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Vander Veen A, Cammarata M, Renner S, Alvarez L. The Clinical Usefulness of the Practice Resource for Driving after Stroke (PReDAS). Occup Ther Health Care 2023; 37:119-144. [PMID: 34955088 DOI: 10.1080/07380577.2021.2018751] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Occupational Therapists (OTs) have identified a critical need for organized, evidence-based resources to approach driving post-stroke. The Practice Resource for Driving After Stroke (PReDAS) is a resource to support the clinical reasoning and practice of health professionals for addressing driving in acute stroke care. The purpose of this pilot study is to evaluate the usefulness of the PReDAS to support clinician and patient decision-making about return to driving after stroke/Transient Ischemic Attack (TIA) in the acute care hospital setting. OTs, physicians, and patients diagnosed with stroke/TIA were surveyed regarding their experience with the PReDAS in acute care. Patient participants were also contacted for a follow-up questionnaire. OT, physician and patient stakeholders reported the PReDAS was useful to support decision-making for driving. The majority of patients recalled information provided in acute care and abstained from driving as advised. This study provides preliminary support for the clinical usefulness of the PReDAS.
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Affiliation(s)
- April Vander Veen
- Integrated Stroke Unit, Grand River Hospital, Kitchener, Canada.,Health and Rehabilitation Sciences, Faculty of Health Sciences London, Western University, London, Canada
| | - Michael Cammarata
- Department of Occupational Therapy, Buffalo, D'Youville College, New York, NY, USA
| | - Sarah Renner
- Integrated Stroke Unit, Grand River Hospital, Kitchener, Canada
| | - Liliana Alvarez
- School of Occupational Therapy, Western University, London, Canada
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Langereis B, Semeniuk S, Kristalovich L, Mortenson W. Identifying current driver rehabilitation practices for clients with physical impairments. Br J Occup Ther 2022. [DOI: 10.1177/03080226211067432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Driving is an important occupation that influences a person’s ability to access community resources and participate in meaningful activities. Occupational therapists and other clinicians who are trained as driver rehabilitation specialists provide interventions to improve function and independence in driving. The objective of this study was to examine consistency of adaptive driving equipment prescription and driver retraining recommendations for clients with physical impairment and identify factors that influence driver rehabilitation recommendations. Methods Clinicians practicing in Canada and the United States were surveyed electronically. Data were analyzed using descriptive statistics and content analysis. Results Out of 36 respondents, the majority (97.2%) were occupational therapists. Completion of in-clinic (97.0%) and on-road (84.4%) evaluations were consistent among the majority of respondents, yet components comprising evaluations varied. Fewer respondents were in agreement in equipment recommendations for secondary controls. Respondents emphasized the importance of clinical reasoning skills when making equipment and intervention recommendations. Conclusion Further development of clinical guidelines and advanced training in driver rehabilitation may be beneficial to facilitate clinical reasoning and improve consistency of practice.
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Affiliation(s)
- Brittany Langereis
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Semeniuk
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lisa Kristalovich
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - W.Ben Mortenson
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Centre, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada
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Rapoport MJ, Plonka SC, Finestone H, Bayley M, Chee JN, Vrkljan B, Koppel S, Linkewich E, Charlton JL, Marshall S, delCampo M, Boulos MI, Swartz RH, Bhangu J, Saposnik G, Comay J, Dow J, Ayotte D, O'Neill D. A systematic review of the risk of motor vehicle collision after stroke or transient ischemic attack. Top Stroke Rehabil 2019; 26:226-235. [PMID: 30614401 DOI: 10.1080/10749357.2018.1558634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Returning to driving after stroke is one of the key goals in stroke rehabilitation, and fitness to drive guidelines must be informed by evidence pertaining to risk of motor vehicle collision (MVC) in this population. OBJECTIVES The purpose of the present study was to determine whether stroke and/or transient ischemic attack (TIA) are associated with an increased MVC risk. METHODS We searched MEDLINE, CINAHL, EMBASE, PsycINFO, and TRID through December 2016. Pairs of reviewers came to consensus on inclusion, based on an iterative review of abstracts and full-text manuscripts, on data extraction, and on the quality of evidence. RESULTS Reviewers identified 5,605 citations, and 12 articles met inclusion criteria. Only one of three case-control studies showed an association between stroke and MVC (OR 1.9, 95% CI 1.0-3.9). Of five cohort reports, only one study, limited to self-report, found an increased risk of MVC associated with stroke or TIA (RR 2.71, 95% CI 1.11-6.61). Two of four cross-sectional studies using computerized driving simulators identified a more than two-fold risk of MVCs among participants with stroke compared with controls. The difference in one of the studies was restricted to those with middle cerebral artery stroke. CONCLUSIONS The evidence does not support a robust increase in risk of MVCs. While stroke clearly prevents some patients from driving at all and impairs driving performance in others, individualized assessment and clinical judgment must continue to be used in assessing and advising those stroke patients who return to driving about their MVC risk.
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Affiliation(s)
- Mark J Rapoport
- a Department of Psychiatry , Sunnybrook Health Sciences Center , Toronto , Canada.,b Faculty of Medicine , University of Toronto , Toronto , Canada
| | - Sarah C Plonka
- c Road Safety Research Office , Ontario Ministry of Transportation , Toronto , Canada
| | - Hillel Finestone
- d Faculty of Medicine, Division of Physical Medicine and Rehabilitation, Bruyère Continuing Care, The Ottawa Hospital , University of Ottawa , Ottawa , Canada
| | - Mark Bayley
- b Faculty of Medicine , University of Toronto , Toronto , Canada.,e Toronto Rehabilitation Institute , University Health Network , Toronto , Canada
| | - Justin N Chee
- a Department of Psychiatry , Sunnybrook Health Sciences Center , Toronto , Canada.,b Faculty of Medicine , University of Toronto , Toronto , Canada
| | - Brenda Vrkljan
- f School of Rehabilitation Science , McMaster University , Hamilton , Canada
| | - Sjaan Koppel
- g Monash University Accident Research Centre , Monash University , Clayton , Australia
| | - Elizabeth Linkewich
- a Department of Psychiatry , Sunnybrook Health Sciences Center , Toronto , Canada.,h Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences , University of Toronto , Toronto , Canada.,i Faculty of Medicine, Department of Medicine (Neurology) , University of Toronto , Toronto , Canada
| | - Judith L Charlton
- g Monash University Accident Research Centre , Monash University , Clayton , Australia
| | - Shawn Marshall
- j Physical Medicine and Rehabilitation , Ottawa Hospital Research Institute , Ottawa , Canada
| | - Martin delCampo
- e Toronto Rehabilitation Institute , University Health Network , Toronto , Canada
| | - Mark I Boulos
- a Department of Psychiatry , Sunnybrook Health Sciences Center , Toronto , Canada.,b Faculty of Medicine , University of Toronto , Toronto , Canada.,i Faculty of Medicine, Department of Medicine (Neurology) , University of Toronto , Toronto , Canada
| | - Richard H Swartz
- a Department of Psychiatry , Sunnybrook Health Sciences Center , Toronto , Canada.,b Faculty of Medicine , University of Toronto , Toronto , Canada.,i Faculty of Medicine, Department of Medicine (Neurology) , University of Toronto , Toronto , Canada
| | - Jaspreet Bhangu
- a Department of Psychiatry , Sunnybrook Health Sciences Center , Toronto , Canada
| | - Gustavo Saposnik
- b Faculty of Medicine , University of Toronto , Toronto , Canada.,k Stroke Outcomes and Decision Neuroscience Unit , St. Michael's Hospital , Toronto , Canada.,l Department of Economics, Neuroeconomics Lab , University of Zurich , Zurich , Switzerland
| | - Jessica Comay
- m Department of Neurology , Assistive Technology Clinic , Toronto , Canada
| | - Jamie Dow
- n Société de l'assurance automobile du Québec , Québec , QC , Canada
| | - Debbie Ayotte
- o Library , Canadian Medical Association , Ottawa , Canada
| | - Desmond O'Neill
- p Trinity College Dublin , The University of Dublin , Dublin 2 , Ireland
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Stack AH, Duggan O, Stapleton T. Assessing fitness to drive after stroke. IRISH JOURNAL OF OCCUPATIONAL THERAPY 2018. [DOI: 10.1108/ijot-03-2018-0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
The assessment of fitness to drive after stroke is an emerging area of occupational therapy practice in Ireland. Despite this, little is known about occupational therapists’ evaluation practices, and there are no internationally agreed clinical guidelines to inform best practice. The purpose of this paper is to investigate occupational therapy evaluation practices for fitness to drive after stroke in Ireland.
Design/methodology/approach
This is a cross-sectional study design targeting occupational therapists working with people after stroke using an online survey. Summary and descriptive statistics were used to analyse the returned surveys.
Findings
In total, 47 occupational therapists participated. Off-road driving assessment was completed by 68 per cent of respondents. Functional assessment and non-driving-specific assessments were most widely used and perceived to be the most useful in informing the off-road assessment. A total of 89 per cent referred clients for on-road assessments; however, some referred without first completing an off-road assessment. The therapists who completed formal post graduate education/training in driving assessment reported greater confidence and competence in their skills and ability to assess fitness to drive. A vast majority of participants agreed that clinical guidelines regarding best practice in this area would be beneficial.
Research limitations/implications
A majority of occupational therapists are assessing fitness to drive after stroke in Ireland with non-driving-specific assessments and functional observations; however, there are many gaps and wide variations between services. Education/training in evaluating fitness to drive after stroke is recommended. The development of clinical guidelines to inform practice would facilitate a consistent approach nationally.
Originality/value
This is the first study completed in Ireland to investigate occupational therapy evaluation practices for fitness to drive after stroke.
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