human
***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 show the possible effect of  left- and right-side total hip arthroplasty ( THA )  on the ability to perform an emergency stop when driving a car . DESIGN Inception cohort . SETTING A driving simulator using an actual car cabin , specifically developed for the experiment , was used for testing driving ability . PARTICIPANTS Patients ( N=40 ; 20 left-side THA/20 right-side THA )  were tested preoperatively and in increments of 8 days and 6 , 12 , and 52 weeks after surgery . INTERVENTIONS Left- and right-side THA . MAIN OUTCOME MEASURES Reaction time , movement time , total brake response time ( TBRT ) , and maximum brake force . RESULTS Eight days postoperatively , measurements on driving performance indicated a slight worsening for all outcome parameters in patients after left-side THA and considerably more worsening in patients after right-side THA . For both patient groups , significant improvements in outcome measures were noted during the 1-year follow-up . Brake force declined significantly in patients with left-side THA ( P=.012 ) and in patients after right-side THA ( P<.001 ) . A total of 35 % of the patients with right-side THA and 15 % with left-side THA could not meet the 600 ms TBRT threshold 6 weeks postoperatively . CONCLUSIONS Most patients who underwent right-side THA reached their preoperative baseline 6 weeks after surgery . Most of the patients with left-side THA showed no TBRT limitations 8 days postoperatively . Because of the patients ' highly individual rehabilitation course and considering the possible consequences of the premature resumption of driving a motor vehicle , individual examination and recommendation are necessary Doctors are frequently asked by patients whether it is safe to drive with an upper limb immobilised in a cast . In the literature there are no objective measurements of the effects of upper-limb immobilisation upon driving performance .  Eight healthy volunteers performed four 20-min driving circuits in a driving simulator ( STISIM 400W ) , circuits 1 and 4 without immobilisation and circuits 2 and 3 with immobilisation . Immobilisation involved a lightweight below-elbow cast with the thumb left free . Volunteers were r and omised to right or left immobilisation for circuit 2 , and the contralateral wrist was immobilised for circuit 3 . Circuits included urban and rural environments and specific hazards ( pedestrians crossing , vehicles emerging from a concealed entrance , traffic lights changing suddenly , avoidance of an oncoming vehicle in the driver 's carriageway ) . Limb immobilisation led to more cautious rural and urban driving , with less adjustment of speed and lateral road position than when unrestricted . However when responding to hazards immobilisation caused less safe driving , with higher speeds , a greater proximity to the hazard before action was taken and less steering adjustment . The effects of restriction upon performance were more prevalent and severe with right-arm immobilisation . Upper-limb immobilisation appears to have little effect on the ability to drive a car unchallenged , but to adversely affect responses to routine hazards . Advice on ability to drive safely should be cautious , as the impact of immobilisation appears to be more subtle and wide ranging than previously thought PROBLEM To develop appropriate assessment criteria to measure the performance of older drivers using an interactive PC-based driving simulator , and to determine which measures were associated with the occurrence of motor-vehicle crash . METHOD One hundred and twenty-nine older drivers residing in a metropolitan city volunteered to participate in this retrospective cohort study . Using the driving simulator , appropriate driving tasks were devised to test the older drivers , whose performances were assessed by 10 reliable assessment criteria . Logistic regression analysis was then undertaken to determine those criteria that influence the self-reported crash outcome . RESULTS As expected , driving skill of older drivers was found to decline with age . Over 60 % of the sample participants reported having at least one motor-vehicle crash during the past year . Adjusting for age in a logistic regression analysis , the cognitive abilities associated with the crash occurrence were working memory , decision making under pressure of time , and confidence in driving at high speed . SUMMARY The findings of this retrospective study indicated those individuals at inflated risk of vehicle crashes could be identified using the PC-based interactive driving simulator . Prospect i ve studies need to be undertaken to determine whether the driving simulator can predict future crash events . IMPACT ON INDUSTRY This study demonstrated an economical driving simulator approach to screen out problematic or unsafe older drivers before a more detailed but expensive road test is considered Patients undergoing total knee arthroplasty often ask when they can safely resume car driving . There is little evidence available on which physicians can rely when advising patients on this issue . In a prospect i ve study we assessed the brake response time of 24 patients admitted to the clinic for left total knee arthroplasty preoperatively and then 10 days after surgery . On each measurement day the patients performed two tasks , a simple and a complex brake response time task in a car simulator . Ten days after left TKA the brake response time for the simple task had decreased by 3.6 % ( p=0.24 ) , the reaction time by 3.1 % ( p=0.34 ) and the movement time by 6.6 % ( p=0.07 ) . However , the performance improvement was not statistically significant . Task complexity increased brake response time at both time points . A 5.8 % increase was significant ( p=0.01 ) at 10 days after surgery . Based on our results , we suggest that patients who have undergone left total knee arthroplasty may resume car driving 10 days after surgery as long as they drive a car with automatic transmission BACKGROUND The purpose of this study was to evaluate the effect of sling immobilization on driving performance with use of a driving simulator . METHODS This is a prospect i ve trial with a cohort of 21 healthy volunteers comparing their driving ability with and without sling immobilization on their dominant ( driving ) extremity . Multiple variables , including number of collisions , off-road excursions , and centerline crossings , were measured with a vali date d driving simulator . Trials were separated by 2 weeks to control for " adaptations " to the simulator . Statistical significance was found in collisions between sling and no-sling tests . RESULTS The total number of collisions for trial 1 ( no sling ) was 36 ( mean , 1.7 ± 1.2 ) compared with 73 ( 3.7 ± 1.6 ) ( P < .01 ) for trial 2 ( sling immobilization ) . Approximately 70 % of participants with upper extremity immobilization were involved in ≥3 collisions ; approximately 70 % of no-sling participants were involved in ≤2 collisions . There was no statistically significant difference between groups with respect to overall vehicle road position and control . CONCLUSION Sling immobilization of the dominant driving arm results in a decrease in driving performance and safety with respect to the number of collisions in a simulated driving circuit ( P < .01 ) . There were no significant differences in driving parameters that are indicative of overall vehicle position and control . The decrease in driving performance with respect to the number of collisions is likely to be related to the effect the immobilized arm has on effectively performing evasive maneuvers during hazardous driving conditions Study Design Prospect i ve study . Objective Surgeons ’ recommendations for a safe return to driving following cervical and lumbar surgery vary and are based on empirical data . Driver reaction time ( DRT ) is an objective measure of the ability to drive safely . There are limited data about the effect of cervical and lumbar surgery on DRT . The purpose of our study was to use the DRT to determine when the patients undergoing a spinal surgery  may safely return to driving . Methods We tested 37 patients ’ DRT using computer software . Twenty-three patients ( mean 50.5 ± 17.7 years ) received lumbar surgery , and 14 patients had cervical surgery ( mean 56.7 ± 10.9 years ) . Patients were compared with 14 healthy male controls ( mean 32 ± 5.19 years ) . The patients having cervical surgery were subdivided into the anterior versus posterior approach and myelopathic versus nonmyelopathic groups . Patients having lumbar spinal surgery were subdivided by decompression versus fusion with or without decompression and single-level versus multilevel surgery . The patients were tested preoperatively and at 2 to 3 , 6 , and 12 weeks following the surgery . The use of opioids was noted . Results Overall , the patients having cervical and lumbar surgery showed no significant differences between pre- and postoperative DRT ( cervical p = 0.49 , lumbar p = 0.196 ) . Only the patients having single-level procedures had a significant improvement from a preoperative DRT of 0.951 seconds ( st and ard deviation 0.255 ) to 0.794 seconds ( st and ard deviation 0.152 ) at 2 to 3 weeks ( p = 0.012 ) . None of the other subgroups had a difference in the DRT . Conclusions Based on these findings , it may be acceptable to allow patients having a single-level lumbar fusion who are not taking opioids to return to driving as early as 2 weeks following the spinal surgery OBJECTIVE Recommendations on safe driving after  anterior cruciate ligament ( ACL ) reconstruction  have been largely intuitive . We studied brake response time in patients who participated in outpatient rehabilitation after right ACL reconstruction .  DESIGN Prospect i ve , repeated measures design comparing 14 patients post-ACL reconstruction with 21 subjects with normal knees . INTERVENTIONS AND MAIN OUTCOME MEASURES The following measures were assessed every 2 weeks for 10 weeks :  brake response time , 6-meter walk time , knee range of motion , pain , and joint effusion . Statistical testing used analysis of covariance with repeated measures . Significant variables were analyzed separately and post hoc tests conducted using the least squares differences method . Both groups were compared with published norms from the American Automobile Association . RESULTS No significant gender differences across main effects were detected . Brake response times for men improved significantly after week 6 ( p < .05 ) and week 10 ( p < .01 ) . Brake response times for women in the ACL treatment group matched controls at 6 weeks . Six-meter walk times for control subjects were faster than those for the ACL group preoperatively ( 2.6 sec vs 5.5 sec ) , but equalized by week 6 . CONCLUSIONS After right ACL reconstruction , brake reaction times of rehabilitated men and women matched those of established controls after 4 to 6 weeks . Measuring brake response times during rehabilitation may ensure that individual patients return to driving in a safe and timely manner Study Design . Prospect i ve observational pilot study . Objective . To investigate the effect of  right and left radiculopathy on  driver reaction time ( DRT ) , and the effect of selective nerve root block ( SNRB ) on DRT . Summary of Background Data . The effect of many orthopedic procedures on DRT has already been assessed . To date the effect of radiculopathy and SNRB on DRT has not been studied . Methods .  DRTs  of 20 radiculopathic patients ( 10 right , 10 left ) were measured using a custom-built car simulator . Each patient was tested pre-SNRB , immediately post-SNRB , and 2 and 6 weeks post-SNRB . As controls 20 age- and sex-matched normal subjects were tested once . Full departmental , institutional , and ethical committee approval were obtained . Results . Mean DRT of the control group was 452 milliseconds . Mean DRT of patients with right or left radiculopathy pre-SNRB was 521 milliseconds ( P < 0.045 ) and 535 milliseconds ( P < 0.018 ) , respectively . In the right radiculopathic group , the measurements immediately post-SNRB , 2 weeks , and 6 weeks were 656 milliseconds ( P < 0.005 ) , 589 milliseconds ( P < 0.019 ) , and 564 milliseconds ( P < 0.10 ) , respectively . The delay immediately and at 2 weeks post-SNRB translates into an increase in stopping distance of 3.8 and 1.9 m , respectively at the speed of 100 km/h . In the left radiculopathic group , the measurements immediately post-SNRB , 2 weeks , and 6 weeks were 585 milliseconds ( P < 0.037 ) , 534 milliseconds , and 530 milliseconds , respectively . The delay immediately post-SNRB translates into an increase in stopping distance of 1.4 m at the speed of 100 km/h . Conclusion . The study identified significant DRTs ’ changes both in radiculopathy and after SNRB . Right and left radiculopathic patients should be advised about the possible changes in their DRTs post-SNRB . Future research with regard to the suitability for radiculopathic patients to drive and the best time to resume driving post-SNRB is needed Purpose Reduced driving reaction time ( DRT ) has already been studied in context with lumbar disc surgeries . Data on whether cervical spine pathologies impair driving abilities are still lacking . In addition , no return-to-driving recommendations after anterior cervical fusion procedures have been published . Therefore , we assessed DRT before and after anterior cervical discectomy and fusion . Methods We performed a prospect i ve study with 12 patients ( mean age 47.2 years ; female 7 , male 5 ) . DRT as well as arm and neck pain were evaluated before surgery , on the day before discharge from hospital and at the 4–6-week follow-up examinations . 31 healthy subjects were tested for DRT  as a control group . Results All patients showed significant improvement in DRT in the longitudinal course ( p < 0.05 ) . DRT was 601 ms ( median , IQR : 63 ) before surgery , which was reduced to 580 ms ( median , IQR : 112 ) on the day 
    Output:
    
agent
Observer-reported outcome measures showed that patients ’ driving abilities often are impaired when wearing an immobilizing cast above or below the elbow or a shoulder sling on their dominant arm .
Conclusions The available evidence provides a best-case scenario for when patients can return to driving .
Survey data suggest that patients are returning to driving before observer-reported outcome measures have normalized , indicating that physicians should tell patients to wait longer before driving .
***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 show the possible effect of  left- and right-side total hip arthroplasty ( THA )  on the ability to perform an emergency stop when driving a car . DESIGN Inception cohort . SETTING A driving simulator using an actual car cabin , specifically developed for the experiment , was used for testing driving ability . PARTICIPANTS Patients ( N=40 ; 20 left-side THA/20 right-side THA )  were tested preoperatively and in increments of 8 days and 6 , 12 , and 52 weeks after surgery . INTERVENTIONS Left- and right-side THA . MAIN OUTCOME MEASURES Reaction time , movement time , total brake response time ( TBRT ) , and maximum brake force . RESULTS Eight days postoperatively , measurements on driving performance indicated a slight worsening for all outcome parameters in patients after left-side THA and considerably more worsening in patients after right-side THA . For both patient groups , significant improvements in outcome measures were noted during the 1-year follow-up . Brake force declined significantly in patients with left-side THA ( P=.012 ) and in patients after right-side THA ( P<.001 ) . A total of 35 % of the patients with right-side THA and 15 % with left-side THA could not meet the 600 ms TBRT threshold 6 weeks postoperatively . CONCLUSIONS Most patients who underwent right-side THA reached their preoperative baseline 6 weeks after surgery . Most of the patients with left-side THA showed no TBRT limitations 8 days postoperatively . Because of the patients ' highly individual rehabilitation course and considering the possible consequences of the premature resumption of driving a motor vehicle , individual examination and recommendation are necessary Doctors are frequently asked by patients whether it is safe to drive with an upper limb immobilised in a cast . In the literature there are no objective measurements of the effects of upper-limb immobilisation upon driving performance .  Eight healthy volunteers performed four 20-min driving circuits in a driving simulator ( STISIM 400W ) , circuits 1 and 4 without immobilisation and circuits 2 and 3 with immobilisation . Immobilisation involved a lightweight below-elbow cast with the thumb left free . Volunteers were r and omised to right or left immobilisation for circuit 2 , and the contralateral wrist was immobilised for circuit 3 . Circuits included urban and rural environments and specific hazards ( pedestrians crossing , vehicles emerging from a concealed entrance , traffic lights changing suddenly , avoidance of an oncoming vehicle in the driver 's carriageway ) . Limb immobilisation led to more cautious rural and urban driving , with less adjustment of speed and lateral road position than when unrestricted . However when responding to hazards immobilisation caused less safe driving , with higher speeds , a greater proximity to the hazard before action was taken and less steering adjustment . The effects of restriction upon performance were more prevalent and severe with right-arm immobilisation . Upper-limb immobilisation appears to have little effect on the ability to drive a car unchallenged , but to adversely affect responses to routine hazards . Advice on ability to drive safely should be cautious , as the impact of immobilisation appears to be more subtle and wide ranging than previously thought PROBLEM To develop appropriate assessment criteria to measure the performance of older drivers using an interactive PC-based driving simulator , and to determine which measures were associated with the occurrence of motor-vehicle crash . METHOD One hundred and twenty-nine older drivers residing in a metropolitan city volunteered to participate in this retrospective cohort study . Using the driving simulator , appropriate driving tasks were devised to test the older drivers , whose performances were assessed by 10 reliable assessment criteria . Logistic regression analysis was then undertaken to determine those criteria that influence the self-reported crash outcome . RESULTS As expected , driving skill of older drivers was found to decline with age . Over 60 % of the sample participants reported having at least one motor-vehicle crash during the past year . Adjusting for age in a logistic regression analysis , the cognitive abilities associated with the crash occurrence were working memory , decision making under pressure of time , and confidence in driving at high speed . SUMMARY The findings of this retrospective study indicated those individuals at inflated risk of vehicle crashes could be identified using the PC-based interactive driving simulator . Prospect i ve studies need to be undertaken to determine whether the driving simulator can predict future crash events . IMPACT ON INDUSTRY This study demonstrated an economical driving simulator approach to screen out problematic or unsafe older drivers before a more detailed but expensive road test is considered Patients undergoing total knee arthroplasty often ask when they can safely resume car driving . There is little evidence available on which physicians can rely when advising patients on this issue . In a prospect i ve study we assessed the brake response time of 24 patients admitted to the clinic for left total knee arthroplasty preoperatively and then 10 days after surgery . On each measurement day the patients performed two tasks , a simple and a complex brake response time task in a car simulator . Ten days after left TKA the brake response time for the simple task had decreased by 3.6 % ( p=0.24 ) , the reaction time by 3.1 % ( p=0.34 ) and the movement time by 6.6 % ( p=0.07 ) . However , the performance improvement was not statistically significant . Task complexity increased brake response time at both time points . A 5.8 % increase was significant ( p=0.01 ) at 10 days after surgery . Based on our results , we suggest that patients who have undergone left total knee arthroplasty may resume car driving 10 days after surgery as long as they drive a car with automatic transmission BACKGROUND The purpose of this study was to evaluate the effect of sling immobilization on driving performance with use of a driving simulator . METHODS This is a prospect i ve trial with a cohort of 21 healthy volunteers comparing their driving ability with and without sling immobilization on their dominant ( driving ) extremity . Multiple variables , including number of collisions , off-road excursions , and centerline crossings , were measured with a vali date d driving simulator . Trials were separated by 2 weeks to control for " adaptations " to the simulator . Statistical significance was found in collisions between sling and no-sling tests . RESULTS The total number of collisions for trial 1 ( no sling ) was 36 ( mean , 1.7 ± 1.2 ) compared with 73 ( 3.7 ± 1.6 ) ( P < .01 ) for trial 2 ( sling immobilization ) . Approximately 70 % of participants with upper extremity immobilization were involved in ≥3 collisions ; approximately 70 % of no-sling participants were involved in ≤2 collisions . There was no statistically significant difference between groups with respect to overall vehicle road position and control . CONCLUSION Sling immobilization of the dominant driving arm results in a decrease in driving performance and safety with respect to the number of collisions in a simulated driving circuit ( P < .01 ) . There were no significant differences in driving parameters that are indicative of overall vehicle position and control . The decrease in driving performance with respect to the number of collisions is likely to be related to the effect the immobilized arm has on effectively performing evasive maneuvers during hazardous driving conditions Study Design Prospect i ve study . Objective Surgeons ’ recommendations for a safe return to driving following cervical and lumbar surgery vary and are based on empirical data . Driver reaction time ( DRT ) is an objective measure of the ability to drive safely . There are limited data about the effect of cervical and lumbar surgery on DRT . The purpose of our study was to use the DRT to determine when the patients undergoing a spinal surgery  may safely return to driving . Methods We tested 37 patients ’ DRT using computer software . Twenty-three patients ( mean 50.5 ± 17.7 years ) received lumbar surgery , and 14 patients had cervical surgery ( mean 56.7 ± 10.9 years ) . Patients were compared with 14 healthy male controls ( mean 32 ± 5.19 years ) . The patients having cervical surgery were subdivided into the anterior versus posterior approach and myelopathic versus nonmyelopathic groups . Patients having lumbar spinal surgery were subdivided by decompression versus fusion with or without decompression and single-level versus multilevel surgery . The patients were tested preoperatively and at 2 to 3 , 6 , and 12 weeks following the surgery . The use of opioids was noted . Results Overall , the patients having cervical and lumbar surgery showed no significant differences between pre- and postoperative DRT ( cervical p = 0.49 , lumbar p = 0.196 ) . Only the patients having single-level procedures had a significant improvement from a preoperative DRT of 0.951 seconds ( st and ard deviation 0.255 ) to 0.794 seconds ( st and ard deviation 0.152 ) at 2 to 3 weeks ( p = 0.012 ) . None of the other subgroups had a difference in the DRT . Conclusions Based on these findings , it may be acceptable to allow patients having a single-level lumbar fusion who are not taking opioids to return to driving as early as 2 weeks following the spinal surgery OBJECTIVE Recommendations on safe driving after  anterior cruciate ligament ( ACL ) reconstruction  have been largely intuitive . We studied brake response time in patients who participated in outpatient rehabilitation after right ACL reconstruction .  DESIGN Prospect i ve , repeated measures design comparing 14 patients post-ACL reconstruction with 21 subjects with normal knees . INTERVENTIONS AND MAIN OUTCOME MEASURES The following measures were assessed every 2 weeks for 10 weeks :  brake response time , 6-meter walk time , knee range of motion , pain , and joint effusion . Statistical testing used analysis of covariance with repeated measures . Significant variables were analyzed separately and post hoc tests conducted using the least squares differences method . Both groups were compared with published norms from the American Automobile Association . RESULTS No significant gender differences across main effects were detected . Brake response times for men improved significantly after week 6 ( p < .05 ) and week 10 ( p < .01 ) . Brake response times for women in the ACL treatment group matched controls at 6 weeks . Six-meter walk times for control subjects were faster than those for the ACL group preoperatively ( 2.6 sec vs 5.5 sec ) , but equalized by week 6 . CONCLUSIONS After right ACL reconstruction , brake reaction times of rehabilitated men and women matched those of established controls after 4 to 6 weeks . Measuring brake response times during rehabilitation may ensure that individual patients return to driving in a safe and timely manner Study Design . Prospect i ve observational pilot study . Objective . To investigate the effect of  right and left radiculopathy on  driver reaction time ( DRT ) , and the effect of selective nerve root block ( SNRB ) on DRT . Summary of Background Data . The effect of many orthopedic procedures on DRT has already been assessed . To date the effect of radiculopathy and SNRB on DRT has not been studied . Methods .  DRTs  of 20 radiculopathic patients ( 10 right , 10 left ) were measured using a custom-built car simulator . Each patient was tested pre-SNRB , immediately post-SNRB , and 2 and 6 weeks post-SNRB . As controls 20 age- and sex-matched normal subjects were tested once . Full departmental , institutional , and ethical committee approval were obtained . Results . Mean DRT of the control group was 452 milliseconds . Mean DRT of patients with right or left radiculopathy pre-SNRB was 521 milliseconds ( P < 0.045 ) and 535 milliseconds ( P < 0.018 ) , respectively . In the right radiculopathic group , the measurements immediately post-SNRB , 2 weeks , and 6 weeks were 656 milliseconds ( P < 0.005 ) , 589 milliseconds ( P < 0.019 ) , and 564 milliseconds ( P < 0.10 ) , respectively . The delay immediately and at 2 weeks post-SNRB translates into an increase in stopping distance of 3.8 and 1.9 m , respectively at the speed of 100 km/h . In the left radiculopathic group , the measurements immediately post-SNRB , 2 weeks , and 6 weeks were 585 milliseconds ( P < 0.037 ) , 534 milliseconds , and 530 milliseconds , respectively . The delay immediately post-SNRB translates into an increase in stopping distance of 1.4 m at the speed of 100 km/h . Conclusion . The study identified significant DRTs ’ changes both in radiculopathy and after SNRB . Right and left radiculopathic patients should be advised about the possible changes in their DRTs post-SNRB . Future research with regard to the suitability for radiculopathic patients to drive and the best time to resume driving post-SNRB is needed Purpose Reduced driving reaction time ( DRT ) has already been studied in context with lumbar disc surgeries . Data on whether cervical spine pathologies impair driving abilities are still lacking . In addition , no return-to-driving recommendations after anterior cervical fusion procedures have been published . Therefore , we assessed DRT before and after anterior cervical discectomy and fusion . Methods We performed a prospect i ve study with 12 patients ( mean age 47.2 years ; female 7 , male 5 ) . DRT as well as arm and neck pain were evaluated before surgery , on the day before discharge from hospital and at the 4–6-week follow-up examinations . 31 healthy subjects were tested for DRT  as a control group . Results All patients showed significant improvement in DRT in the longitudinal course ( p < 0.05 ) . DRT was 601 ms ( median , IQR : 63 ) before surgery , which was reduced to 580 ms ( median , IQR : 112 ) on the day 
    Output:
    