Driving ability among people with stroke : developing assessments and exploring the lived-experience. Thesis Karolinska Institutet, Stockholm.

The overall aim of this thesis was to explore and describe methods for assessing driving ability and awareness of driving disability following stroke, and to explore and describe the lived-experience of driving ability in the process of a driving evaluation. The thesis included four studies. In Study I people with stroke drove in a driving simulator and the focus was to investigate aspects of validity and stability of a newly developed assessment tool, PDrive, using Rasch statistics. In Study II people with stroke who had previously conducted a driving test in a driving simulator and had difficulties driving safely participated. The aim was to investigate awareness of driving disability. In Study III four men with stroke were interviewed during their driving evaluations. The aim was to explore and describe the lived-experience of driving ability in the context of being in the process of a driving evaluation using a phenomenological approach. In Study IV participants were people with stroke, dementia and mild cognitive impairments. The participants took an on-road driving test and the aim was to determine aspects of validity and reliability of P-Drive (on-road version), using Rasch statistics. In conclusion, the results of Studies I and IV indicated that P-Drive (two new versions) was an assessment tool that was valid and reliable for assessing driving ability in people with stroke in a driving simulator or on-road, respectively. Both versions of P-Drive demonstrated evidence of internal scale validity, person response validity and also acceptable levels of person separation reliability. In Study II lack of awareness of driving disability was evident since the majority of the drivers who failed the simulator test also had limited awareness of their disability. In Study III the participants experienced their driving ability as unaffected by the onset of stroke, and driving ability was taken for granted. Limited awareness of disability was indicated since participants were driving despite recommendations not to drive. The results (Study III) also increased our knowledge about the negative feelings that could be aroused by driving cessation and evaluation. (Author/publisher)