***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To determine the reliability of the road test performed by stroke patients . DESIGN Prospect i ve study of a 6-month predriving evaluation . SETTING Driving safety center in Belgium . PARTICIPANTS Thirty patients with sequelae of stroke . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Results of driving performance as judged by 2 assessors from the Center for Determination of Fitness to Drive and Car Adaptations ( CARA ) , in a car fitted with a video camera . A third assessor also evaluated all the video recordings .  Interrater reliability was evaluated by comparing results from real-life performance and video recording , as judged by the CARA assessors and video judgments between CARA assessors and the third assessor . RESULTS Most subitems of the road test showed more than 80 % scoring agreement between the various evaluations . Intraclass correlation coefficients ( ICCs ) of the items varied from -.08 to 1.0 . The ICC of the overall performance was.62 when real-life scores were compared with video evaluations and .80 in video versus video comparison . CONCLUSION The reliability of assessing overall performance of stroke patients in the road test is moderately high and better when assessed using the same evidence . Yet , the reliability of some items needs further attention Background : Neurologically impaired persons seem to benefit from driving-training programs , but there is no convincing evidence to support this notion . The authors therefore investigated the effect of simulator-based training on driving after stroke . Methods : Eighty-three first-ever subacute stroke patients entered a 5-week 15-hour training program in which they were r and omly allocated to either an experimental ( simulator-based training ) or control ( driving-related cognitive tasks ) group . Performance in off-road evaluations and an on-road test were used to assess the driving ability of subjects pre- and post-training . Outcome of an official predriving assessment administered 6 to 9 months poststroke was also considered . Results : Both groups significantly improved in a visual and many neuropsychological evaluations and in the on-road test after training . There were no significant differences between both groups in improvements from pre- to post-training except in the “ road sign recognition test ” in which the experimental subjects improved more . Significant improvements in the three-class decision ( “ fit to drive , ” “ temporarily unfit to drive , ” and “ unfit to drive ” ) were found in favor of the experimental group post-training . Academic qualification and overall disability together determined subjects that benefited most from the simulator-based driving training . Significantly more experimental subjects ( 73 % ) than control subjects ( 42 % ) passed the follow-up official predriving assessment and were legally allowed to resume driving . Conclusions : Simulator-based driving training improved driving ability , especially for well educated and less disabled stroke patients . However , the findings of the study may have been modified as a result of the large number of dropouts and the possibility of some neurologic recovery unrelated to training This paper compares the predictive value of the cognitive test battery developed at the Stroke Research Unit , City Hospital , Nottingham with existing assessment procedures . Subjects were referred from 3 stroke units ( Mansfield , Nottingham and Lincoln ) . Those who had been driving in the three months before the stroke , a minimum of 10 weeks previously , and had a full driving licence were considered . After a road test in a dual controlled , automatic vehicle on a set route around public roads , subjects were grade d by the instructor into pass or fail groups . Subjects were then r and omly allocated into two groups , one of which was tested on the stroke drivers screening assessment . In this group scores from the three tasks were used to predict the likelihood of passing a road test . Details of the tests were sent to the subjects doctors with recommendations as to the fitness to drive . The control group was just instructed to request the advice of their general practitioner . After six months subjects were contacted to ascertain the decisions on fitness to drive . The two types of assessment , cognitive and st and ard procedure were compared to determine which assessment method agreed most closely with the performance on the road tests . The results indicate that the stroke drivers screening assessment correctly predicted road performance significantly better than the st and ard procedure and that this was not due to chance A representation and interpretation of the area under a receiver operating characteristic ( ROC ) curve obtained by the " rating " method , or by mathematical predictions based on patient characteristics , is presented . It is shown that in such a setting the area represents the probability that a r and omly chosen diseased subject is ( correctly ) rated or ranked with greater suspicion than a r and omly chosen non-diseased subject . Moreover , this probability of a correct ranking is the same quantity that is estimated by the already well-studied nonparametric Wilcoxon statistic . These two relationships are exploited to ( a ) provide rapid closed-form expressions for the approximate magnitude of the sampling variability , i.e. , st and ard error that one uses to accompany the area under a smoothed ROC curve , ( b ) guide in determining the size of the sample required to provide a sufficiently reliable estimate of this area , and ( c ) determine how large sample sizes should be to ensure that one can statistically detect differences in the accuracy of diagnostic techniques BACKGROUND As the number of older adult drivers increases , distinguishing safe from unsafe older adult drivers will become an increasing public health concern . We report on the medical and functional factors associated with vehicle crashes in a cohort of Alabama drivers , 55 years old and older . METHODS This prospect i ve study involved 174 older adults , on whom demographic , medical , functional , and physical performance data were collected in 1991 . Subjects were then followed through 1996 for incident vehicle crashes . RESULTS Sixty-one subjects experienced between one and four police-reported vehicle crashes during the study period . Following adjustment for age , race , days driven per week , and gender , Cox proportional-hazards models showed the following variables to be associated with crash involvement : reported difficulty with yardwork or light housework ( relative risk [ RR ] = 2.1 ; 95 % confidence interval [ CI ] 1.1 , 4.0 ; p = .02 ) , or opening ajar ( RR = 3 . 1 ; 95 % CI 1.4 , 6.7 ; p = .004 ) ; at least one crash before 1991 ( RR = 2.1 ; 95 % CI 1.2 , 3.7 ; p = .008 ) ; using hypnotic medication ( RR = 2.9 ; 95 % CI 1.3 , 6.6 ; p = .01 ) ; self-reported stroke or transient ischemic attack ( RR = 2.7 ; 95 % CI 1.1 , 6.6 ; p = .03 ) ; scoring within the depressed range on the Geriatric Depression Scale ( RR = 2.5 ; 95 % CI 1.1 , 6.0 ; p = .03 ) , and failing the useful field-of-view test ( RR = 1.9 ; 95 % CI 1.0 , 3.5 ; p = .05 ) . CONCLUSIONS Variables related to function , medication use , affect , neurological disease , and visuocognitive skills were associated with vehicle crash involvement in this cohort . Our findings suggest that multifactorial assessment s are warranted to identify at-risk older drivers OBJECTIVES We sought to determine the criterion validity of the Useful Field of View ( UFOV ) assessment and Stroke Drivers ' Screening Assessment ( SDSA ) through comparison to the results of on-road assessment . METHOD This was a prospect i ve study with people with stroke . Outcome measures used were UFOV , SDSA , and the results of on-road assessment . RESULTS Both the results on UFOV  ( Divided Attention subtest , p<.01 ; Selective Attention subtest , p<.05 ) and SDSA ( p<.05 ) were significantly related to the recommendation from on-road assessment . The Divided Attention subtest of the UFOV had the highest sensitivity value ( 88.9 % ) . CONCLUSIONS UFOV and SDSA are valid assessment s of driving ability for stroke . The Divided Attention subtest of the UFOV can guide decision making of occupational therapists in stroke driver rehabilitation and in determining those who require further assessment on road because they pose a safety risk . Screening assists people with stroke to decide whether they are ready to have an on-road assessment 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 OBJECTIVE The aim of this prospect i ve study was to confirm the accuracy of a short assessment battery , used previously in a study to predict fitness-to-drive after stroke , in a new cohort of stroke survivors without severe deficits . DESIGN A prospect i ve study . SUBJECTS A total of 43 ( 39 men and 4 women ) consecutive survivors after stroke who were not severely impaired and who performed the pre-driving assessment , which included a st and ardized on-road test at the Belgian Road Safety Institute in Brussels , Belgium . On average , participants were 6 months post-stroke , independently ambulant with or without assistive devices , possessed valid drivers ' licenses and actively drove prior to stroke onset . METHODS Fitness-to-drive decisions based on performance in 15 tests of a full-scale assessment battery were predicted using only the scores from the 3 predictive tests previously identified . RESULTS When the discriminant equation from the previous study including performance in the 3 tests ( figure of Rey , visual neglect ( lateralized mean reaction time ) and on-road test ) was applied , 37 ( 86 % ) of the 43 participants were correctly predicted to pass or fail the pre-driving assessment . The sensitivity and specificity of the predictions were 77 % and 92 % , respectively . CONCLUSION This study shows that the short assessment battery is a good predictor of fitness-to-drive in stroke survivors with moderate physical and cognitive impairments UNLABELLED Crotty M , George S. Retraining visual processing skills to improve driving ability after stroke . OBJECTIVE To evaluate the effectiveness of retraining using the Dynavision on driving performance of people with stroke . DESIGN R and omized controlled trial . SETTING Outpatient rehabilitation clinic in Australia . PARTICIPANTS People with stroke ( N=26 ) referred for driving assessment . INTERVENTIONS Eligible participants were r and omized to either receive retraining with the Dynavision apparatus for 18 sessions or to receive no intervention and go onto a waitlist . MAIN OUTCOME MEASURES The primary outcome was an assessment of on-road ability . Secondary outcomes included measures of response speed , visual scanning , and self-efficacy . All assessment s were conducted by assessors blinded to group assignment . RESULTS No significant difference ( P=.223 ) was found between the intervention and control groups in results of on-road assessment in terms of pass or fail ; the primary outcome measure ; or the results on the secondary outcome measures of response speed , visual scanning , and self-efficacy . CONCLUSIONS In this small trial , training underlying skills ( such as executing a continuous wide scan , combining motor and visual processing into a motor response ) using the Dynavision apparatus did not improve the outcomes of an on-road assessment for people after strokes . Larger trials are needed to evaluate devices that cl aim to retrain underlying skills related to driving OBJECTIVE To compare the effectiveness of a visual attention retraining program using the Useful Field of View ( UFOV ) with a traditional visuoperception treatment program on the driving performance of clients with stroke . DESIGN R and omized controlled trial . SETTING Rehabilitation hospital located in Quebec , Canada . PARTICIPANTS Ninety-seven individuals referred for driving evaluation after a stroke . INTERVENTIONS Participants were r and omized to receive 20 sessions of either UFOV training of visual processing speed , divided attention , and selective attention or traditional computerized visuoperception retraining . MAIN OUTCOME MEASURES Subjects were evaluated with an on-road driving evaluation , visuoperception tests , and the Test of Everyday Attention . An occupational therapist unaware of group assignment conducted all evaluations . RESULTS Eighty-four participants completed the outcome evaluation . There were no significant differences between groups on any of the outcome measures . There was , however , almost a 2-fold increase ( 52.4 % vs 28.6 % ) in the rate of success on the on-road driving evaluation after UFOV training for subjects with right-sided lesions . CONCLUSIONS Rehabilitation that targets visual attention skills was not significantly more beneficial than traditional perceptual training in improving the outcome of an on-road driving evaluation . However , results suggest a potential improvement for subjects with right-sided lesions , indicating that training must target specific skills Object 
    Output:
    
Conclusions : The Road Sign Recognition , Compass , and TMT B are clinical ly administrable office-based tests that can be used to identify persons with stroke at risk of failing an on-road assessment .