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 arnputation, 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 pre-amputation 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.