Abstract
We have previously demonstrated an abnormally delayed mean brake response time and
an increased frequency of abnormally delayed brake responses in a group of neuropathic
diabetic drivers compared with a control group of drivers with neither diabetes nor
lower extremity neuropathy. The objective of the present case-control study was to
compare the mean brake response time between neuropathic diabetic drivers with and
without specific diabetic foot pathology. The braking performances of the participants
were evaluated using a computerized driving simulator with specific measurement of
the mean brake response time and the frequency of abnormally delayed brake responses.
We analyzed a control group of 20 active drivers with type 2 diabetes, lower extremity
neuropathy, and no history of diabetic foot pathology and an experimental group of
20 active drivers with type 2 diabetes, lower extremity neuropathy, and a history
of diabetic foot pathology (ulceration, amputation, and/or Charcot neuroarthropathy)
from an urban U.S. podiatric medical clinic. Neuropathic diabetic drivers without
a history of specific foot pathology demonstrated an 11.11% slower mean brake response
time (0.790 ± 0.223 versus 0.711 ± 0.135 second; p < .001), with abnormally delayed reactions occurring at a similar frequency (58.13%
versus 48.13%; p = .0927). Both groups demonstrated a mean brake response time slower than a suggested
threshold of 0.70 second. The results of the present investigation provide evidence
that diabetic patients across a spectrum of lower extremity sensorimotor neuropathy
and foot pathology demonstrate abnormal automobile brake responses and might be at
risk of impaired driving function.
Level of Clinical Evidence
Keywords
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References
- Driving after orthopedic surgery.J Am Acad Orthop Surg. 2013; 21: 696-706
- Driving after orthopedic surgery.Orthopedics. 2013; 36: 469-474
- Resuming driving after a fracture of the lower extremity: a survey among Dutch (orthopaedic) surgeons.Injury. 2005; 36: 1365-1370
- “Doctor, when can I drive?”: a medical and legal view of the implications of advice after injury or operation.Injury. 1996; 27: 495-497
- Emergency brake response time after first metatarsal osteotomy.J Bone Joint Surg Am. 2008; 90: 1660-1664
- Braking function after complex lower extremity trauma.J Trauma. 2008; 65: 1435-1438
- Lower-extremity function for driving an automobile after operative treatment of ankle fracture.J Bone Joint Surg Am. 2003; 85: 1185-1189
- Brake response time before and after total knee arthroplasty: a prospective cohort study.BMC Musculoskelet Disord. 2010; 11: 267
- Measurement of brake response time after right anterior cruciate ligament reconstruction.Arthroscopy. 2000; 16: 151-155
- The effect of total hip replacement on driving reactions.J Bone Joint Surg Br. 2008; 70: 202-205
- Driving reaction time before and after primary fusion of the lumbar spine.Spine (Phila Pa 1976). 2010; 35: 330-335
- 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; 8: 107-111
- Driving brake reaction time following right ankle arthrodesis.Foot Ankle Int. 2011; 32: 896-899
- Effects of orthopaedic immobilization of the right lower limb on driving performance: an experimental study during simulated driving by healthy volunteers.J Bone Joint Surg Am. 2009; 91: 2860-2866
- Immobilisation of the knee and ankle and its impact on drivers’ braking times: a driving simulator study.J Bone Joint Surg Br. 2001; 93: 928-931
- Effects of right lower limb orthopedic immobilization on braking function: an on-the-road experimental study with healthy volunteers.J Foot Ankle Surg. 2015; 54: 554-558
- 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; 35: 883-887
- Ability to return to driving after major lower limb amputation.J Rehabil Med. 2012; 44: 19-23
- Return to driving after lower-extremity amputation.Arch Phys Med Rehabil. 2006; 87: 1183-1188
- Driving pedal reaction times after right transtibial amputations.Arch Phys Med Rehabil. 2006; 87: 390-394
- Diabetes and driving.Diabetes Care. 2012; 35: S81-S86
- Diabetes and driving.Diabetes Obes Metab. 2013; 15: 775-783
- Diabetes and driving safety: science, ethics, legality and practice.Am J Med Sci. 2013; 345: 263-265
- Implications of new European Union driving regulations on patients with type 1 diabetes who participated in the Diabetes Control and Complications trial.Diabet Med. 2013; 30: 616-619
- Diabetic driving studies—part 1: brake response time in diabetic drivers with lower extremity sensorimotor neuropathy.J Foot Ankle Surg. 2017; 56: 568-572
- Mechanisms and management of diabetic painful distal symmetrical polyneuropathy.Diabetes Care. 2013; 36: 2456-2465
- Lowering the risk of neuropathy, foot ulcers and amputations.Diabet Med. 1998; 15: S57-S59
- Risk factors for diabetic neuropathy and foot ulceration.Curr Diabetes Rep. 2001; 1: 202-207
- Surgical site infections after foot and ankle surgery: a comparison of patients with and without diabetes.Diabetes Care. 2011; 34: 2211-2213
- Motor dysfunction in diabetes.Diabetes Metab Res Rev. 2012; 28: 89-92
- Accelerated atrophy of lower leg and foot muscles—a follow-up study of long-term diabetic polyneuropathy using magnetic resonance imaging (MRI).Diabetologia. 2009; 52: 1182-1191
- Muscle strength in type 2 diabetes.Diabetes. 2004; 53: 1543-1548
- Diabetes and postural stability: review and hypothesis.J Mot Behav. 2009; 41: 172-190
- Mild diabetic neuropathy affects ankle motor function.Clin Biomech (Bristol, Avon). 2001; 16: 522-528
- Balance interventions for diabetic peripheral neuropathy: a systematic review.J Geriatr Phys Ther. 2011; 34: 109-116
- Foot and ankle sensory neuropathy, proprioception, and postural stability.J Orthop Sports Phys Ther. 1999; 29: 718-726
- Diabetic sensory neuropathy effect on ankle joint movement perception.Arch Phys Med Rehabil. 1996; 77: 453-460
- Postural instability in diabetic neuropathic patients at risk of foot ulceration.Diabet Med. 1997; 14: 296-300
- Study of auditory, visual reaction time and glycemic control (HBA1C) in chronic type II diabetes mellitus.J Clin Diagn Res. 2014; 8: BC11-BC13
- Simple reaction times and performance in the detection of visual stimuli of patients with diabetes.Comput Biol Med. 2010; 40: 591-596
- Reaction time in clinical diabetes mellitus.Indian J Physiol Pharmacol. 1984; 28: 311-314
- Meta-analysis on total braking time.Ergonomics. 1998; 41: 1129-1140
- How long does it take to stop? Methodological analysis of driver perception-brake times.Transport Hum Factors. 2000; 2: 195-216
- A practical two-step quantitative clinical and electrophysiological assessment for diagnosis and staging of diabetic neuropathy.Diabetes Care. 1994; 17: 1281-1289
- Prevalence of diabetic neuropathy in patients undergoing foot and ankle surgery.Foot Ankle Spec. 2012; 5: 97-101
- US policies to enhance older driver safety: a systematic review of the literature.J Aging Soc Policy. 2013; 25: 335-352
- 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; 16: 578-586
- International older driver consensus conference on assessment, remediation and counseling for transportation alternatives: summary and recommendations.Phy Occup Ther Geriatr. 2005; 23: 103-121
- Driving competence in older persons.Disabil Rehabil. 1994; 16: 149-161
- The relationship between self-regulation and driving-related abilities in older drivers: an exploratory study.Traffic Inj Prev. 2008; 9: 314-319
- Self-regulation of older drivers with cognitive impairment: a systematic review.Australas J Ageing. 2014; 33: 74-80
Article info
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
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