Stroke Recurrence among Stroke Patients Referred for Driving Assessment and Rehabilitation

Most stroke survivors ask the same question, and they ask it early: Can I drive again?

For working adults and parents, this is not a comfort issue. Driving is how they get to work, collect children, and care for ageing parents. Losing it reshapes daily life. Yet the conversation is often avoided — on both sides. The survivor dreads the answer. The clinician is unsure how much risk to sanction.

A 2023 Singapore study gives both parties something more concrete to work with.

What the TTSH Study Found

Researchers examined stroke survivors referred to the Tan Tock Seng Hospital Driving Assessment and Rehabilitation Programme (DARP) — an occupational therapist-led programme for evaluating and supporting return to driving after stroke.

Over a median follow-up of 30 months, 11.3% of participants had a recurrent stroke.

That is just over one in ten patients across two and a half years. Not trivial — but considerably lower than most clinicians and families tend to assume.

The more striking finding: over a period of 30 months, no participant was involved in a collision with another driver — the accident scenario families worry about most. For anyone who has sat through the return-to-driving conversation with an anxious family, that matters.

Age Is the Variable That Changes Everything

The study found that patients aged 60 and above had approximately four times the recurrence risk of younger survivors.

For survivors under 60, the picture is quite different. This group also tends to have the most pressing occupational reasons to return to driving — work, family, caregiving. The data supports moving them toward formal assessment promptly, rather than defaulting to an open-ended hold.

For older survivors, higher risk does not automatically mean no driving. It means structured, repeated assessment — not a single clearance decision and nothing further.

Why OT-Led Assessment Is the Right Model

Driving after stroke is not simply a medical clearance question. It is a functional one.

Driving draws simultaneously on cognition, visual perception, reaction time, motor control, and real-time judgement. A neurologist can identify what the stroke affected. An occupational therapist evaluates how those effects translate into actual task performance — which is a different question.

The OT-led driving assessment framework combines off-road clinical evaluation with on-road assessment where appropriate, and can include compensatory strategy training or vehicle modification recommendations. It is a rehabilitation pathway, not just a tick-box.

At Lifeweavers, driving assessments are conducted by our occupational therapists within the broader context of each client’s post-stroke rehabilitation goals.

What This Means for Clinicians

Stroke survivors often push for a return to driving before clinical teams feel confident clearing them. And unnecessarily prolonged driving cessation carries real costs — social isolation, job loss, reduced access to community participation, and the downstream effect on rehabilitation motivation.

The TTSH data offers a more calibrated starting point. Recurrence risk is real, but lower than commonly assumed. It is strongly age-stratified. And a structured OT-led assessment pathway appears to be a safe route forward — as the zero multi-vehicle collision figure over 30 months suggests.

The question for rehabilitation teams is not whether to assess. It is when and how.

A Note on the Study’s Scope

The cohort was drawn from patients already referred to a driving assessment programme — meaning the most severely affected survivors had likely been excluded before referral. Keep that selection effect in mind when reading the recurrence and collision figures. The findings are reassuring within their context. They are not a blanket statement about every post-stroke driver.

What they do support is structured, OT-led assessment as the appropriate mechanism for making that determination.

Frequently Asked Questions

Can I drive again after a stroke? It depends on how the stroke has affected your cognition, vision, and motor function. A formal driving assessment with an occupational therapist is the standard pathway for finding out.

How soon after a stroke can I drive? In Singapore, the Land Transport Authority (LTA) requires notification of medical conditions that affect driving. Most clinicians recommend at least one month of abstinence before formal reassessment, though the right timeline varies by individual recovery.

What happens during a driving assessment after stroke? An OT-led assessment typically covers cognition, visual fields, reaction time, and limb function — off-road first, then on-road where appropriate. The outcome may be clearance, restriction, a rehabilitation plan, or vehicle modification advice.

What does the research say about recurrent stroke risk while driving? The 2023 TTSH study found an 11.3% recurrence rate over a median 30 months among stroke survivors assessed through a structured driving programme. Survivors aged 60 and above had roughly four times the risk of younger survivors. No participants were involved in multi-vehicle collisions.

Does age affect the risk? Yes, significantly. The study found a fourfold difference in recurrence risk between those aged 60 and above and younger survivors. Higher risk in older adults does not preclude driving — it calls for more structured, ongoing assessment rather than a single clearance decision.

Do occupational therapists do driving assessments? Yes. Driving assessment and rehabilitation after stroke is a recognised area of OT practice. OTs evaluate the functional skills needed for safe driving and can support return through assessment, intervention, and liaison with licensing authorities.