While patients recovering from orthopaedic surgery or musculoskeletal injury may be anxious to get back into their old routines, knowing when it’s safe to get behind the wheel of a car can be a complex decision, according to a recent press release from the American Academy of Orthopaedic Surgeons (AAOS). A discussion of the concerns of orthopaedic surgeons and patients alike, published in the December 2008 issue of The Journal of Bone and Joint Surgery, indicates that return-to-driving recommendations often vary.

“Deciding when a patient can return to driving is a difficult decision that may require information that is beyond what is commonly available to the treating physician,” says Edward Rodriquez, MD, PhD, an orthopaedic surgeon and instructor at Harvard University’s Beth Israel Deaconess Medical Center in Boston. “Driving is a multi-system task, and although we, as orthopaedic surgeons, may be able to tell when a limb is strong enough to endure the physical demands of driving, many times there are other concerns that vary from patient to patient.

“At the same time, not being able to drive can result in substantial inconvenience and financial hardship, so patients may be anxious to drive before they are really ready,” Dr. Rodriguez adds.

Currently no universally accepted guidelines exist to help determine when a patient is ready to drive after orthopaedic surgery or injury. Physical differences among patients and the extent of their different injuries make the formation of specific policies based on time after injury unlikely, and probably not very useful, Dr. Rodriguez says.

Only 19 states have a readily available testing procedure that a patient can follow once he or she has recovered from an orthopaedic injury or surgical care. Dr. Rodriguez says patients in some areas may be able to find occupational therapy centers that offer return-to-driving programs certified by the American Occupational Therapy Association, but those programs are not very common in most of the country.

Dr. Rodriguez offers the following advice for patients recovering from orthopaedic injury:

• Talk to your orthopaedic surgeon early in your treatment to determine how the recovery process will affect your ability to drive.
• Ask what steps surgeons take to make sure a patient is ready to return to driving and whether they recommend recertification.
• Ask about the existence of any state sponsored or private recertification programs in your area.
• Recognize that the recovery process may take longer than anticipated and plan accordingly.

“Above all, never be afraid to ask your orthopaedic surgeon about their process for helping patients return to driving,” Dr. Rodriguez says. “Those are perfectly valid questions, and should definitely be asked. The earlier you ask them, the sooner you can begin to make arrangements for retesting, if that’s necessary, and for alternate transportation while you’re in the recovery process.”

When state-sponsored or private systems for retesting or recertifying are not available, Dr. Rodriguez says patients may talk to their doctor about individual options to make the return to driving less stressful, including:

• Practice driving on less-traveled roads
• Practice driving in large parking lots
• Drive short distances until the patient is sure of his or her endurance and limitations

“A safe return to driving is very important to most patients, and good communication is key to deciding when the patient is ready to get back behind the wheel,” Dr. Rodriguez notes.