Effect of Variable Lower Extremity Immobilization Devices on Emergency Brake Response Driving Outcomes

doi:10.1053/j.jfas.2016.05.010

The Journal of Foot and Ankle Surgery

Volume 55, Issue 5, September–October 2016, Pages 999-1002

https://doi.org/10.1053/j.jfas.2016.05.010 Get rights and content

Abstract

The effect of lower extremity pathologic features and surgical intervention on automobile driving function has been a topic of contemporary interest in the orthopedic medical literature. The objective of the present case-control investigation was to assess 3 driving outcomes (i.e., mean emergency brake response time, frequency of abnormally delayed brake responses, and frequency of inaccurate brake responses) in a group of participants with 3 variable footwear conditions (i.e., regular shoe gear, surgical shoe, and walking boot). The driving performances of 25 participants without active right-sided lower extremity pathology were evaluated using a computerized driving simulator. Both the surgical shoe (0.611 versus 0.575 second; p < .001) and the walking boot (0.736 versus 0.575 second; p < .001) demonstrated slower mean brake response times compared with the control shoe gear. Both the surgical shoe (18.5% versus 2.5%; p < .001) and the walking boot (55.5% versus 2.5%; p < .001) demonstrated more frequent abnormally delayed brake responses compared with the control shoe gear. The walking boot (18.0% versus 2.0%; p < .001) demonstrated more frequent inaccurate brake responses compared with the control shoe gear. However, the surgical shoe (4.0% versus 2.0%; p = .3808) did not demonstrate a difference compared with the control shoe gear. The results of the present investigation provide physicians working with the lower extremity with a better understanding on how to assess the risk and appropriately advise their patients who have been prescribed lower extremity immobilization devices with respect to the safe operation of an automobile.

Section snippets

Patients and Methods

With approval from our institutional review board (Temple University; protocol no. 23148), the braking performances of participants were evaluated with a computerized driving simulator (Stationary Simple Reaction Timer; Vericom Computers, Inc., Rogers, MN). This device has previously been used to evaluate the brake response times in the setting of lower extremity impairment, and it measures to a precision of 0.01 second (9). The simulator consists of a laptop computer, steering wheel, and

Results

The data were collected from 25 participants (11 males), with a mean age ± standard deviation of 25.9 ± 3.2 years (range 22 to 37). The mean ± standard deviation brake response time of the participants in their regular shoe gear (n = 200 total braking trials) was 0.575 ± 0.063 second (range 0.45 to 0.74). Five of these 200 trials (2.5%) were defined as “abnormally delayed,” and 4 (2.0%) were defined as “inaccurate.” The mean ± standard deviation brake response time of the participants in the

Discussion

The results of the present investigation provide physicians working with the lower extremity with a better understanding on how to assess the risk and appropriately advise their patients who have been prescribed lower extremity immobilization devices with respect to the safe operation of an automobile.

Compared with their regular shoe gear, the participants demonstrated significantly slower mean brake response times and more frequent “abnormally delayed” brake responses wearing both the surgical

References (35)

R.S. Gotlin et al.
Measurement of brake response time after right anterior cruciate ligament reconstruction
Arthroscopy
(2000)
B. Meikle et al.
Driving pedal reaction times after right transtibial amputations
Arch Phys Med Rehabil
(2006)
J.C. Murray et al.
Effects of right lower limb orthopedic immobilization on braking function: an on-the-road experimental study with healthy volunteers
J Foot Ankle Surg
(2015)
D. Dammerer et al.
Effect of knee brace type of braking response time during automobile driving
Arthroscopy
(2015)
O.A. Von Arx et al.
Driving whilst plastered: is it safe, is it legal? A survey of advice to patients given by orthopaedic surgeons, insurance companies and the police
Injury
(2004)
C. Boulias et al.
Return to driving after lower-extremity amputation
Arch Phys Med Rehabil
(2006)
D.J. Cox et al.
Diabetes and driving safety: science, ethics, legality and practice
Am J Med Sci
(2013)
M. Levasseur et al.
Awareness tool for safe and responsible driving (OSCAR): a potential educational intervention for increasing interest, openness and knowledge about the abilities required and compensatory strategies among older drivers
Traffic Inj Prev
(2015)
G. Holt et al.
Emergency brake response time after first metatarsal osteotomy
J Bone Joint Surg Am
(2008)
K.A. Egol et al.
Lower-extremity function for driving an automobile after operative treatment of ankle fracture
J Bone Joint Surg Am
(2003)

C.L. Jeng et al.

Driving brake reaction time following right ankle arthrodesis

Foot Ankle Int

(2011)

M.C. Liebensteiner et al.

Brake response time before and after total knee arthroplasty: a prospective cohort study

BMC Musculoskelet Disord

(2010)

W. MacDonald et al.

The effect of total hip replacement on driving reactions

J Bone Joint Surg Br

(2008)

M.C. Liebensteiner et al.

Driving reaction time before and after primary fusion of the lumbar spine

Spine (Phila Pa 1976)

(2010)

K.A. Egol et al.

Braking function after complex lower extremity trauma

J Trauma

(2008)

P.G. Talusan et al.

Driving reaction times in patients with foot and ankle pathology before and after image-guided injection: pain relief without improved function

Foot Ankle Spec

(2015)

U.K. Hofmann et al.

Osteoarthritis of the knee or hip significantly impairs driving ability (cross-sectional survey)

BMC Musculoskelet Disord

(2014)

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Citation Excerpt :
Ultimately, they recommended that no patient should be allowed to drive when immobilized in a short leg cast, CAM boot, or with a left-foot driving adaptor.29 A study by Sansosti and colleagues30 assessed the effect of lower extremity immobilization on emergency braking response in 25 healthy participants. This was a young group of patients (25 ± 3.2 years) who were evaluated with different forms of immobilization to include a regular shoe, surgical shoe, or walking boot.
Reaction Time and Brake Pedal Depression Following Arthroscopic Hip Surgery: A Prospective Case-Control Study
2018, Arthroscopy - Journal of Arthroscopic and Related Surgery
Citation Excerpt :
National organizations outside the United States have variably estimated a normal BRT cutoff of between 700 and 1,500 msec.27 This variability likely explains divergent definitions of normal BRT given in orthopaedic studies, which range anywhere from 600 to 1,500 msec.5,16,22,26,27,31,33 In this context, it is difficult to interpret the absolute values for BRT in various studies, since in the vast majority of studies they fall well below these arbitrarily defined cutoffs.
The purpose of this study was to determine whether patients diagnosed with femoroacetabular impingement (FAI) syndrome have prolonged braking times compared with age- and gender-matched controls and how long after surgery braking times return to preoperative baseline.
Fifty-nine patients undergoing arthroscopic hip surgery for FAI and 59 age- and gender-matched controls without FAI were enrolled in a prospective comparative study between September 2015 and October 2016. Total brake reaction time (BRT) and brake pedal depression (BPD) were measured for study patients preoperatively, and at 2, 4, and 6 weeks postoperatively. BRT and BPD were compared between study and control patients and between preoperative and postoperative time periods, using mixed effects models.
Patients with FAI had significantly prolonged BRT (but not BPD) prior to surgery compared with controls (568 vs 520 msec, P = .002). For study patients undergoing left hip surgery, there was no difference in BRT or BPD between preoperative measurements and any postoperative time point, including the first postoperative appointment at 2 weeks (563 vs 566 msec, P = .89). Patients undergoing right hip surgery had significantly prolonged BRT at 2 weeks postoperatively compared with their preoperative baseline (688 vs 573 msec, P < .001). By 4 weeks postoperatively, study patients undergoing right hip surgery had returned to their preoperative baseline (573 vs 594 msec, P = .28). No significant effect was seen based on visual analog scale pain score, opiate usage, or patient-reported outcome scores.
Patients undergoing arthroscopic surgery of the right hip show significantly prolonged BRT until 4 weeks after surgery, while patients undergoing surgery of the left hip show no postoperative impairment in either BRT or BPD. The clinical relevance of this measured difference (an increase in 10 feet of stopping distance at 60 miles per hour) remains an open question.
Level II, diagnostic, prospective.
U.S. State Driving Regulations Relevant to Foot and Ankle Surgeons
2017, Journal of Foot and Ankle Surgery
The effect of lower extremity pathology and surgery on automobile driving has been a topic of contemporary interest, because these conditions can be associated with impaired driving function. We reviewed the U.S. driving laws relative to foot and ankle patients, for the 50 U.S. states (and District of Columbia). We aimed to address the following questions relative to noncommercial driving regulations: does the state have regulations with respect to driving in a lower extremity cast, driving with a foot/ankle immobilization device, driving with acute or chronic lower extremity pathology or disability, those who have undergone foot and/or ankle surgery, and those with diabetes? Full state-specific answers to the preceding questions are provided. Most states had no explicit or specific regulations with respect to driving in a lower extremity cast, a lower extremity immobilization device, or after foot and/or ankle surgery. Most states asked about diabetes during licensing application and renewal, and some asked specifically about lower extremity neuropathy and amputation. Most did not require physicians to report their patients with potentially impaired driving function (Pennsylvania and Oregon excepted) but had processes in place to allow them to do so at their discretion. Most states have granted civil and/or criminal immunity to physicians with respect to reporting (or lack of reporting) of potentially impaired drivers. It is our hope that this information will be useful in the development of future investigations focusing on driving safety in patients with lower extremity dysfunction.
Return to driving post upper or lower extremity orthopaedic surgical procedures: a scoping review of current published literature
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Evaluation of driving fitness in patients with musculoskeletal disorders: A systematic review
2019, Unfallchirurg
A review of the effect of lower-extremity pathology on automobile driving function
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View all citing articles on Scopus

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: Conflict of Interest: None reported.

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Original ResearchEffect of Variable Lower Extremity Immobilization Devices on Emergency Brake Response Driving Outcomes

Abstract

Section snippets

Patients and Methods

Results

Discussion

Arthroscopy

Arch Phys Med Rehabil

J Foot Ankle Surg

Arthroscopy

Injury

Arch Phys Med Rehabil

Am J Med Sci

Traffic Inj Prev

Emergency brake response time after first metatarsal osteotomy

J Bone Joint Surg Am

Lower-extremity function for driving an automobile after operative treatment of ankle fracture

J Bone Joint Surg Am

Driving brake reaction time following right ankle arthrodesis

Foot Ankle Int

Brake response time before and after total knee arthroplasty: a prospective cohort study

BMC Musculoskelet Disord

The effect of total hip replacement on driving reactions

J Bone Joint Surg Br

Driving reaction time before and after primary fusion of the lumbar spine

Spine (Phila Pa 1976)

Braking function after complex lower extremity trauma

J Trauma

Driving reaction times in patients with foot and ankle pathology before and after image-guided injection: pain relief without improved function

Foot Ankle Spec

Osteoarthritis of the knee or hip significantly impairs driving ability (cross-sectional survey)

BMC Musculoskelet Disord

Original Research
Effect of Variable Lower Extremity Immobilization Devices on Emergency Brake Response Driving Outcomes