Revision of the Competency Standards for Occupational Therapy Driver Assessors: An overview of the evidence for the inclusion of cognitive and perceptual assessments within fitness-to-drive evaluations

Does aphasia impact on return to driving after stroke? A scoping review

PURPOSE

Stroke can affect driving, an important activity of daily living. Little is known about whether aphasia (language impairment) impacts driving post-stroke. This scoping review explores impacts and perceived impacts of aphasia on driving performance, and the process of returning to driving post-stroke.

MATERIALS AND METHODS

Scoping review using Arksey and O'Malley's framework, reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Bibliographic databases were searched and international clinical practice guidelines were sourced online. Full-text articles were independently assessed by two reviewers. Results were tabulated and summarised using narrative synthesis.

RESULTS

Forty-three literature sources and 17 clinical practice guidelines were identified. Six studies investigated return to driving with aphasia post-stroke; 37 sources from the broader literature contributed to objectives. It remains unclear whether aphasia impacts fitness-to-drive; however, people with aphasia face barriers in returning to driving due to: (1) uncertainty regarding the role of language in driving; (2) poor awareness and knowledge of aphasia, and (3) communication demands in the patient-journey and assessment.

CONCLUSIONS

The current evidence base is limited, inconsistent, and lacking in quality and recency and there is a lack of guidelines to support clinical practice. People with aphasia face barriers in returning to driving; however, it is unclear if aphasia affects fitness-to-drive post-stroke. Implications for rehabilitationPeople with aphasia, their caregivers and clinicians have identified return to driving as a top 10 research priority.We do not know if aphasia affects fitness-to-drive post-stroke, but communication difficulties can make the process of returning to driving more difficult.Speech pathologists have an important role in ensuring that driving is discussed with people with aphasia post-stroke.Speech pathologists should support the multidisciplinary team to understand and meet the communication needs of people with aphasia throughout the driving evaluation process.

Methods to evaluate driving competence for people with acquired brain injury (ABI): A systematic review

Driving is essential for independence, community involvement and quality of life. Driving is the primary transportation method in Saudi Arabia. Despite the high rates of brain injuries and disability in Saudi Arabia, currently there are no guidelines regarding driver assessment and rehabilitation to facilitate people with brain injuries to resume driving. Therefore, this systematic review aimed to understand the assessment methods used internationally to evaluate driving competence for people with acquired brain injuries (ABI). A systematic search of six electronic databases was conducted by two authors and twenty-six studies were identified for review. Four main approaches to driver assessment: clinical assessments such as neuropsychological tests, off-road screening tools, simulator testing, and comprehensive driving assessment were identified. However, our findings revealed a lack of consistency in their use to assess driving competence after ABI. On-road driving performance tests were predominantly used to determine driving competence either independently or in combination with another method in over two-thirds of the reviewed studies. While clinical assessments of cognitive impairments showed some capacity to predict driving performance of people with ABI, they should be used with caution since they cannot replace on-road driving performance tests. Driver assessment should be part of rehabilitation following high prevalence conditions such as ABI. This systematic review offers guidance for Saudi clinicians, as well as policymakers, about providing rehabilitation services for people with ABI, and recommendations for further research and collaborations to improve this much-needed area of practice.

Education leads to increased adherence to the 'Australian Competency Standards for Occupational Therapy Driver Assessors'

BACKGROUND

Occupational therapy competency standards provide an evidence-base to inform clinical best practice, however it is not known whether education about competency standards will increase occupational therapists' adherence to their use.

AIMS/OBJECTIVES

To investigate if education about the 'Australian Competency Standards for Occupational Therapy Driver Assessors' leads to increased adherence to the competency standards in the clinical practice of occupational therapy driver assessors.

MATERIALS AND METHODS

A mixed methods multiple case study design was used to evaluate 5 occupational therapy driver assessors' adherence to the competency standards. An audit of 25 client files and interviews were conducted to evaluate practice against the competency standards prior to an education session, followed by an audit of a further 25 files, interview and feedback after education.

RESULTS

Qualitative and quantitative analyses suggest that education about the 'Australian Competency Standards for Occupational Therapy Driver Assessors' was associated with increased adherence to the competency standards in clinical practice. The results also support the use of competency standards in clinical practice.

CONCLUSIONS AND SIGNIFICANCE

Competency standards can be used to inform and guide clinical practice, and individualised education and feedback of practice against the competency standards can increase occupational therapists' adherence to these standards.

Fitness to drive practices among non-driver trained occupational therapists in an Australian community-based rehabilitation setting

INTRODUCTION

Driving is a valued occupation given the independence and freedom it provides. Safe driving performance can be impacted by medical conditions, change in functional status and ageing processes. Occupational therapy driver assessors (OTDAs) provide invaluable driving recommendations; however, this requires specialist training for the therapist and is costly for clients. The number of OTDAs is not expected to meet the growing demand for expert services in this area, and little is known about the practices that non- OTDAs use to assist clients with returning to driving. The aims of this study were to investigate the practices of non-OTDAs in a community-based rehabilitation setting in Australia with respect to knowledge, confidence and skills in assessments, recommendations and outcomes for clients as part of the return to driving process.

METHODS

A descriptive study including medical record audits between April and September 2019 and staff surveys were completed at a large metropolitan community-based rehabilitation facility. Descriptive statistics and thematic analysis were used to summarise data.

RESULTS

A total of 102 client medical records were audited, and 13 clinician surveys were completed. Medical record audits identified that return to driving was not consistently addressed by occupational therapists. Clinician surveys outlined a lack of knowledge and confidence of return to driving processes and available assessment tools to guide this process.

CONCLUSION

All occupational therapists have an ethical obligation to address driving as an activity of daily living; however, non-OTDAs report that they are not equipped for this role. This may negatively impact on driver safety, independence and overall health and well-being of clients in community-based rehabilitation. Further research is indicated to develop evidence-based driving resources to support best practice of non-OTDAs.

The revision of competency standards for occupational therapy driver assessors in Australia: A mixed methods approach

INTRODUCTION

Competency standards outline the knowledge, skills, and attributes that are required for competent practice. This study describes the process followed to revise and validate the competency standards for occupational therapy driver assessors in order to guide clinical practice in this area of advanced occupational therapy practice.

METHODS

A mixed methods research approach was used in this study. In phase 1, three focus groups with driver assessors reviewed and suggested revisions to the competency standards for occupational therapy driver assessors. Phase 2 involved content validation with key stakeholders through a focus group with consumers, written feedback from Australian state, and territory driver licensing authorities, and a two-round Delphi process with Australian occupational therapy driver assessors.

RESULTS

Forty-nine occupational therapy driver assessors participated in the phase 1 focus groups. Deductive content analysis of the transcripts provided data to revise the competency standards. Inductive analysis provided an in-depth understanding of the participants' views and was interpreted through six categories and their underlying subcategories: purposes and benefits; jurisdictional variations and practice diversity; language use; defining competent practice; challenging systems and processes; and competency standards content. Forty-eight occupational therapy driver assessors participated in the Delphi process. In Round 1, only 1 of the 164 competency standards and practice behaviours rated did not achieve the pre-determined 70% consensus rate. In Round 2, all statements achieved consensus, with the overall average consensus level obtained across the Round 2 statements at 96.8%.

CONCLUSION

The revised Australian Competency Standards for Occupational Therapy Driver Assessors have been endorsed by Occupational Therapy Australia and released for clinical use. The methods described in this research provide a framework suitable for revision or development of competency standards in both other areas of occupational therapy practice and other health-care professions.

Decisions on driving after brain injury/disease: Feasibility and construct validity of a new simulator assessment tool

Introduction

Driving is a complex activity involving a high level of cognitive abilities and thus might be affected after a brain injury/disease. The aim of this research was to evaluate the feasibility and construct validity of a driving simulator tool as a complement to existing driving assessments of patients with cognitive dysfunctions after a brain injury/disease.

Method

A descriptive and prospective research design was achieved. For construct validation, decisions were based on results from the Useful Field of View, Nordic Stroke Driver Screening Assessment, Trail Making Test and, when necessary for the decision, an on-road observation. Results from the simulator tool were not included in the clinical decision process.

Results

A total of 129 patients from four different rehabilitation services were included. The results showed a significant difference in test results between those who were considered medically fit versus unfit to drive. A factor analysis revealed four components, all including attention in combination with processing speed, visuospatial function, simultaneous capacity and executive function; these are all represented in the simulator tool. A correlation analysis showed that simulator subtest 3 (response/divergent response to stimuli) had the strongest correlation with most of the other tests included.

Conclusions

The simulator was found to be feasible and valid and found to include components other than those measured in the other tests.