Agreement Between Physician Rating and On-Road Decision for Drivers with Multiple Sclerosis

The recommendation of the referring physician is paramount in the decision making process of fitness to drive for individuals with multiple sclerosis (MS). This medical advice is carefully considered by fitness to drive officials when making a final decision. In this study, the authors sought to determine the reliability between physician recommendation and decision of the on-road assessor in 95 individuals with MS. The percentage agreement (po) and prevalence and bias adjusted kappa (PABAK) were used as measures of reliability. The on-road assessor found no concerns on the road in 87 (92%) of the individuals; 6 (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 po between referring physician and on-road assessor was 83%. The PABAK showed a reliability coefficient of 0.76 (p < 0.0001). No differences were found in po between neurologists (83%) and general practitioners (88%, Fisher’s Exact = 0.56). Binocular acuity correlated significantly with the on-road driving decision (Spearman Rho = -0.30; p = 0.004). The authors conclude that, in this sample of drivers with MS, physicians were most of the time accurate in their appraisal of their patients’ driving capabilities.