Return to Driving After Foot and Ankle Surgery

Abstract

Category: Ankle, Ankle Arthritis, Arthroscopy, Bunion, Sports Introduction/Purpose: The time frame for safe return to driving is an important question amongst physicians and patients following orthopaedic surgery of the right lower extremity. There is no universally validated foot and ankle psychometric test that confirms patients’ ability to safely return to driving after surgery. The purpose of the study is to report a novel, validated survey that can be used to confirm safe return to driving after orthopaedic surgery of the right foot and ankle. Methods: Patients that had undergone right achilles rupture repair, total ankle arthroplasty, and hallux valgus correction by four fellowship-trained foot and ankle surgeons were prospectively included over a trial period of 4 months. A four-question survey (see Figure 1) was administered at the 6 week post-operative office visit. Breaking reaction time (BRT) was then assessed using the Reaction Time Tester, Model RT-2 S (Advanced Therapy Products, Glen Allen, VA). A passing BRT for safe return to driving was considered 0.850 seconds. Statistical analysis was performed and Cronbach’s alpha was calculated to determine validity of the survey relative to BRT results. One hundred and twenty-two patients were included with ages ranging from 21 to 76 years (average 45 years). Results: One hundred and nine (89%) of 122 patients achieved a braking time of 0.850 seconds or less. Using time-to-event analysis, 95% of patients passed at 7.6 weeks. With a “strongly agree” or “agree” response to question 4, the survey predicts a 96% certainty of passing the BRT. At first, validating the psychometric test across all three procedures resulting in a poor Cronbach’s a of 0.6. When question 3 was removed from statistical analysis, the Cronbach’s alpha was 0.76 and the psychometric test was validated for all studied procedures. Upon calculating a composite score from the 3-question survey, the optimum threshold for a passing braking time was at least 10 points resulting in a very good AUC score of 0.948. Conclusion: This novel, three-question driving readiness survey can accurately predict a passing breaking reaction test. This provides foot and ankle surgeons with a valuable tool to objectively determine if a patient can safely return to driving after achilles repair, total ankle arthroplasty, and hallux valgus correction. Further study is required to determine whether patients who come to clinic weeks before their standard post-operative follow up appointment with the belief that they are ready to drive also pass the BRT. Additional validation of the survey would be valuable across other foot and ankle procedures.