On the Road to Recovery After Critical Illness

Recovery from critical illness is often prolonged and challenging due to a combination of acquired physical, psychological and cognitive impairments, which have been termed Post Intensive care syndrome (PICS). These impairments are common, slow to recover and have cumulative effects on patients' personal, social and financial wellbeing. An increasing awareness and recognition of PICS has prompted commitments to enhance multidisciplinary aftercare with the overall goal of improving patient-centred outcomes and health-related quality of life.

For many adult ICU survivors, resumption of driving is perceived as an important milestone in their recovery pathway. Driving is an advanced task reliant on complex physical and mental functioning. It also necessitates independence, self-confidence and motivation. As such clinicians may view the return to driving as an objective marker of recovery.

Furthermore, returning to drive accelerates resumption of "normal life", enablement of social interactions, hobbies, leisure activities, and most vitally, returning to work. This is not only because of its enabling effect on commuting to place of work. Approximately one million people in the UK are employed primarily as drivers, or are required to drive or operate motorised vehicles as part of their job. Thus driving after ICU is important for the UK economy as well as for patients' wellbeing and that of their loved ones. Reducing avoidable delay to driving ought therefore to be viewed as a low-cost high-impact intervention to enhance health-related quality of life.

Inclusion criteria

• Adult >18 years
• Severe critical illness and high risk PICS as defined by 72 hours or more of invasive mechanical ventilation in ICU
• Previously driving car in the 12 months prior to admission and currently holds UK category B driving licence (i.e.: car category)
• Able and willing to travel to Carshalton, Surrey and undergo full driving ability assessment and study follow up for a duration of 12 months
• Intention to resume driving, or has already resumed driving

Exclusion criteria

• DVLA-confirmed long term driving ineligibility (as per existing DVLA medical guidance)
• Invalid, revoked or expired driving licence
• Deemed unlikely to return to independent living status due to e.g.: severe neurological injury, advanced cancer, progressive/degenerative condition, or other
• High risk of illness recurrence or readmission to hospital
• Social or neuropsychiatric circumstances deemed likely to adversely study participation