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Lau SCL, Connor LT, Baum CM. Subjective and objective assessments are associated for physical function but not cognitive function in community-dwelling stroke survivors. Disabil Rehabil 2022; 44:8349-8356. [PMID: 34904503 DOI: 10.1080/09638288.2021.2012845] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To investigate the relation between subjectively and objectively assessed cognitive and physical functioning among community-dwelling stroke survivors, and to examine the association of stroke severity with subjectively and objectively assessed cognitive and physical impairments. MATERIALS AND METHODS Secondary data analysis was conducted with 127 community-dwelling stroke survivors. For cognitive functioning, objective measures included the NIH Toolbox Cognition Battery and the Executive Function Performance Test; subjective measures included the Quality of Life in Neurological Disorders Applied Cognition. Objective and subjective physical functioning was measured by the NIH Toolbox 2-Minute Walk Test and the Patient-Reported Outcomes Measurement Information System Physical Function, respectively. RESULTS A positive correlation was observed between subjective and objective physical functioning, whereas the correlation between subjective and objective cognitive functioning was nonsignificant. Stroke severity was associated with objective cognitive impairment and objective and subjective physical impairment, but not subjective cognitive impairment. CONCLUSIONS The lack of association between objective and subjective cognitive functioning challenges the conventional assumption that perceived functioning reflects actual performance. We recommend using both objective and subjective measures to accurately identify cognitive and physical impairment following stroke.Implications for RehabilitationSubjective cognitive functioning is not associated with objective cognitive functioning, suggesting that solely relying on stroke patients' reports is inadequate and may inaccurately estimate patients' actual deficits.Both objective and subjective measures should be used to accurately identify cognitive and physical impairment following stroke.Practitioners should be cognizant of stroke patients' behavioral signs associated with underlying cognitive problems that warrant further evaluation.
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Affiliation(s)
- Stephen C L Lau
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Lisa Tabor Connor
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Carolyn M Baum
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.,Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
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2
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Rosenfeld M, Goverover Y, Weiss P. Self-awareness predicts fitness to drive among adults referred to occupational therapy evaluation. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1005025. [PMID: 36466937 PMCID: PMC9708717 DOI: 10.3389/fresc.2022.1005025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/26/2022] [Indexed: 09/10/2024]
Abstract
Background Driving is associated with independence, well-being, quality of life, and an active lifestyle. Driving requires cognitive, motor, and visual skills, including self-awareness and processing speed. This study examines whether driver self-awareness, motor processing speed, and cognitive processing speed can predict fitness to drive among individuals referred to occupational therapy evaluation due to concerns about their driving ability. Method In this cross-sectional study, 39 participants were referred to off- and on-road driving evaluation to determine their fitness to drive due to changes in health status, advanced age, license renewal requirement, or prior automobile accidents. A registered occupational therapist (OT) classified 23 of the participants as fit to drive and 16 as unfit to drive. Motor and cognitive processing speed were assessed by the Stationary Perception-Reaction Timer and the Color Trails Test, respectively. Driving self-awareness was assessed by comparing the DI and OT evaluations to the participants' estimation of their own on-road driving performance. Results The fit-to-drive participants had a better motor and cognitive processing speed than those unfit-to-drive. The unfit-to-drive group overestimated their driving ability, whereas the fit-to-drive group accurately or almost accurately estimated their driving ability. Driving self-awareness was a significant predictor of participants' fitness to drive. Conclusions This study demonstrates the importance of self-awareness for predicting fitness to drive among people at risk for compromised driving skills. Thus, driving self-awareness should be addressed as part of fitness-to-drive evaluations and interventions.
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Affiliation(s)
- Meirav Rosenfeld
- Department of Occupational Therapy, New York University, New York, NY, United States
| | - Yael Goverover
- Department of Occupational Therapy, New York University, New York, NY, United States
- Kessler Foundation, East Hanover, NJ, United States
| | - Penina Weiss
- Occupational Therapy Department, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
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Almosallam A, Qureshi AZ, Ullah S, Alibrahim A. Return to driving post stroke; patients' perspectives and challenges in Saudi Arabia. Top Stroke Rehabil 2021; 29:192-200. [PMID: 33775236 DOI: 10.1080/10749357.2021.1905201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BackgroundReturning to driving remains one of the most important goals for stroke survivors. In Saudi Arabia, there are no structured processes to address the issue of return to driving in individuals with disabilities. There are increasing rates of strokes in the country and road traffic accidents are the highest in the region. Returning to driving among male stroke survivors in Saudi Arabia is of particular importance due to socio-economic and cultural reasons.AimsThe study aims to explore the factors involved in return to driving among stroke survivors in Saudi population.MethodsThis cross-sectional study was carried out on 100 male stroke survivors who had completed an inpatient rehabilitation program and had at least one follow-up assessment three months post-discharge. Information was collected regarding demographics, stroke characteristics, and factors related to pre and post-stroke driving. Data were analyzed using SPSS.ResultsMajority (60%) of patients were 51 years of age and above. Most commonly reported stroke impairments were weakness and spasticity with majority of participants having right-sided body involvement. Out of 94 stroke survivors who were driving prior to stroke, only 7 resumed driving. None of the stroke survivors who returned to driving reported receiving any formal driving assessment. Only one patient who reported being aware of the need of driving assessment did not resume driving after stroke.ConclusionsThere is a dire need to increase awareness and to develop a structured integrated system in Saudi Arabia to facilitate stroke survivors to return to driving.
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Affiliation(s)
| | - Ahmad Zaheer Qureshi
- Department of Physical Medicine & RehabilitationKing Fahad Medical City,Ryiadh,Saudi Arabia
| | - Sami Ullah
- Department of Physical Medicine & RehabilitationKing Fahad Medical City,Ryiadh,Saudi Arabia
| | - Abdullah Alibrahim
- Department of Comprehensive Rehabilitation CareKing Fahad Medical City,Riyadh,Saudi Arabia
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“Not as Safe as I Believed”: Differences in Perceived and Self-Reported Cycling Behavior between Riders and Non-Riders. SUSTAINABILITY 2021. [DOI: 10.3390/su13041614] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cycling behavior remains a key issue for explaining several traffic causalities occurring every day. However, recent studies have shown how the assessment of the own safety-related behaviors on the road may substantially differ from how third parties assess them. Thus, the aim of this study was to evaluate the differences between cyclists’ self-reported behavior and the proxy-reported behavior that other (non-cyclist) road users perceive from bike riders. For this purpose, this study used data from two samples: (i) 1064 cyclists (M = 32.83 years) answering the Cycling Behavior Questionnaire—CBQ, and (ii) 1070 non-cyclists (M = 30.83 years) answering an adapted version of the CBQ for external raters—ECBQ. The results show how the self-reported and proxy-reported behaviors of cyclists greatly differ in terms of all behavioral factors composing the CBQ model, i.e., traffic violations, riding errors, and positive behaviors. Also, external raters (non-cyclists) are those targeting significantly riskier behaviors than those self-reported by cyclists. These discrepancies between perceived behaviors may give rise to conflicting viewpoints on the interaction between bicycle riders and other road users. Therefore, this study underscores the importance of behavioral awareness, providing highlights for future studies on the behavioral interaction between cyclists and other road users. Results can be used to improve the road safety of all road users by giving indications on self-and proxy-perceived safety-related behaviors and visibility of protective riding habits.
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Bassingthwaighte L, Griffin J, Fleming J, Gustafsson L. Evaluating the effectiveness of on-road driving remediation following acquired brain injury: A wait-list feasibility study with follow-up. Aust Occup Ther J 2020; 68:124-134. [PMID: 32909309 DOI: 10.1111/1440-1630.12694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/09/2020] [Accepted: 07/29/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Return to driving is an important goal for people recovering from acquired brain injury. Occupational therapy driving assessments aim to determine the impact of acquired brain injury on a person's capacity to drive and may include on-road driving rehabilitation. The primary objective of this project was to conduct a feasibility randomised controlled trial (RCT) of an on-road driving remediation program for adults with acquired brain injury. Secondary objectives were to measure the effectiveness of the on-road driving program and determine sample size required for a randomised controlled trial. METHODS A wait-list randomised controlled trial with blinded assessment and 6-month follow-up aimed to recruit 10 participants with acquired brain injury. Concealed methods randomly allocated participants to receive the on-road driving rehabilitation program immediately (intervention group) or after 6 weeks (wait-list group). The primary outcome measure of functional fitness to drive, was assessed pre- and post-intervention, and at 6-month follow-up. Driving performance was measured by percentage of correct manoeuvres and driving instructor intervention. RESULTS Eight participants (seven male; average age 46 years; six traumatic brain injury and two stroke) were recruited. The protocol was feasible. Results of the RCT suggest intervention effectiveness initially with two of the three interventions, and no wait-list, participants achieving fitness to drive. This increased to five out of eight participants after the wait-list group completed the intervention. While three participants retained this outcome at 6-month follow-up, universal deterioration in on-road driving performance was evident for all participants at 6-month follow-up. CONCLUSION The trial was feasible and findings suggest that on-road driving remediation assists people with acquired brain injury to achieve functional fitness to drive but the skills may not be maintained 6 months later. A full RCT is warranted to further determine the effectiveness of on-road driving remediation and capacity of participants to maintain the skills developed.
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Affiliation(s)
- Louise Bassingthwaighte
- Driving Assessment and Rehabilitation Service, Occupational Therapy Department, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Janelle Griffin
- Brain Injury Rehabilitation, Occupational Therapy Department, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Louise Gustafsson
- School of Allied Health Sciences, Griffith University, Brisbane, QLD, Australia
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Ku FL, Chen WC, Chen MD, Tung SY, Chen TW, Tsai CC. The determinants of motorized mobility scooter driving ability after a stroke. Disabil Rehabil 2020; 43:3701-3710. [PMID: 32297816 DOI: 10.1080/09638288.2020.1748125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To investigate the determinants related to the ability to drive a motorized mobility scooter after a stroke.Method: The study was a cross-sectional study. The ability to drive a motorized mobility scooter was measured with the Power Mobility Clinical Driving Assessment. The independent variables included cognitive functions measured by the Color Trails Test and reaction time test, visual functions measured by a visual acuity test and visual field test, and motor functions measured with a dynamometer, the Box and Block Test, and the Functional Independence Measure.Results: The correlation analyses revealed that the Power Mobility Clinical Driving Assessment scores had significant correlations with reaction time (ρ = -.65, p < 0.01), binocular visual field (r = .64, p < 0.01), binocular visual acuity (r = .40, p = 0.03), and the grip strength of the unaffected hand (r = .47, p = 0.01). The multiple regression analysis indicated that reaction time, binocular visual field, and the grip strength of the unaffected hand were the most significant determinants of the ability to drive a motorized mobility scooter (R2 = .76).Conclusions: The reaction time, binocular visual field, and grip strength of the unaffected hand were the most significant determinants related to the ability to drive a motorized mobility scooter after a stroke. IMPLICATIONS FOR REHABILITATIONMotorized mobility scooter driving ability for stroke patients is correlated with demographics (age, mobility scooter driving experience, time since last drive) and cognitive, visual and motor functions (reaction time, binocular visual field, visual acuity, and the grip strength of unaffected hand).Primary determinants of motorized mobility scooter driving ability for stroke patients include reaction time, binocular visual field, and grip strength of the unaffected hand.Comprehensive assessments incorporating cognitive, visual and motor functions are needed to evaluate the ability to drive a motorized mobility scooter after a stroke.
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Affiliation(s)
- Fang-Ling Ku
- Department of Rehabilitation, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Wei-Chung Chen
- Department of Traditional Chinese Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ming-De Chen
- Department of Rehabilitation, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Szu-Ya Tung
- Department of Rehabilitation, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Tien-Wen Chen
- Department of Rehabilitation, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Chiu-Chin Tsai
- Department of Rehabilitation, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
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Dimech-Betancourt B, Ponsford JL, Charlton JL, Ross PE, Stolwyk RJ. User experiences and perspectives of a driving simulator intervention for individuals with acquired brain injury: A qualitative study. Neuropsychol Rehabil 2020; 31:773-796. [PMID: 32114901 DOI: 10.1080/09602011.2020.1731555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Driving a motor vehicle is a common rehabilitation goal following acquired brain injury (ABI). There is increasing interest in the use of driving simulators for driver rehabilitation post-ABI; however, there is still limited research demonstrating efficacy and acceptability. This study sought to examine the user experience of a driving simulator intervention for ABI survivors. Semi-structured interviews were conducted with 14 individuals, including 12 ABI survivors (42% male; Mean age = 53.92 years, SD age = 17.63) who completed the intervention, and 2 occupational therapist driver assessors who facilitated the intervention. Thematic analysis was adopted to analyse interview data. Findings suggest that individual differences (e.g., anxiety, previous experience) influenced participant response to training. The intervention allowed participants to practise various driving skills, re-familiarize themselves with the task of driving, and prepare for return to on-road driving within a safe environment. The intervention was perceived to be useful for enhancing driver self-awareness, autonomy, confidence and patience. Fidelity and simulator sickness were considered limitations of the simulator technology. Subjective accounts of the appropriateness of intervention components are also documented. Overall, the simulator intervention was reported to be a positive experience for participants. Themes emerging from this study can inform future driving simulator interventions for ABI survivors.
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Affiliation(s)
- Bleydy Dimech-Betancourt
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Jennie L Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia.,Epworth Rehabilitation, Richmond, Australia
| | - Judith L Charlton
- Monash University Accident Research Centre, Monash University, Clayton, Australia
| | - Pamela E Ross
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia.,Epworth Rehabilitation, Richmond, Australia
| | - Renerus J Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
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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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Frith J, Warren-Forward H, Hubbard I, James C. Shifting gears: An inpatient medical record audit and post-discharge survey of return-to-driving following stroke/transient ischaemic attack. Aust Occup Ther J 2017; 64:264-272. [DOI: 10.1111/1440-1630.12359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Janet Frith
- School of Health Sciences; University of Newcastle; Callaghan New South Wales Australia
| | - Helen Warren-Forward
- School of Health Sciences; University of Newcastle; Callaghan New South Wales Australia
| | - Isobel Hubbard
- School of Medicine and Public Health; Faculty of Health; University of Newcastle; Callaghan New South Wales Australia
| | - Carole James
- School of Health Sciences; University of Newcastle; Callaghan New South Wales Australia
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Rossheim ME, Weiler RM, Barnett TE, Suzuki S, Walters ST, Barry AE, Cannell B, Pealer LN, Moorhouse MD, Zhang Q, Thombs DL. Self-Efficacy to Drive While Intoxicated: Insights into the Persistence of Alcohol-Impaired Driving. Alcohol Clin Exp Res 2015; 39:1547-54. [PMID: 26147102 DOI: 10.1111/acer.12795] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/28/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Scant research has examined event-level risk factors for impaired driving in natural drinking settings. This study assessed driving self-efficacy among intoxicated individuals to better understand decision-making about alcohol-impaired driving at night after exiting on-premise drinking establishments. METHODS Interview and breath test data were collected from bar patrons (n = 512) exiting 2 college bar districts in Florida and Texas. RESULTS Results from a multivariable linear regression model indicated that self-efficacy to drive while intoxicated was more strongly associated with situational variables, that is, perceived drunkenness and self-estimated blood alcohol concentration than patron traits, that is, past-year history of drinking, risk proneness, and sex. A large proportion of bar patrons, particularly men, expressed confidence in their ability to drive, despite being highly intoxicated. Moreover, the majority of legally intoxicated patrons who were confident in their ability to drive were aware of their high level of intoxication. CONCLUSIONS Emphasis should be placed on the enactment and enforcement of policies and laws to prevent alcohol-impaired driving.
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Affiliation(s)
- Matthew E Rossheim
- Department of Global and Community Health , George Mason University, Fairfax, Virginia
| | - Robert M Weiler
- Department of Global and Community Health , George Mason University, Fairfax, Virginia
| | - Tracey E Barnett
- Department of Behavioral Science and Community Health , University of Florida, Gainesville, Florida
| | - Sumihiro Suzuki
- Department of Biostatistics and Epidemiology , University of North Texas Health Science Center, Fort Worth, Texas
| | - Scott T Walters
- Department of Behavioral and Community Health , University of North Texas Health Science Center, Fort Worth, Texas
| | - Adam E Barry
- Department of Health and Kinesiology , Texas A&M University, College Station, Texas
| | - Brad Cannell
- Department of Biostatistics and Epidemiology , University of North Texas Health Science Center, Fort Worth, Texas
| | - Lisa N Pealer
- Department of Behavioral and Community Health , University of North Texas Health Science Center, Fort Worth, Texas
| | - Michael D Moorhouse
- Department of Behavioral Science and Community Health , University of Florida, Gainesville, Florida
| | - Qianzi Zhang
- Department of Biostatistics and Epidemiology , University of North Texas Health Science Center, Fort Worth, Texas
| | - Dennis L Thombs
- Department of Behavioral and Community Health , University of North Texas Health Science Center, Fort Worth, Texas
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Hird MA, Vesely KA, Christie LE, Alves MA, Pongmoragot J, Saposnik G, Schweizer TA. Is it safe to drive after acute mild stroke? A preliminary report. J Neurol Sci 2015; 354:46-50. [DOI: 10.1016/j.jns.2015.04.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/07/2015] [Accepted: 04/27/2015] [Indexed: 01/13/2023]
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Abstract
SummaryTransport is the invisible glue that holds our lives together, an under-recognized contributor to economic, social and personal well-being. In public health terms, the medical profession had previously allowed itself to focus almost exclusively on the downsides of transport. However, the research basis for transport, driving and ageing is steadily evolving and has important academic and practical considerations for gerontologists and geriatricians. For gerontologists, teasing out the critical role of transport in the health and well-being of older people is an imperative, as well as the key challenges inherent in transitioning from driving to not driving. The safe crash record of a group with significant multi-morbidity allows us to focus on the remarkable strategic and adaptive skills of older people. From a policy perspective, strictures on older drivers are an exemplar of institutionalized ageism. For geriatricians, a key challenge is to develop strategies for including transportation in our clinical assessments, formulating effective strategies for assessment of medical fitness to drive, incorporating enabling techniques, giving due consideration to ethical and legal aspects, and developing and promoting multi-modality and alternative transportation options.
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Stapleton T, Connolly D, O'Neill D. Factors Influencing the Clinical Stratification of Suitability to Drive after Stroke: A Qualitative Study. Occup Ther Health Care 2015; 29:253-271. [PMID: 26020451 DOI: 10.3109/07380577.2015.1036192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
While a clinical pre-selection screening process for a stroke patient's suitability for driving has been acknowledged, little is known about the factors or processes influencing this screening typically conducted by clinicians practicing at a generalist level. This study explored this clinical stratification process through the use of semi-structured interviews with senior occupational therapists (n = 17) and stroke physicians (n = 7) using qualitative description methodology. The findings revealed a trichotomy stratification of stroke patients for driving in the clinical setting; those who are fit to drive, unfit to drive, and a "maybe" group who need more detailed assessment and observation. Factors that had a major influence on this clinical-based stratification of driving suitability were client's levels of awareness, insight, and impulsivity. A period of prolonged contact with the client was preferential to guide the stratification decision in order for clinicians to build a comprehensive picture of the person. A mix of assessment approaches including standardized assessment but with increased emphasis on naturalistic observation of functional performance underpinned the clinical stratification process. This study uncovers some of the factors and processes influencing the early clinical-based stratification of driving suitability after stroke, and highlights the contribution of the generalist practitioner in the assessment of fitness to drive continuum.
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Affiliation(s)
- Tadhg Stapleton
- 1Discipline of Occupational Therapy, Trinity College Dublin , Dublin , Ireland
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Cognitive, On-road, and Simulator-based Driving Assessment after Stroke. J Stroke Cerebrovasc Dis 2014; 23:2654-2670. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.06.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/21/2014] [Accepted: 06/10/2014] [Indexed: 11/21/2022] Open
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McNamara A, Walker R, Ratcliffe J, George S. Perceived confidence relates to driving habits post-stroke. Disabil Rehabil 2014; 37:1228-33. [DOI: 10.3109/09638288.2014.958619] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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McNamara A, Ratcliffe J, George S. Evaluation of driving confidence in post-stroke older drivers in South Australia. Australas J Ageing 2014; 33:205-7. [PMID: 24373131 DOI: 10.1111/ajag.12117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To determine whether self-perceived driving confidence levels are lower in the post-stroke driving population than their aged-matched non-stroke driving peers. A lack of driving confidence has been linked to self-limiting driving behaviours. METHOD Adelaide Driving Self-Efficacy Scale (ADSES) scores were collected for a stroke population who returned to driving (N = 40, 25 men) with a mean age of 65 (SD = 12.17) years and an older non-stroke driver population (N = 114, 56 men) with a mean age of 72 (SD = 5.2) years. RESULTS The non-stroke and stroke groups showed no significant differences in ADSES scores (t(153) = 0.32, P = 0.58). CONCLUSION Stroke survivors who return to driving have no differences in their driving confidence to their aged-matched non-stroke driving peers. Timely recognition of lack of driving confidence might allow for appropriately targeted intervention strategies and prevent premature driving cessation.
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McNamara A, Chen G, George S, Walker R, Ratcliffe J. What factors influence older people in the decision to relinquish their driver's licence? A discrete choice experiment. ACCIDENT; ANALYSIS AND PREVENTION 2013; 55:178-84. [PMID: 23548875 DOI: 10.1016/j.aap.2013.02.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 02/23/2013] [Accepted: 02/24/2013] [Indexed: 05/10/2023]
Abstract
PURPOSE To investigate the relative importance of a number of key factors that influence older people in the decision to relinquish their driver's licence. METHOD A discrete choice experiment (DCE) was administered as an online survey to Australian adults, 65 years plus (N=114) who drive, recruited from an online panel. The survey was composed of three main sections. (A) The Adelaide Driving Self Efficacy Scale to assess confidence in driving. The scale is generated from individual's responses about confidence in their driving ability in various situations. (B) The DCE in which respondents were presented with a series of hypothetical binary choice situations and asked to indicate in which situation they would be more likely to relinquish their driving licence. (C) Socio-demographic and health status questions. A conditional logit regression model was adopted to analyse the DCE data. RESULTS Older people would be more likely to relinquish their driver's licence due to advanced age, low confidence in driving ability and in situations where their local doctor advises them to cease driving. Other transport options availability and the cost of public transport were not found to be influential to this decision. CONCLUSIONS Factors pertaining to the individual themselves including advanced old age and low confidence in driving ability may be more influential than environmental factors such as availability of other transport options and the cost of public transport in an older person's decision to relinquish their driving licence.
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Affiliation(s)
- Annabel McNamara
- Flinders University, Rehabilitation, Aged and Extended Care, C Block, Repatriation General Hospital, Daws Road, Daw Park, SA 5041, Australia.
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Seiler S, Schmidt H, Lechner A, Benke T, Sanin G, Ransmayr G, Lehner R, Dal-Bianco P, Santer P, Linortner P, Eggers C, Haider B, Uranues M, Marksteiner J, Leblhuber F, Kapeller P, Bancher C, Schmidt R. Driving cessation and dementia: results of the prospective registry on dementia in Austria (PRODEM). PLoS One 2012; 7:e52710. [PMID: 23300746 PMCID: PMC3530518 DOI: 10.1371/journal.pone.0052710] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 11/20/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the influence of cognitive, functional and behavioral factors, co-morbidities as well as caregiver characteristics on driving cessation in dementia patients. METHODS The study cohort consists of those 240 dementia cases of the ongoing prospective registry on dementia in Austria (PRODEM) who were former or current car-drivers (mean age 74.2 (±8.8) years, 39.6% females, 80.8% Alzheimer's disease). Reasons for driving cessation were assessed with the patients' caregivers. Standardized questionnaires were used to evaluate patient- and caregiver characteristics. Cognitive functioning was determined by Mini-Mental State Examination (MMSE), the CERAD neuropsychological test battery and Clinical Dementia Rating (CDR), activities of daily living (ADL) by the Disability Assessment for Dementia, behavior by the Neuropsychiatric Inventory (NPI) and caregiver burden by the Zarit burden scale. RESULTS Among subjects who had ceased driving, 136 (93.8%) did so because of "Unacceptable risk" according to caregiver's judgment. Car accidents and revocation of the driving license were responsible in 8 (5.5%) and 1(0.7%) participant, respectively. Female gender (OR 5.057; 95%CI 1.803-14.180; p = 0.002), constructional abilities (OR 0.611; 95%CI 0.445-0.839; p = 0.002) and impairment in Activities of Daily Living (OR 0.941; 95%CI 0.911-0.973; p<0.001) were the only significant and independent associates of driving cessation. In multivariate analysis none of the currently proposed screening tools for assessment of fitness to drive in elderly subjects including the MMSE and CDR were significantly associated with driving cessation. CONCLUSION The risk-estimate of caregivers, but not car accidents or revocation of the driving license determines if dementia patients cease driving. Female gender and increasing impairment in constructional abilities and ADL raise the probability for driving cessation. If any of these factors also relates to undesired traffic situations needs to be determined before recommendations for their inclusion into practice parameters for the assessment of driving abilities in the elderly can be derived from our data.
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Affiliation(s)
- Stephan Seiler
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Helena Schmidt
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
- Institute of Molecular Biology and Biochemistry, Centre for Molecular Medicine, Medical University of Graz, Graz, Austria
| | - Anita Lechner
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Thomas Benke
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Guenter Sanin
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Riccarda Lehner
- Department of Neurology, General Hospital Linz, Linz, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Peter Santer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Patricia Linortner
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Christian Eggers
- Department of Neurology, Konventhospital der Barmherzigen Brüder Linz, Linz, Austria
| | - Bernhard Haider
- Department of Neurology, Konventhospital der Barmherzigen Brüder Linz, Linz, Austria
| | - Margarete Uranues
- Department of Geriatric Psychiatry, Landesnervenklinik Sigmund Freud Graz, Graz, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy, Regional Hospital Hall in Tirol, Hall in Tirol, Austria
| | - Friedrich Leblhuber
- Department of Neurology and Geriatric Psychiatry, Nervenklinik Wagner-Jauregg Linz, Linz, Austria
| | - Peter Kapeller
- Department of Neurology and Psychosomatic Medicine, Regional Hospital Villach, Villach, Austria
| | | | - Reinhold Schmidt
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
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