Return to Driving After Lower-Extremity Amputation

Abstract

Boulias C, Meikle B, Pauley T, Devlin M. Return to driving after lower-extremity amputation. Objectives To study driving behaviors after major lower-extremity amputations and to determine which factors influence return to driving after amputation. Design A cross-sectional study. Setting Data were collected from patients attending an outpatient amputee and prosthetics clinic between February 2001 and September 2001. Participants A convenience sample (N=123). Inclusion criteria were: age greater than 18 years, unilateral or bilateral major lower-extremity amputation, minimum 1 year since prosthetic fitting, and active automobile driver within 6 months prior to amputation. Subjects had an average age of 63.4±12.1 years and were on average 6.8±8.3 years since amputation. Common causes for amputation were peripheral vascular disease (73.2%), trauma (13.8%), and tumor (12.2%). Interventions Not applicable. Main Outcome Measure Driving habits after lower-extremity amputation. Results Overall, 80.5% of participants were able to return to driving an average of 3.8 months after amputation, although the majority reported a decreased driving frequency. Female sex (odds ratio [OR]=.08; 95% confidence interval [CI], .02–.34), age of 60 years or greater (OR=.16; 95% CI, .03–.74), right-sided amputation (OR=.13; 95% CI, .03–.52), and preamputation driving frequency of less than every day (OR=.18; 95% CI, .05–.69) were all significantly related to a reduced likelihood of return to driving postamputation. Items that did not have a statistically significant association with return to driving included level of amputation, reason for amputation, preamputation automobile transmission, and accessibility to public transit. Subjects with left-sided amputation had significantly fewer concerns about driving, while those with a right amputation frequently required vehicle modifications (40.6%) or switch to a left-foot driving style for braking (81.3%) and accelerating (65.6%). Common barriers to return to driving included preference not to drive, fear and/or lack of confidence, and related medical conditions. Conclusions The majority of subjects with major lower-extremity amputation were able to return to driving after major lower-extremity amputation. Major automobile modifications are commonly performed by right-sided amputees. Several predictors of return to driving and barriers preventing return to driving were identified.