The present study examined the influence of disease progression, cognitive deficits, awareness of deficit, and social influences on driving outcomes among individuals with MS. Seventy-eight pairs of MS patients and their significant others participated. Driving outcomes included driving status, miles driven per week, and driving incidents (including DMV records). Objective disease-related indices were obtained from patient medical records and cognitive functioning was assessed using a neuropsychological test battery. Unawareness of deficit was measured as the discrepancy between the patient's self-report of their functional abilities and their significant other's report of the patient's abilities. Information related to patients' driving habits and behaviors were collected using a driving questionnaire. Results indicate that the majority of patients with MS are driving, and this group of drivers includes some persons with meaningful deficits. Predictors of whether these patients were driving differed from predictors of how much and how safely these patients drove. Drivers were physically and cognitively healthier than non-drivers, they showed greater awareness of their deficits, and they reported fewer barriers to driving than non-drivers. Among drivers, both neuropsychological deficits and duration of illness were inversely related to miles driven; however, the patients' perceptions of social barriers to driving was the dominant predictor of how much the patients drive as well as how safely they drive. The most important finding indicates that awareness of deficit plays a special and important role in driving outcome among patients who continue to drive, because awareness moderates the tendency to invoke compensatory behaviors for acquired deficits, which in turn influences how much and how safely these patients drive. The present findings contribute to a limited body of research into the predictors of fitness to drive among individuals with MS. Patients who are unaware of their deficits and do not compensate for them are at increased risk for driving incidents. This finding raises an important dilemma regarding the goal of psychological interventions with MS as unawareness had been found to be beneficial to the emotional well-being of persons with MS. (Author/publisher)
Abstract