Physician Rating of Fitness-to-Drive in Multiple Sclerosis

Background:

In Belgium, individuals with multiple sclerosis (MS) are typically referred by their physician for an official fitness-to-drive assessment. The referrals usually include the physician’s judgment of the patient’s fitness-to-drive. At the assessment center, a standardized on-road assessment is administered as part of a comprehensive fitness-to-drive evaluation. The on-road assessor also makes a judgment of the patient’s fitness-to-drive after the test.

Objectives:

To determine the reliability between the physician’s judgment and that of the on-road assessor.

Methods:

Referring physicians and on-road assessors used the same three-class decision as outcome variable: (1) favorable, i.e. no substantial problems with on-road driving; (2) reserved, i.e. some concerns with on-road driving; and (3) unfavorable, i.e. serious concerns with on-road driving. The percentage agreement (p_o), weighted kappa (k_w), and prevalence and bias adjusted kappa (PABAK) between the physician's and assessor's judgment were determined using the data of 95 random individuals (mean age ± SD = 53 ± 12; 50 (55%) females). The referring physician was either a neurologist or general practitioner.

Results:

The on-road assessor found no concerns on road test in the majority of MS drivers (n = 87 (92%)). Six (6%) exhibited difficulties on the road that were of concern, and 2 (2%) were advised to discontinue driving based on the findings of the road test. The p_o between referring physicians and on-road assessors was 83% and the k_w was 0.11 (p = 0.21). The low k_w was likely the result of the uneven proportion in the three categories. The PABAK adjusted for the uneven distribution and showed a reliability coefficient of 0.76 (p < 0.0001). No differences were found in p_o between neurologists (83%) and general practitioners (88%, Fisher’s Exact = 0.56).

Conclusions:

In this sample of drivers with MS, physicians were most of the time accurate in their appraisal of their patients’ driving capabilities.