is a prospect i ve trial with a cohort of 21 healthy volunteers comparing their driving ability with and without sling immobilization on their dominant ( driving ) extremity . Multiple variables , including number of collisions , off-road excursions , and centerline crossings , were measured with a vali date d driving simulator . Trials were separated by 2 weeks to control for " adaptations " to the simulator . Statistical significance was found in collisions between sling and no-sling tests . RESULTS The total number of collisions for trial 1 ( no sling ) was 36 ( mean , 1.7 ± 1.2 ) compared with 73 ( 3.7 ± 1.6 ) ( P < .01 ) for trial 2 ( sling immobilization ) . Approximately 70 % of participants with upper extremity immobilization were involved in ≥3 collisions ; approximately 70 % of no-sling participants were involved in ≤2 collisions . There was no statistically significant difference between groups with respect to overall vehicle road position and control . CONCLUSION Sling immobilization of the dominant driving arm results in a decrease in driving performance and safety with respect to the number of collisions in a simulated driving circuit ( P < .01 ) . There were no significant differences in driving parameters that are indicative of overall vehicle position and control . The decrease in driving performance with respect to the number of collisions is likely to be related to the effect the immobilized arm has on effectively performing evasive maneuvers during hazardous driving conditions OBJECTIVE To show the possible effect of  left- and right-side total hip arthroplasty ( THA )  on the ability to perform an emergency stop when driving a car . DESIGN Inception cohort . SETTING A driving simulator using an actual car cabin , specifically developed for the experiment , was used for testing driving ability . PARTICIPANTS Patients ( N=40 ; 20 left-side THA/20 right-side THA )  were tested preoperatively and in increments of 8 days and 6 , 12 , and 52 weeks after surgery . INTERVENTIONS Left- and right-side THA . MAIN OUTCOME MEASURES Reaction time , movement time , total brake response time ( TBRT ) , and maximum brake force . RESULTS Eight days postoperatively , measurements on driving performance indicated a slight worsening for all outcome parameters in patients after left-side THA and considerably more worsening in patients after right-side THA . For both patient groups , significant improvements in outcome measures were noted during the 1-year follow-up . Brake force declined significantly in patients with left-side THA ( P=.012 ) and in patients after right-side THA ( P<.001 ) . A total of 35 % of the patients with right-side THA and 15 % with left-side THA could not meet the 600 ms TBRT threshold 6 weeks postoperatively . CONCLUSIONS Most patients who underwent right-side THA reached their preoperative baseline 6 weeks after surgery . Most of the patients with left-side THA showed no TBRT limitations 8 days postoperatively . Because of the patients ' highly individual rehabilitation course and considering the possible consequences of the premature resumption of driving a motor vehicle , individual examination and recommendation are necessary Study Design . Controlled prospect i ve study . Objective . To determine whether driving reaction time ( DRT ) is influenced by primary lumbar fusion . Summary of Background Data . The effects of radiculopathy and nerve root blocks on DRT have been reported recently . To our knowledge , the relationship between lumbar fusion and DRT has not been previously studied although it is important for driving safety . The aim of the present study was to test the hypotheses that DRT after lumbar fusion is ( 1 ) altered after the operation , ( 2 ) influenced by pain , ( 3 ) influenced by the patient 's driving skill , and ( 4 ) differs from the DRT of healthy controls . Methods . Twenty-one consecutive patients ( mean age , 53.5 years ; SD 10.8 ) receiving primary lumbar fusion were tested for their DRT 1 day before surgery ( preoperative ) , the day before discharge ( postoperative ) and 3 months after surgery ( follow-up ; FU ) .  DRT  was assessed using a custom-made driving simulator . The severity of back pain was determined on visual analogue scales separately for usual pain ( VAS-U ) and pain during testing ( VAS-T ) . We also determined the patients ' subjective driving frequency . Normative DRT data from 31 age-matched healthy controls were used for comparison . Results . The preoperative DRT was 685 milliseconds ( Md ; IQR 246 ) and the postoperative DRT 728 milliseconds ( Md ; IQR 264 ) , which was further reduced to 671 milliseconds ( Md ; IQR 202 ) after the FU period . Statistical significance was registered between postoperative and FU DRT ( P = 0.007 ) . Moderate to high correlations ( 0.537 < r < 0.680 ) were found between the VAS rating of back pain and DRT . Control subjects had a DRT of 487 milliseconds ( Md ; IQR 116 ) , which differed significantly from the DRT of patients at all 3 time points of testing ( P < 0.001 ) . Conclusion . It appears safe to continue driving after discharge from the hospital following lumbar fusion . DRT improved significantly during FU , indicating a positive effect of the intervention on driving skills . DRT correlates with the severity of back pain Changes in drivers , vehicles , and roadways pose substantial challenges to the transportation safety community . Crash records and naturalistic driving data are useful for examining the influence of past or existing technology on drivers , and the associations between risk factors and crashes . However , they are limited because causation can not be established and technology not yet installed in production vehicles can not be assessed . Driving simulators have become an increasingly widespread tool to underst and evolving and novel technologies . The ability to manipulate independent variables in a r and omized , controlled setting also provides the added benefit of identifying causal links . This paper introduces a special issue on  simulator-based safety studies . The special issue comprises 25 papers that demonstrate the use of driving simulators to address pressing transportation safety problems and includes topics as diverse as neurological dysfunction , work zone design , and driver distraction Old studies recommend 6weeks post-operative before patients can return to driving safely . This is a prospect i ve study assessing brake reaction time ( BRT ) after THA  . 38 patients underwent a pre-operative , 2  ,  4 and 6weeks post-operative BRT test . General linear repeated measurement was used . The mean pre-operative reaction time was 0.635±0.160seconds SD and 2-week was 0.576±0.137seconds SD ( P=0.029 ) ; 33 patients ( 87 % ) were able to reach their baseline time by 2weeks . The remaining five patients ( 13 % ) reached their baseline at the 4-week post-operative . No differences were found with respect to age , gender , and the use of assistive devices . With new techniques in THA , most of patients return to normal times within the 2-week PURPOSE The purpose of the study was to quantify the amount of agreement among orthopaedic surgeons regarding the natural history of the anterior cruciate ligament (ACL)-deficient knee , surgery , and rehabilitation , and the treatment of these patients . TYPE OF STUDY Physician mail survey . METHODS Orthopaedic surgeons were r and omly selected from the American Academy of Orthopaedic Surgeons ( AAOS ) directory . Only individuals who treated or referred ACL-insufficient patients for treatment within the past year were asked to complete the 3-page survey . The survey included 25 questions regarding clinical opinion . Clinical agreement was present when 80 % or more of the surgeons agreed on the same response option . RESULTS The total number of surgeons who responded to the survey was 397 ( response rate , 54.8 % ) and the number who had treated or referred ACL-insufficient patients in the past year was 261 . Among surgeons who completed the question naire , the response rates to the individual questions ranged from 92 % to 100 % . The mean response rate for all questions was 97.4 % . The mean age of the surgeons was 48.4 years , and 35.8 % considered their practice to be a subspecialty in sports medicine or knee surgery . For 12 questions ( 48 % ) , there was clinical disagreement among the surgeons . Surgical volume was associated with clinical opinion for 16 of 25 questions ( P < or = .05 ) . CONCLUSIONS Significant variation is seen in clinical opinion and decision-making regarding ACL injuries among members of the AAOS , particularly regarding whether ACL-deficient patients can participate in all recreational sports activities , that ACL reconstruction reduces the rate of arthrosis , and on the use of braces in the postoperative period . Additionally , surgeons disagreed on the effect of 4 patient characteristics ( age over 40 , presence of pain , irreparable meniscal tear , injury involving Workers ' Compensation ) on the decision to perform surgery . Areas of significant clinical uncertainty should be the focus of future research and medical education for orthopaedic surgeons who treat ACL injuries Background . No long-term studies have been reported on the effect of training programs on driving after stroke . Objectives . The authors ’ primary aim was to determine the effect of simulator versus cognitive rehabilitation therapy on fitness-to-drive at 5 years poststroke . A second aim was to investigate differences in clinical characteristics between stroke survivors who resumed and stopped driving . Methods . In a previously reported r and omized controlled trial , 83 stroke survivors received 15 hours of simulator training  ( n = 42 ) or cognitive therapy ( n = 41 ) . In this 5-year follow-up study , 61 participants were reassessed . Fitness-to-drive decisions were obtained from medical , visual , neuropsychological , and on-road tests ; 44 participants ( simulator group , n = 21 ; cognitive group , n = 23 ) completed all assessment s. The primary outcome measures were fitness-to-drive decision and current driving status . Results . The authors found that 5 years after stroke , 18 of 30 participants ( 60 % ) in the simulator group were considered fit to drive , compared with 15 of 31 ( 48 % ) in the cognitive group ( P = .36 ) ; 34 of 61 ( 56 % ) participants were driving . Current drivers were younger ( P = .04 ) , had higher Barthel scores ( P = .008 ) , had less comorbidity ( P = .01 ) , and were less severely depressed ( P = .02 ) than those who gave up driving . Conclusions . The advantage of simulator-based driving training over cognitive rehabilitation therapy , evident at 6 months poststroke , had faded 5 years later . Poststroke drivers were younger and less severely affected and depressed than nondrivers Study Design Post hoc analysis of prospect i ve , r and omized trial . Objective To investigate the disability associated with driving and single-level degenerative , cervical disc disease and to investigate the effect of surgery on driving disability . Methods Post hoc analysis of data obtained from three sites participating in a multicenter , r and omized , controlled trial comparing cervical disc arthroplasty ( TDA ) with anterior cervical discectomy and fusion ( ACDF ) .  The driving subscale of the Neck Disability Index ( NDI ) was analyzed for all patients . A dichotomous severity score was created from the NDI . Statistical comparisons were made within and between groups . Results Two-year follow-up was available for 118/135 ( 87 % ) patients . One half of the study population ( 49.6 % ) reported moderate or severe preoperative driving difficulty . This disability associated with driving was similar among the two groups ( ACDF : 2.5 ± 1.1 , TDA : 2.6 ± 1.0 , p = 0.646 ) . The majority of patients showed improvement , with no or little driving disability , at the sixth postoperative week ( ACDF : 75 % , TDA : 90 % , p = 0.073 ) . At no follow-up point did a difference exist between groups according to the severity index . Conclusions Many patients suffering from radiculopathy or myelopathy from cervical disc disease are limited in their ability to operate an automobile . Following anterior cervical spine surgery , most patients are able to return to comfortable driving at 6 weeks
Observer-reported outcome measures showed that patients ’ driving abilities often are impaired when wearing an immobilizing cast above or below the elbow or a shoulder sling on their dominant arm .
Conclusions The available evidence provides a best-case scenario for when patients can return to driving .
Survey data suggest that patients are returning to driving before observer-reported outcome measures have normalized , indicating that physicians should tell patients to wait longer before driving .
Background Patients often ask their doctors when they can safely return to driving after orthopaedic injuries and procedures , but the data regarding this topic are diverse and sometimes conflicting .
Some studies provide observer-reported outcome measures , such as brake response time or simulators , to estimate when patients can safely resume driving after surgery , and patient survey data describing when patients report a return to driving , but they do not all agree .
We performed a systematic review and quality appraisal for available data regarding when patients are safe to resume driving after common orthopaedic surgeries and injuries affecting the ability to drive .
Questions / purpose sBased on the available evidence , we sought to determine when patients can safely return to driving after ( 1 ) lower extremity orthopaedic surgery and injuries ; ( 2 ) upper extremity orthopaedic surgery and injuries ; and ( 3 ) spine surgery .