Psychometric Properties of Vestibular and Ocular Measures Used for Concussion Assessments: A Scoping Review

BACKGROUND

Concussions most commonly affect the vestibular and ocular systems. Clinical measures used in the assessment of vestibular and ocular deficits should contain strong psychometric properties so that clinicians can accurately detect abnormality to guide treatment interventions.

OBJECTIVES

The aim of this scoping review was: (1) to identify the measures used to evaluate the vestibular and ocular domains postconcussion and (2) to document the psychometric properties of the measures.

METHODS

Two databases (Medline (Ovid) and Embase) were searched from inception to May 2023. An updated search was completed in January 2024 using the same databases and search terms. Studies were screened and data were extracted independently by 2 reviewers. Measures were categorized into vestibular, ocular, or both (vestibular and ocular) domains, and relevant psychometric properties were documented.

RESULTS

Fifty-two studies were included in this review. 28 studies explored the use of vestibular measures, 12 explored ocular measures, and 12 explored both vestibular and ocular measures or explored the use of vestibulo-ocular reflex measures. Most studies explored the properties associated with balance measures, particularly the balance error scoring system. Diagnostic accuracy (sensitivity and specificity metrics) of the associated measures was the most frequently documented characteristic in the literature.

CONCLUSION

Identification of clinical measures used to evaluate vestibular and ocular deficits postconcussion is needed to understand the evidence supporting their use in practice. Documenting the psychometric properties will allow clinicians and researchers to understand the status of the current literature and support for the use of certain measures in practice in terms of their ability to appropriately detect deficits in people with concussion when deficits are truly present.

Clinician-Prioritized Measures to Use in a Remote Concussion Assessment: Delphi Study

BACKGROUND

There is little guidance available, and no uniform assessment battery is used in either in-person or remote evaluations of people who are experiencing persistent physical symptoms post concussion. Selecting the most appropriate measures for both in-person and remote physical assessments is challenging because of the lack of expert consensus and guidance.

OBJECTIVE

This study used expert consensus processes to identify clinical measures currently used to assess 5 physical domains affected by concussion (neurological examination, cervical spine, vestibular, oculomotor, or effort) and determine the feasibility of applying the identified measures virtually.

METHODS

The Delphi approach was used. In the first round, experienced clinicians were surveyed regarding using measures in concussion assessment. In the second round, clinicians reviewed information regarding the psychometric properties of all measures identified in the first round by at least 15% (9/58) of participants. In the second round, experts rank-ordered the measures from most relevant to least relevant based on their clinical experience and documented psychometric properties. A working group of 4 expert clinicians then determined the feasibility of virtually administering the final set of measures.

RESULTS

In total, 59 clinicians completed survey round 1 listing all measures they used to assess the physical domains affected by a concussion. The frequency counts of the 146 different measures identified were determined. Further, 33 clinicians completed the second-round survey and rank-ordered 22 measures that met the 15% cutoff criterion retained from round 1. Measures ranked first were coordination, range of motion, vestibular ocular motor screening, and smooth pursuits. These measures were feasible to administer virtually by the working group members; however, modifications for remote administration were recommended, such as adjusting the measurement method.

CONCLUSIONS

Clinicians ranked assessment of coordination (finger-to-nose test and rapid alternating movement test), cervical spine range of motion, vestibular ocular motor screening, and smooth pursuits as the most relevant measures under their respective domains. Based on expert opinion, these clinical measures are considered feasible to administer for concussion physical examinations in the remote context, with modifications; however, the psychometric properties have yet to be explored.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/40446.

Reliability and Sensitivity of a Virtual Assessment Developed for Workplace Concussions: Protocol for a Method-Comparison Study

BACKGROUND

Workplace mild traumatic brain injuries are frequently associated with persistent symptoms, leading to a reduction in productivity at work or even disability. People who sustain workplace injuries frequently need rehabilitation and support, and the challenges of delivering these services was heightened during the COVID-19 pandemic as injured workers had to be cared for remotely. Currently, clinicians are conducting both in-person and virtual (remote) concussion assessments; however, the measures that are being used to complete these assessments have undocumented psychometric properties.

OBJECTIVE

This study will document the psychometric properties of the clinical measures that are being used remotely and their ability to produce similar results to in-person assessments. Specifically, through this method-comparison study, we aim to (1) evaluate the sensitivity of the measures included in a virtual assessment toolkit when compared to an in-person assessment and (2) determine the interrater and intrarater reliabilities of the measures included in a virtual assessment toolkit.

METHODS

Patient participants (people living with acquired brain injuries) will attend two assessments (in person and virtual) at the Ottawa Hospital. The two assessments will be identical, consisting of the measures included in our previously developed virtual concussion assessment toolkit, which includes finger-to-nose testing, the Vestibular/Ocular Motor Screening tool, balance testing, cervical spine range of motion, saccades testing, and evaluation of effort. All virtual assessments will occur using the Microsoft Teams platform and will be audio/video-recorded. The clinician assessor and patient participant will complete a feedback form following completion of the assessments. A different clinician will also document the findings on observed videos of the virtual assessment shortly after completion of both in-person and virtual assessments and approximately 1 month later. Interrater reliability will be assessed by comparing the second clinician's observation with the first clinician's initial virtual assessment. Intrarater reliability will be evaluated by comparing the second clinician's observation with their own assessment approximately 1 month later. Sensitivity will be documented by comparing the findings (identification of abnormality) of the in-person assessment completed by the initial clinician assessor with those of the second clinician assessor on the observation of the recording of the virtual assessment.

RESULTS

As of May 2024, we have recruited 7 clinician assessors and completed study assessments with 39 patient participants. The study recruitment is expected to be completed by September 2024.

CONCLUSIONS

Currently, it is unknown if completing concussion assessments virtually produces similar results to the in-person assessment. This work will serve as a first step to determining the similarity of the virtual assessment to the matching in-person assessment and will provide information on the reliability of the virtual assessment.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/57663.

What to Measure in Aneurysmal Subarachnoid Haemorrhage Research-An International Delphi Survey

Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating condition with high mortality and morbidity. The outcome measures used in aSAH clinical research vary making it challenging to compare and combine different studies. Additionally, there may be a mismatch between the outcomes prioritized by patients, caregivers, and health care providers and those selected by researchers. We conducted an international, online, multiple round Delphi study to develop consensus on domains (where a domain is a health concept or aspect) prioritized by key stakeholders including those with lived experience of aSAH, health care providers, and researchers, funders, or industry professionals. One hundred seventy-five people participated in the survey, 59% of whom had lived experience of aSAH. Over three rounds, 32 domains reached the consensus threshold pre-defined as 70% of participants rating the domain as being critically important. During the fourth round, participants ranked the importance of each of these 32 domains. The top ten domains ranked highest to lowest were (1) Cognition and executive function, (2) Aneurysm obliteration, (3) Cerebral infarction, (4) Functional outcomes including ability to walk, (5) Delayed cerebral ischemia, (6) The overall quality of life as reported by the SAH survivor, (7) Changes to emotions or mood (including depression), (8) The basic activities of daily living, (9) Vasospasm, and (10) ICU complications. Our findings confirm that there is a mismatch between domains prioritized by stakeholders and outcomes used in clinical research. Our future work aims to address this mismatch through the development of a core outcome set in aSAH research.

Achievement of Target Gain Larger than Unity in an Inertial Fusion Experiment

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G_{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G_{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

Older Drivers Reduced Engagement in Distracting Behaviors Over a Six-Year Period: Findings From the Candrive Longitudinal Study

OBJECTIVES

Baltes and Baltes' "selective optimization with compensation" model is pertinent to driving but evidence about the use of compensation using longitudinal designs is scarce. Therefore, we sought to determine if older drivers reduced their engagement in distracting behaviors while driving, over a 6-year period.

METHODS

We used data captured over several annual assessments from a cohort of 583 drivers aged 70 and older to determine if their engagement in 12 distracting behaviors (e.g., listening to the radio, talking with passengers) declined over time. We adjusted our multivariable model for several potential confounders of the association between our outcome variable and time.

RESULTS

Overall, and after adjustment for potential confounders, the participants reduced their engagement in distracting behaviors over the study period (odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.95-0.97). Baseline age was negatively associated with engagement in distracting behaviors (OR = 0.95, 95% CI = 0.94-0.96). Men engaged in more distracting behaviors than women (OR = 1.15, 95% CI = 1.03-1.27), as did participants living in the largest urban centers compared to participants living in the smallest areas (OR = 1.21, 95% CI = 1.04-1.41). The number of kilometers driven per year (for every 10,000 km) was positively associated with the proportion of distracting behaviors drivers engaged in (OR = 1.13, 95% CI = 1.08-1.19).

DISCUSSION

Drivers in our cohort reduced their engagement in distracting behaviors over the study period. This suggests that older drivers adjust their driving over time, which aligns with age-related theories and models about compensation.

Candrive-Development of a Risk Stratification Tool for Older Drivers

BACKGROUND

Assessing an older adult's fitness-to-drive is an important part of clinical decision making. However, most existing risk prediction tools only have a dichotomous design, which does not account for subtle differences in risk status for patients with complex medical conditions or changes over time. Our objective was to develop an older driver risk stratification tool (RST) to screen for medical fitness-to-drive in older adults.

METHODS

Participants were active drivers aged 70 and older from 7 sites across 4 Canadian provinces. They underwent in-person assessments every 4 months with an annual comprehensive assessment. Participant vehicles were instrumented to provide vehicle and passive Global Positioning System (GPS) data. The primary outcome measure was police-reported, expert-validated, at-fault collision adjusted per annual kilometers driven. Predictor variables included physical, cognitive, and health assessment measures.

RESULTS

A total of 928 older drivers were recruited for this study beginning in 2009. The average age at enrollment was 76.2 (standard deviation [SD] = 4.8) with 62.1% male participants. The mean duration for participation was 4.9 (SD = 1.6) years. The derived Candrive RST included 4 predictors. Out of 4 483 person-years of driving, 74.8% fell within the lowest risk category. Only 2.9% of person-years were in the highest risk category where the relative risk for at-fault collisions was 5.26 (95% confidence interval = 2.81-9.84) compared to the lowest risk group.

CONCLUSIONS

For older drivers whose medical conditions create uncertainty regarding their fitness-to-drive, the Candrive RST may assist primary health care providers when initiating a conversation about driving and to guide further evaluation.

The Association between Psychological Resilience and Driving Behavior among Older Drivers in Australia

This study compared a sample of Australian drivers aged 77 years and older to participants from an older driver longitudinal cohort study (Ozcandrive) and examined the relationship between resilience and self-reported driving measures within these samples. Using a survey with a subset of questions from Ozcandrive, data were collected from 237 older drivers throughout Australia. The two samples were analyzed for differences in demographics, health, resilience, and self-reported driving behavior. A series of multiple regression models were fit for each driving outcome measure for both samples. The two samples had both similarities and differences, with the largest difference observed for resilience. Strong and consistent associations were found between resilience and driving comfort, abilities, and frequency for the Australian sample. Across samples, resilience remained a significant variable in seven of 10 regression models, more than any other independent variable.

Physical Frailty and Functional Status in Patients With Advanced Chronic Kidney Disease: A Systematic Review

Background

With an aging population and growing number of patients with chronic kidney disease (CKD), integrating the latest risk factors when deciding on a treatment plan can result in better patient care. Frailty remains a prevalent syndrome in CKD resulting in adverse health outcomes. However, measures of frailty and functional status remain excluded from clinical decision making.

Objective

To examine the degree to which different measures of frailty and functional status are associated with mortality, hospitalization, and other clinical outcomes in patients with advanced CKD.

Design

Systematic review.

Setting

Observation studies including cohort study, case-control study, or cross-sectional study examining frailty and functional status on clinical outcomes. There were no restrictions on type of setting or country of origin.

Patients

Adults with advanced CKD, including both types of dialysis patients.

Measurements

Data including demographic information (e.g., sample size, follow-up time, age, country), assessments of frailty or functional status and their domains, and outcomes including mortality, hospitalization, cardiovascular events, kidney function, and composite outcomes were extracted.

Methods

A search was conducted using databases Medline, Embase, and Cochrane Central Register for Controlled Trials. Studies were included from inception to March 17, 2021. The eligibility of studies was screened by 2 independent reviewers. Data were presented by instrument and clinical outcome. Point estimates and 95% confidence intervals from the fully adjusted statistical model were reported or calculated from the raw data.

Results

A total of 117 unique instruments were found among 140 studies. The median sample size of studies was 319 (interquartile range, 161-893). Most studies focused on incident and chronic dialysis patient populations, with only 15% of studies examining non-dialysis CKD patients. Frailty and lower functional status were associated with an increased risk for adverse clinical outcomes such as mortality and hospitalization. The 5 individual domains of frailty were also found to be associated with poor health outcomes.

Limitations

Meta-analysis could not be performed due to significant heterogeneity between studies and methods used to measure frailty and functional status. Many studies had issues with methodological rigor. Selection bias and the validity of data collection could not be ascertained for some studies.

Conclusion

Frailty and functional status measures should be integrated to help guide clinical care decision making for a comprehensive assessment of risk for adverse outcomes among patients with advanced CKD.

Registration PROSPERO

CRD42016045251.

Remotely Supervised Exercise Programmes to Improve Balance, Mobility, and Activity Among People with Moderate to Severe Traumatic Brain Injury: Description and Feasibility

Purpose

Further investigation into the feasibility of using videoconferencing and activity tracking devices to provide high-intensity home-based exercise programmes for people with a moderate or severe traumatic brain injury (TBI) is needed to inform clinical implementation and patient adoption. This study aimed to (1) determine if home-based telerehabilitation exercise programmes were feasible for people with a moderate or severe TBI and (2) better understand the lived experience of people with a TBI and their family partners with this programme.

Methods

A mixed-methods approach consisting of measures of feasibility and semi-structured interviews was used. Five participants with moderate to severe TBI and their family partners completed two high-intensity home-based exercise programmes delivered remotely by a physiotherapist (i.e., daily and weekly).

Results

Telerehabilitation services in home-based settings were feasible for this population. Adherence and engagement were high. Dyads were satisfied with the use of technology to deliver physiotherapy sessions.

Conclusion

Telerehabilitation provides a delivery option that allows people with TBI to spend energy on therapy rather than on travelling. A pre-programme training on key components, such as the use of technology, safety precautions, and communication methods, likely improved the overall feasibility. Further research is needed to better understand the effectiveness of such a programme on balance, mobility, and physical activity levels.

The Impact of Two Telerehabilitation Supervision Schedules on Physical Activity, Mobility, and Balance Among People with Moderate to Severe Traumatic Brain Injury: A Mixed-Method Single-Subject Design

Background

Many individuals who experience a moderate or severe traumatic brain injury (TBI) have long-term deficits in physical activity, balance, and mobility requiring specialized care. New delivery models are being investigated for interventions to address challenges caused by living in remote communities, difficulties with transportation, and/or physical distancing requirements. Determining the effectiveness of telerehabilitation is critical given the current movement toward remote health care delivery.

Objective

We investigated the effectiveness of two teletherapy supervision schedules used to deliver a home-based, intensive exercise programme on 1) physical activity, mobility, balance, participation, and 2) concerns with falling, and satisfaction with life.

Methods

A mixed methods approach with alternating single subject design (SSD) and interviews was used. Five individuals who experienced a moderate or severe TBI completed two intensive home-based telerehabilitation programmes. Programmes differed only by supervision schedule - daily or weekly. Impacts on objective and patient-reported outcomes were measured.

Results

Four individuals demonstrated clinically significant improvements in physical activity level, balance, and mobility. One individual experienced less concerns with falling after both schedules, while two other individuals showed a trend in that direction after the weekly remote supervision. Important functional gains (i.e., improved balance and decreased fatigue) were also perceived and reported by family partners regardless of supervision schedule.

Conclusion

Although the study has limitations, the findings indicate that exercise programmes delivered via telerehabilitation can improve balance and mobility as well as positively affect concerns with falling and physical activity levels for this population. No clear differences were seen between the two telerehabilitation supervision schedules.

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part I: Posttraumatic Amnesia

INTRODUCTION

Posttraumatic amnesia (PTA) is a common occurrence following moderate to severe traumatic brain injury (TBI) and emergence from coma. It is characterized by confusion, disorientation, retrograde and anterograde amnesia, poor attention and frequently, agitation. Clinicians and family need guidelines to support management practices during this phase.

METHODS

An international team of researchers and clinicians (known as INCOG) met to update the INCOG guidelines for assessment and management of PTA. Previous recommendations and audit criteria were updated on the basis of review of the literature from 2014.

RESULTS

Six management recommendations were made: 1 based on level A evidence, 2 on level B, and 3 on level C evidence. Since the first version of INCOG (2014), 3 recommendations were added: the remainder were modified. INCOG 2022 recommends that individuals should be assessed daily for PTA, using a validated tool (Westmead PTA Scale), until PTA resolution. To date, no cognitive or pharmacological treatments are known to reduce PTA duration. Agitation and confusion may be minimized by a variety of environmental adaptations including maintaining a quiet, safe, and consistent environment. The use of neuroleptic medications and benzodiazepines for agitation should be minimized and their impact on agitation and cognition monitored using standardized tools. Physical therapy and standardized activities of daily living training using procedural and errorless learning principles can be effective, but delivery should be tailored to concurrent levels of cognition, agitation, and fatigue.

CONCLUSIONS

Stronger recommendations regarding assessment of PTA duration and effectiveness of activities of daily living training have been made. Evidence regarding optimal pharmacological and nonpharmacological management of confusion and agitation during PTA remains limited, with further research needed. These guidelines aim to enhance evidence-based care and maximize consistency of PTA management.

Identification of Clinical Measures to Use in a Virtual Concussion Assessment: Protocol for a Mixed Methods Study

BACKGROUND

Workplace concussions can have a significant impact on workers. The impact of concussion symptoms, combined with challenges associated with clinical environments that are loud, bright, and busy, create barriers to conducting effective in-person assessments. Although the opportunity for remote care in rural communities has long been recognized, the COVID-19 pandemic has catalyzed the transition to virtual assessments and care into the mainstream. With this rapid shift, many clinicians have been completing remote assessments. However, the approaches and measures used in these assessments have not yet been standardized. Furthermore, the psychometric properties of the assessments when completed remotely using videoconference have not yet been documented.

OBJECTIVE

Through this mixed methods study, we aim to (1) identify the concussion assessment measures clinicians are currently using in person and are most relevant to the following 5 physical domains: neurological examination (ie, cranial nerve, coordination, motor, and sensory skills), cervical spine, vestibular, oculomotor, and effort assessment; (2) document the psychometric properties of the measures identified; (3) identify measures that appear feasible in a virtual context; and (4) identify practical and technical barriers or challenges, facilitators, and benefits to conducting or engaging in virtual concussion assessments.

METHODS

This study will follow a sequential mixed methods design using a survey and Delphi approach, working groups with expert clinicians, and focus groups with experienced clinicians and people living with concussions. Our target sample sizes are 50 clinicians for the Delphi surveys, 4 clinician-participants for the working group, and 5-7 participants for each focus group (roughly 6-10 total groups being planned with at least two groups consisting of people living with concussions). The results from this study will inform the decision regarding the measures that should be included in a virtual assessment tool kit to be tested in a future planned prospective evaluation study.

RESULTS

The study is expected to be completed by January 2023.

CONCLUSIONS

This mixed methods study will document the clinical measures that are currently used in person and will identify those that are most relevant to assessing the physical domains impacted by concussions. Potential feasibility of using these measures in a virtual context will be explored.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/40446.

COMMUNITY MOBILITY PATTERNS OF OLDER ADULTS DURING THE COVID-19 PANDEMIC

The COVID-19 pandemic has had appreciative impacts on the lives of older adults. At various times during the pandemic, Canadian provinces put in place public health measures to prevent the spread of the virus, including closures of non-essential businesses and services. The Candrive Driving Cessation sub-study is a 12-year, mixed methods, longitudinal study. During the COVID-19 pandemic, participants from four sites (n=124, mean age=85.5 years) were asked to report how their community mobility patterns during the pandemic compared with before the pandemic. They also completed the COVID-19 Anxiety Syndrome Scale and the Assessment of Readiness for Mobility Transition (ARMT) tool. The results indicated that during the pandemic, participants were less likely to drive (χ2=7.11, p=.004) or ride a public bus (χ2=20.05, p<.001) when leaving their home. During the pandemic, they reported fewer trips to the supermarket (χ2=99.00, p<.001) and fewer visits with family (χ2=68.00, p=.001). We observed a statistically significant relationship between COVID-19 Anxiety Syndrome Scale scores and ARMT (Anticipatory Anxiety subscale; r= .810, p<.001), such that higher COVID-19-related anxiety was associated with greater anxiety related to anticipating changes in mobility. These results emphasize the impacts of the COVID-19 pandemic on the mobility patterns of older adults. Promoting community mobility for older adults alongside preventative public health measures is essential.

Enhancing COVID Rehabilitation with Technology (ECORT): protocol for an open-label, single-site randomized controlled trial evaluating the effectiveness of electronic case management for individuals with persistent COVID-19 symptoms

BACKGROUND

As of May 2022, Ontario has seen more than 1.3 million cases of COVID-19. While the majority of individuals will recover from infection within 4 weeks, a significant subset experience persistent and often debilitating symptoms, known as "post-COVID syndrome" or "Long COVID." Those with Long COVID experience a wide array of symptoms, with variable severity, including fatigue, cognitive impairment, and shortness of breath. Further, the prevalence and duration of Long COVID is not clear, nor is there evidence on the best course of rehabilitation for individuals to return to their desired level of function. Previous work with chronic conditions has suggested that the addition of electronic case management (ECM) may help to improve outcomes. These platforms provide enhanced connection with care providers, detailed symptom tracking and goal setting, and access to relevant resources. In this study, our primary aim is to determine if the addition of ECM with health coaching improves Long COVID outcomes at 3 months compared to health coaching alone.

METHODS

The trial is an open-label, single-site, randomized controlled trial of ECM with health coaching (ECM+) compared to health coaching alone (HC). Both groups will continue to receive usual care. Participants will be randomized equally to receive health coaching (± ECM) for a period of 8 weeks and a 12-week follow-up. Our primary outcome is the WHO Disability Assessment Scale (WHODAS), 36-item self-report total score. Participants will also complete measures of cognition, fatigue, breathlessness, and mental health. Participants and care providers will be asked to complete a brief qualitative interview at the end of the study to evaluate acceptability and implementation of the intervention.

DISCUSSION

There is currently little evidence about the optimal treatment of Long COVID patients or the use of digital health platforms in this population. The results of this trial could result in rapid, scalable, and personalized care for people with Long COVID which will decrease morbidity after an acute infection. Results from this study will also inform decision making in Long COVID and treatment guidelines at provincial and national levels.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05019963. Registered on 25 August 2021.

Examining the contribution of psychological resilience on self-reported and naturalistic driving behavior of older adults

INTRODUCTION

This study examined the contribution of psychological resilience on self-reported driving comfort, abilities, and restrictions, and on naturalistic driving (ND) behavior of older adults at two time points, five years apart (N = 111; Male: 65.8%, Mean age = 86.1 years).

METHOD

Participants from the Ozcandrive older driver cohort study completed a demographic questionnaire, functional assessments, psychosocial driving questionnaires, and a resilience scale. Participants' vehicles were equipped with a recording device to monitor driving behavior throughout the study. Over 1.7 million kilometers of ND data were analyzed.

RESULTS

There was a significant increase in resilience over time, and both self-reported and ND measures revealed reduced driving across five years. Hierarchical regression analyses using age, sex, driving exposure, functional measures, and resilience showed that adding resilience into the models at the final step resulted in statistically significant increases in the amount of variance explained for driving comfort during the day and night, perceived driving abilities, number of trips, trip distance, and proportion of night trips.

CONCLUSIONS

This research leveraged the longitudinal nature of the Ozcandrive study to provide the first insights into the role of resilience and ND. The observed patterns of reduced driving, captured by both subjective and objective measures, are suggestive of increased levels of self-regulation. As resilience is associated with adaptive coping skills, older adults with higher resilience may be able to more effectively engage in appropriate coping behaviors with regard to driving behavior, safety, and mobility.

PRACTICAL APPLICATIONS

Effective methods of increasing resilience in the context of driving is worthy of future research as it will provide valuable information about how older drivers navigate the process of aging as it relates to driving and may assist stakeholders in developing suitable measures to support older driver safety.

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

Protocol for a living systematic review for the management of concussion in adults

INTRODUCTION

Concussion/mild traumatic brain injury (mTBI) often presents initially with disabling symptoms that resolve, but for an unfortunate minority some of these symptoms may become prolonged. Although research into diagnosis and interventions for concussion is increasing, study quality overall remains low. A living systematic review that is updated as evidence becomes available is the ideal research activity to inform a living guideline targeting clinicians and patients. The purpose of this paper is to present the protocol of an ongoing living systematic review for the management of adult concussion that will inform living guidelines building off the Guideline for Concussion/Mild Traumatic Brain Injury and Persistent Symptoms: third Edition.

METHODS AND ANALYSIS

The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol guidelines were followed in the reporting of this systematic review protocol. We are including English peer-reviewed observational studies, trials, qualitative studies, systematic reviews and clinical practice guidelines related to diagnosis/assessment or treatment of adult concussion. Future searches will be conducted at minimum every 6 months using the following databases: MEDLINE ALL, EMBASE, Cochrane, PsycInfo and CINAHL. The data are managed in the Covidence website. Screening, data extraction and risk-of-bias assessments are being done through multiple raters working independently. Multiple validated tools are being used to assess risk of bias, and the tool applied matches the document or study design (eg, Downs and Black Scale for healthcare interventions). Many concussion experts in various clinical disciplines from across North America have volunteered to examine the evidence in order to make recommendations for the living guidelines.

ETHICS AND DISSEMINATION

No ethical approval is necessary because primary data are not collected. The results will be disseminated through peer-reviewed publications and on the living guidelines website once built.

PROSPERO REGISTRATION NUMBER

CRD42022301786.

Perceived Community Age-friendliness is Associated With Quality of Life Among Older Adults

We examined the positive association between perceived community age-friendliness and self-reported quality of life for older adults. A total of 171 participants, aged 77–96 years, completed a mail-in questionnaire package that included measures of health (SF-36 Physical), social participation (Social Participation Scale), community age-friendliness (Age-Friendly Survey [AFS]), and quality of life (WHO Quality of Life). Hierarchical regression models including age, gender, driving status, finances, health, social participation, and AFS scores explained 8 to 21 per cent of the variance in quality of life scores. Community age-friendliness was a statistically significant variable in all models, accounting for three to six and a half per cent of additional variance in quality of life scores. Although the proportion of variance explained by age-friendliness was small, our findings suggest that it is worthwhile to further investigate whether focused, age-friendly policies, interventions, and communities could play a role towards successful and healthy aging.

The Validity of Three New Driving Simulator Scenarios: Detecting Differences in Driving Performance by Difficulty and Driver Gender and Age

OBJECTIVE

We explored the convergent and discriminant validity of three driving simulation scenarios by comparing behaviors across gender and age groups, considering what we know about on-road driving.

BACKGROUND

Driving simulators offer a number of benefits, yet their use in real-world driver assessment is rare. More evidence is needed to support their use.

METHOD

A total of 104 participants completed a series of increasingly difficult driving simulation scenarios. Linear mixed models were estimated to determine if behaviors changed with increasing difficulty and whether outcomes varied by age and gender, thereby demonstrating convergent and discriminant validity, respectively.

RESULTS

Drivers adapted velocity, steering, acceleration, and gap acceptance according to difficulty, and the degree of adaptation differed by gender and age for some outcomes. For example, in a construction zone scenario, drivers reduced their mean velocities as congestion increased; males drove an average of 2.30 km/hr faster than females, and older participants drove more slowly than young (5.26 km/hr) and middle-aged drivers (6.59 km/hr). There was also an interaction between age and difficulty; older drivers did not reduce their velocities with increased difficulty.

CONCLUSION

This study provides further support for the ability of driving simulators to elicit behaviors similar to those seen in on-road driving and to differentiate between groups, suggesting that simulators could serve a supportive role in fitness-to-drive evaluations.

APPLICATION

Simulators have the potential to support driver assessment. However, this depends on the development of valid scenarios to benchmark safe driving behavior, and thereby identify deviations from safe driving behavior. The information gained through simulation may supplement other forms of assessment and possibly eliminate the need for on-road testing in some situations.