Background/Purpose: Osteoarthritis (OA) and rheumatoid arthritis (RA) cause functional impairments that impact daily life activities, including automobile driving. Radiographic presence of OA on knee and hip imaging significantly affects braking response time, and use of vehicle adaptations is common in patients with RA. There is little information on the correlation of functional disability scores, particularly the HAQ-DI score, with driving impairment in OA and/or RA patients. Limited studies suggested that an HAQ-DI score ≥ 1 correlated to driving difficulty, but driving difficulties were also present in those with lower scores. Only three studies from Canada and Europe reported rates of physician counseling on driving difficulties (0-8%) in surveyed patients with RA. Rates of physician counseling on driving safety in OA and/or RA patients in the United States are unknown. Our study aims to address these information gaps by surveying patients with OA and/or RA on functional disability (HAQ-DI), driving habits and limitations, use of vehicle modifications, and whether counseling about driving safety by a healthcare professional has occurred. We hypothesize low rates of physician driving counseling, but suspect that patients with HAQ-DI scores ≥ 1 will have higher rates of counseling and vehicle modifications.

Methods: Participants were recruited and surveyed through the ResearchMatch Network, a national web-based recruitment tool maintained at Vanderbilt University Medical Center. A total of 4,435 patients with OA and/or RA were recruited; 304 (6.9%) respondents met screening criteria (held current US driver’s license and were at least 18 years old) and completed the electronic HAQ-DI and study specific survey. Data was dichotomized with HAQ-DI ≥ 1 as a cut point and was analyzed using chi-squared analysis.

Results: Of the 304 completed surveys, 17.1% were male, 82.2% female, and 0.7% other; 65.1% reported OA, 16.8% RA and 18.1% both.  The HAQ-DI score was ≥ 1 in 60.5%. Respondents with HAQ-DI ≥ 1 reported driving fewer miles each day that those with HAQ-DI ≤ 1 (p = 0.001), and greater level of difficulty with seven areas of driving activities (p ≤ 0.020 for each activity). Physicians inquired about driving safety in 6.3% and other healthcare providers inquired in 8.6% respondents, with no significant differences based on HAQ-DI scores. Respondents with HAQ-DI ≥ 1 more frequently made the following vehicle modifications: seat supports (26.1% vs 10.8%; p = 0.001), extra mirrors (10.9% vs 3.3%; p = 0.017), and padded steering wheels (25% vs 5%; p < 0.001).

Conclusion: Survey respondents with HAQ-DI ≥ 1 indicated significant disability and impairment with driving related activities and were more likely to report vehicular assistive modifications. Despite this, physician and other healthcare provider rates of driving counseling remain low. Increased physician inquiry into driving safety is needed in patients with OA and RA.  An HAQ-DI ≥ 1 could be considered as a screening tool to determine which patients may need more immediate counseling or vehicular modifications.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/counseling-on-safe-driving-strategies-in-patients-with-osteoarthritis-and-rheumatoid-arthritis/