Development of the Adelaide Driving Self-Efficacy Scale

Return to Driving Following Moderate-to-Severe Traumatic Brain Injury: A TBI Model System Longitudinal Investigation

OBJECTIVE

To examine longitudinal patterns of return to driving (RTD), driving habits, and crash rates associated with moderate-to-severe traumatic brain injury (TBI).

SETTING

Eight TBI Model System sites.

PARTICIPANTS

Adults (N = 334) with TBI that required inpatient acute rehabilitation with follow-up of 197 and 218 at 1 and 2 years post-injury, respectively. Data collection at 2 years occurred almost exclusively during the pandemic, which may have affected results.

DESIGN

Longitudinal and observational.

MAIN MEASURES

Driving survey completed during rehabilitation and at phone follow-up 1 and 2 years after injury.

RESULTS

The rate of RTD was 65% at 1-year follow-up and 70% at 2-year follow-up. RTD at both follow-up time points was positively associated with family income. The frequency of driving and distance driven were diminished compared to before injury. Limitation of challenging driving situations (heavy traffic, bad weather, and at night) was reported at higher rates post-injury than before injury. Crash rates were 14.9% in the year prior to injury (excluding crashes that resulted in TBI), 9.9% in the first year post-injury, and 6% during the second year.

CONCLUSION

RTD is common after TBI, although driving may be limited in terms of frequency, distance driven, and avoiding challenging situations compared to before injury. Incidence of crashes is higher than population-based statistics; however, those who sustain TBI may be at higher risk even prior to injury. Future work is needed to better identify characteristics that influence the likelihood of crashes post-TBI.

On-road driving remediation following acquired brain injury: a randomized controlled trial

OBJECTIVE

To investigate the relationship between on-road driving remediation and achieving fitness to drive following acquired brain injury.

DESIGN

Randomized controlled trial.

SETTING

Tertiary hospital outpatient driver assessment and rehabilitation service, Australia.

PARTICIPANTS

Thirty-five participants (54.3% male), aged 18-65 years, 41 days-20 years post-acquired brain injury (including stroke, aneurysm, traumatic brain injury) recommended for on-road driving remediation following occupational therapy driver assessment were randomly assigned to intervention (n = 18) and waitlist control (n = 17) groups.

INTERVENTION

Intervention group received on-road driving remediation delivered by a qualified driving instructor in a dual-control vehicle. The waitlist control group completed a 6 week period of no driving-related remediation.

MAIN MEASURE

Fitness to drive rated following the conduct of an on-road occupational therapy driver assessment with a qualified driving instructor where outcome assessors were blinded to group allocation.

RESULTS

The intervention group were significantly more likely to achieve a fit to drive recommendation than no driving specific intervention (p = 0.003).

CONCLUSION

Following comprehensive assessment, individualized on-road driving remediation programs devised by an occupational therapist with advanced training in driver assessment and rehabilitation and delivered by a qualified driving instructor are significantly associated with achieving fitness to drive after acquired brain injury.

Metacognitive Awareness of Older Adult Drivers with Mild Cognitive Impairment: Relationships with Demographics, Subjective Evaluation of Cognition, and Driving Self-Efficacy

(1) Self-regulation of driving is a means of maintaining one's driving identity. The purpose of this study was to investigate the extent to which older drivers with Mild Cognitive Impairment (MCI) are metacognitively aware of the requirements of specific demanding driving conditions and whether this awareness is linked to subjective assessments of cognition. (2) One hundred seventeen (117) older MCI drivers participated in a telephone survey in which they reported their metacognitive experiences in nine driving conditions, listed as an aim of self-regulation. The analyses included the participants' subjective cognitive assessments, both in terms of their cognitive state and their perceived driving self-efficacy. (3) The analyses pointed out a direct and negative effect of age on the formation of the metacognitive feeling of certainty. Furthermore, an indirect effect of sex through driving self-efficacy was established. This effect was negative in the case of the metacognitive feeling of difficulty and the estimation of effort and positive in the case of the metacognitive feeling of certainty. (4) This position points out the need to establish appropriate levels of the perceived self-efficacy of older drivers with MCI, and it raises issues when it moves to fictitious levels.

R2DRV: study protocol for longitudinal assessment of driving after mild TBI in young drivers

BACKGROUND

Mild traumatic brain injury (mTBI) and traffic-related injuries are two major public health problems disproportionately affecting young people. Young drivers, whose driving skills are still developing, are particularly vulnerable to impaired driving due to brain injuries. Despite this, there is a paucity of research on how mTBI impacts driving and when it is safe to return to drive after an mTBI. This paper describes the protocol of the study, R2DRV, Longitudinal Assessment of Driving After Mild TBI in Young Drivers, which examines the trajectory of simulated driving performance and self-reported driving behaviors from acutely post-injury to symptom resolution among young drivers with mTBI compared to matched healthy drivers. Additionally, this study investigates the associations of acute post-injury neurocognitive function and cognitive load with driving among young drivers with and without mTBI.

METHODS

A total of 200 young drivers (ages 16 to 24) are enrolled from two study sites, including 100 (50 per site) with a physician-confirmed isolated mTBI, along with 100 (50 per site) healthy drivers without a history of TBI matched 1:1 for age, sex, driving experience, and athlete status. The study assesses primary driving outcomes using two approaches: (1) high-fidelity driving simulators to evaluate driving performance across four experimental study conditions at multiple time points (within 96 h of injury and weekly until symptom resolution or 8 weeks post-injury); (2) daily self-report surveys on real-world driving behaviors completed by all participants.

DISCUSSION

This study will fill critical knowledge gaps by longitudinally assessing driving performance and behaviors in young drivers with mTBI, as compared to matched healthy drivers, from acutely post-injury to symptom resolution. The research strategy enables evaluating how increased cognitive load may exacerbate the effects of mTBI on driving, and how post-mTBI neurocognitive deficits may impact the driving ability of young drivers. Findings will be shared through scientific conferences, peer-reviewed journals, and media outreach to care providers and the public.

Hazard perception training effectiveness on experienced drivers: decay of improvement in the follow-up

A variety of road hazard perception training programmes have been proposed recently, based on the assumption that these skills contribute to lower crash rates across different countries. However, the long-term effectiveness of suggested programmes has been under-investigated. The main objective of this study is to explore the long-term effectiveness of online hazard perception training for experienced drivers and examine the moderating role of driving self-efficacy. Fifty-six experienced drivers (21 males and 35 females) were assigned to the experimental (n = 31) or the control (n = 25) group. The experimental group received two 45 min session interventions; the control group received no intervention. The effectiveness of the programme was tested by the change in scores of Lithuanian hazard prediction test (HPT) LHP12 that was conducted before training (pre-test), immediately after training (post-test) and six months after training (follow-up). The twelve-item Adelaide Driving Self-Efficacy Scale (ADSES; George et al., 2007) was used to measure self-reported driving self-efficacy at the pre-test. The results revealed a significant increase in hazard prediction scores immediately after training, but the short-term effect of training decayed at follow-up. Experienced drivers with higher self-efficacy developed better hazard prediction skills during training. The results confirmed short-term effectiveness of the programme.

Crash Risk Following Return to Driving After Moderate-to-Severe TBI: A TBI Model Systems Study

OBJECTIVE

To examine motor vehicle crash frequency and risk factors following moderate-to-severe traumatic brain injury (TBI).

SETTING

Eight TBI Model Systems sites. Participants: Adults ( N = 438) with TBI who required inpatient acute rehabilitation.

DESIGN

Cross-sectional, observational design.

MAIN MEASURES

Driving survey completed at phone follow-up 1 to 30 years after injury.

RESULTS

TBI participants reported 1.5 to 2.5 times the frequency of crashes noted in the general population depending on the time frame queried, even when accounting for unreported crashes. Most reported having no crashes; for those who experienced a crash, half of them reported a single incident. Based on logistic regression, age at survey, years since injury, and perception of driving skills were significantly associated with crashes.

CONCLUSION

Compared with national statistics, crash risk is higher following TBI based on self-report. Older age and less time since resuming driving were associated with lower crash risk. When driving was resumed was not associated with crash risk. These results do not justify restricting people from driving after TBI, given that the most who resumed driving did not report experiencing any crashes. However, there is a need to identify and address factors that increase crash risk after TBI.

Effects of cannabidiol on simulated driving and cognitive performance: A dose-ranging randomised controlled trial

BACKGROUND

Cannabidiol (CBD), a major cannabinoid of Cannabis sativa, is widely consumed in prescription and non-prescription products. While CBD is generally considered 'non-intoxicating', its effects on safety-sensitive tasks are still under scrutiny.

AIM

We investigated the effects of CBD on driving performance.

METHODS

Healthy adults (n = 17) completed four treatment sessions involving the oral administration of a placebo, or 15, 300 or 1500 mg CBD in a randomised, double-blind, crossover design. Simulated driving performance was assessed between ~45-75 and ~210-240 min post-treatment (Drives 1 and 2) using a two-part scenario with 'standard' and 'car following' (CF) components. The primary outcome was standard deviation of lateral position (SDLP), a well-established measure of vehicular control. Cognitive function, subjective experiences and plasma CBD concentrations were also measured. Non-inferiority analyses tested the hypothesis that CBD would not increase SDLP by more than a margin equivalent to a 0.05% blood alcohol concentration (Cohen's d_z = 0.50).

RESULTS

Non-inferiority was established during the standard component of Drive 1 and CF component of Drive 2 on all CBD treatments and during the standard component of Drive 2 on the 15 and 1500 mg treatments (95% CIs < 0.5). The remaining comparisons to placebo were inconclusive (the 95% CIs included 0 and 0.50). No dose of CBD impaired cognition or induced feelings of intoxication (ps > 0.05). CBD was unexpectedly found to persist in plasma for prolonged periods of time (e.g. >4 weeks at 1500 mg).

CONCLUSION

Acute, oral CBD treatment does not appear to induce feelings of intoxication and is unlikely to impair cognitive function or driving performance (Registration: ACTRN12619001552178).

Association of Driving Fitness and Driving Efficacy in the Elderly with Generalized Anxiety Disorder

Purpose

The purpose of this study was to investigate the relationship between driving fitness and driving efficacy in elderly patients with generalized anxiety disorder and identify factors influencing anxiety.

Methods

The anxiety level, driving efficacy, and driving performance were assessed for 45 elderly drivers who had been diagnosed with or were suspected of having an anxiety disorder in the past. The Korean-Self-rating Anxiety Scale (K-SAS), Korean-Adelaide Driving Self-Efficacy Scale (K-ADSES), and Korean-Drivers 65 Plus (K-D65+) were used as test tools. Factors affecting anxiety and the differences between the groups with high anxiety symptoms and anxiety in the normal range were analyzed.

Results

There were differences in driving efficiency and driving performance between elderly drivers with anxiety scores in the normal range and those with mild-to-moderate anxiety (p < 0.05). Significant factors (p < 0.001) influencing driving anxiety in the high anxiety group were GAD duration (β = 0.170), driving difficulty (β = 10.648), drug use (β = 0.656), traffic sign/signal awareness (β = −0.870).

Conclusion

Our results suggest that a combination of a driving rehabilitation approach and interventions that can provide emotional support and reduce mental health anxiety, as well as exposure treatment for driving performance training, may be necessary for driving rehabilitation of the elderly with generalized anxiety disorder.

Development of a Web-Based Mini-Driving Scene Screening Test (MDSST) for Clinical Practice in Driving Rehabilitation

(1) Background: For the elderly and disabled, self-driving is very important for social participation. An understanding of changing driving conditions is essential in order to drive safely. This study aimed to develop a web-based Korean Mini-Driving Scene Screening Test (MDSST) and to verify its reliability and validity for clinical application. (2) Methods: We developed a web-based MDSST, and its content validity was verified by an expert group. The tests were conducted with 102 elderly drivers to verify the internal consistency and reliability of items, and the validity of convergence with the existing Korean-Safe Driving Behavior Measure (K-SDBM) and the Korean-Adelaide Driving Self-Efficacy Scale (K-ADSES) driving tests was also verified. The test–retest reliability was verified using 54 individuals who participated in the initial test. (3) Results: The average content validity index of MDSST was 0.90, and the average internal consistency of all items was 0.822, indicating high content validity and internal consistency. The exploratory factor analysis for construct validity, the KOM value of the data, was 0.658, and Bartlett’s sphericity test also showed a strongly significant result. The four factors were road traffic and signal perception, situation understanding, risk factor recognition, and situation prediction. The explanatory power was reliable at 61.27%. For the convergence validation, MDSST and K-SDBM showed r = 0.435 and K-ADSES showed r = 0.346, showing a moderate correlation. In the evaluation–reevaluation reliability verification, the reliability increased to r = 0.952. (4) Conclusions: The web-based MDSST test developed in this study is a useful tool for detecting and understanding real-world driving situations faced by elderly drivers. It is hoped that the MDSST test can be applied more widely as a driving ability test that can be used in the clinical field of driving rehabilitation.

Take-Over Intention during Conditionally Automated Driving in China: Current Situation and Influencing Factors

Drivers’ take-over intention is important for the design of the automated driving systems and affects the safety of automated driving. This study explored the influence factors on drivers’ take-over intention during conditionally automated driving, examined the correlations among factors through path analysis, and established a take-over intention model. A questionnaire survey was conducted in Hefei, China, and a sample of 277 drivers was obtained. Our study shows that the average take-over intention of those aged under 20 is lower than that of the older age groups. In the positive emotions (PE) scenarios, the take-over intention of aged 31–40 is significantly higher than that of the other age groups. Education and occupation have a significant influence on the take-over intention. The perceived ease of use (PEofU) and perceived usefulness (PU) of automated driving are significantly negatively correlated with drivers’ take-over intention in the road conditions (RC) and climate conditions (CC) scenarios. In addition, through path model analysis, our study shows that trust in the safety of autonomous vehicles (AVs) plays an important role in drivers’ take-over intention. Technology acceptance, risk perception and self-efficacy has indirectly correlated with take-over intention through trust in the safety of AVs. In general, drivers with lower technology acceptance, lower self-efficacy and higher risk perception are less likely to trust automated driving technology and have shown stronger intention to take-over the control of the vehicles.

Evaluation of a Persian version of the Adelaide driving self-efficacy scale among Iranian older adults

OBJECTIVE

Our aim in the present study was to estimate the psychometric properties of the full-length Adelaide driving self-efficacy scale (ADSES) for use among community-based resident older adults in Tehran, Iran.

METHODS

We recruited older adults (60+ years) from various sampling units nested in the Tehran district's general urban population (20 subjects/questionnaire-item). The questionnaire was translated and back-translated by using recommended pathways. Multiple forms of validity and reliability, including Cronbach alpha, were estimated. Also, we measured intra-class correlation coefficient, and did confirmatory factor analysis (CFA).

RESULTS

A total of 243 participants (mean age: 65.8, 95%CI 65.4-66.3) met our inclusion criteria. For ADSES, the alpha coefficient was 0.77, the intraclass correlation coefficient was 0.97 (95% CI: 0.95-0.98), and the average item-test correlation was 0.67. Upon CFA, we found a 0.95 comparative fit index, a coefficient of determination = 92.6%, and standardized size of the residual = 0.04.

CONCLUSION

Our Persian language ADSES was found to have adequate validity and factor structure parameters for evaluating driving self-efficacy among community-based older adults in a non-western context. Our questionnaire is an essential first step toward evaluating driving self-efficacy among older adults, especially where no such tool is available, to help develop driving self-efficacy as a healthy aging measure.

Driving patterns, confidence, and perception of abilities following moderate to severe traumatic brain injury: a TBI model system study

OBJECTIVE

Describe driving patterns following moderate-to-severe traumatic brain injury (TBI). Participants: Adults (N = 438) with TBI that required inpatient acute rehabilitation who had resumed driving.

DESIGN

Cross-sectional, observational design.

SETTING

Eight TBI Model System sites.

MAIN MEASURES

A driving survey was completed at phone follow-up.

RESULTS

Most respondents reported driving daily, although 41% reported driving less than before their injury. Driving patterns were primarily associated with employment, family income, sex, residence, and time since injury, but not injury severity. Confidence in driving was high for most participants and was associated with a perception that the TBI had not diminished driving ability. Lower confidence and perceived loss of ability were associated with altered driving patterns.

CONCLUSION

Most people with moderate-to-severe TBI resume driving but perhaps not at pre-injury or normal levels compared to healthy drivers. Some driving situations are restricted. The relationship between low confidence/perceived loss of ability and driving patterns/restrictions suggests people with TBI are exhibiting some degree of caution consistent with those perceptions. Careful assessment of driving skills and monitoring during early stages of RTD is warranted, particularly for younger, male, and/or single drivers who express higher levels of confidence.

Return to Driving After Moderate-to-Severe Traumatic Brain Injury: A Traumatic Brain Injury Model System Study

OBJECTIVE

Describe who is able to return to driving (RTD) after moderate-to-severe traumatic brain injury (TBI), when this occurs, who maintains that activity, and the association with outcome.

DESIGN

Cross-sectional descriptive study.

SETTING

Eight follow-up sites of the TBI Model Systems (TBIMS) program.

PARTICIPANTS

618 participants enrolled in the TBIMS and 88 caregivers (N=706).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

A survey was completed from 1-30 years postinjury focusing on RTD. Descriptors included demographic information, injury severity, and current employment status. Outcome was assessed at the time of the interview, including depression, quality of life, functional status, and community participation.

RESULTS

Of 706 respondents, 78% (N = 552) RTD, but 14% (N = 77) of these did not maintain that activity. Of those who RTD, 43% (N = 192) did so within 6 months of the injury and 92% did so within 24 months postinjury. The percentage of people driving after TBI did not differ significantly based on age at time of injury or follow-up. There were significant differences between drivers and nondrivers with respect to severity of injury, seizures, race, education, employment, rural vs urban setting, marital status, and family income. We performed a multivariate logistic regression to examine the association between driving status and demographic variables, adjusting for other variables in the model. The strongest associations were with current employment, family income, race, seizures, and severity of injury. Driving was associated with greater community participation, better functional outcomes, fewer symptoms of depression, and greater life satisfaction.

CONCLUSIONS

Over a span of 30 years, three-quarters of people experiencing moderate-to-severe TBI return to driving a personal vehicle, although not everyone maintains this activity. Employment, race, family income, and seizures are strongly associated with RTD.

The Effects of Acute Exercise on Driving and Executive Functions in Healthy Older Adults

The benefits of exercise on cognitive functioning in older adults are well recognized. One limitation of the current literature is that researchers have almost exclusively relied on well-controlled laboratory tasks to assess cognition. Moreover, the effects of a single bout of aerobic exercise in older adults have received limited attention. The proposed study addresses these limitations by assessing the effects of a single bout of exercise on a more ecologically valid task - driving. Seventy-one participants (M _age = 66.39 ± 4.70 years) were randomly allocated to 20min cycling at moderate intensity or sitting and watching driving videos. Participants were then tested on their driving performance using a driving simulator. Driving performance was measured with three different scenarios assessing decision making, driving errors, reaction time, and attention. On a subsequent session, all participants were tested on executive functioning before and after a fitness test. Non-significant effects of exercise were observed on driving performance. However, participants performed better on the Trail Making Test (Cohen's d = 0.25) and Stroop test (d = 0.50) after the fitness test compared to their baseline. These results suggest that post-exercise cognitive improvements do not transfer to improved driving performance among healthy older adults. This study also highlights the importance of assessing expectations as a possible moderator of the effects of acute exercise on activities of daily living. Future studies must examine other relevant ecologically valid tasks and ensure similar expectations between experimental and control groups to further advance the knowledge base in the field.

The Predictors of Driving Cessation among Older Drivers in Korea

Background: As the elderly population and the number of older drivers grow, public safety concerns about traffic accidents involving older drivers are increasing. Approaches to reduce traffic accidents involving older drivers without limiting their mobility are needed. This study aimed to investigate the driving cessation (DC) rate among older Korean adults and predictors of DC based on the comprehensive mobility framework. Method: In this cross-sectional study, data from 2970 to 10,062 older adults over 65 years old from the 2017 National Survey of Elderly People were analyzed in April 2020. Multivariate logistic regression analyses were conducted to identify the predictors of DC. Results: Residential area, an environmental factor, was a strong predictor of DC (Odds Ratio (OR) 2.21, 95% Confidential Interval (CI) 1.86–2.62). Older drivers living in an area with a metro system were 2.21 more likely to stop driving than those living in an area without a metro system. Other demographic, financial, psychosocial, physical, and cognitive variables also predicted DC. Conclusion: Environmental factors were strong predictors of older adults’ DC. Therefore, political and environmental support, such as the provision of accessible public transportation, is essential to increase the DC rate among older adults to increase public safety without decreasing their mobility.

The effect of cannabidiol on simulated car driving performance: A randomised, double-blind, placebo-controlled, crossover, dose-ranging clinical trial protocol

OBJECTIVE

Interest in the use of cannabidiol (CBD) is increasing worldwide as its therapeutic effects are established and legal restrictions moderated. Unlike Δ9 -tetrahydrocannabinol (Δ9 -THC), CBD does not appear to cause cognitive or psychomotor impairment. However, further assessment of its effects on cognitively demanding day-to-day activities, such as driving, is warranted. Here, we describe a study investigating the effects of CBD on simulated driving and cognitive performance.

METHODS

Thirty healthy individuals will be recruited to participate in this randomised, double-blind, placebo-controlled crossover trial. Participants will complete four research sessions each involving two 30-min simulated driving performance tests completed 45 and 210 min following oral ingestion of placebo or 15, 300, or 1,500 mg CBD. Cognitive function and subjective drug effects will be measured, and blood and oral fluid sampled, at regular intervals. Oral fluid drug testing will be performed using the Securetec DrugWipe® 5S and Dräger DrugTest® 5000 devices to determine whether CBD increases the risk of "false-positive" roadside tests to Δ9 -THC. Noninferiority analyses will test the hypothesis that CBD is no more impairing than placebo.

CONCLUSION

This study will clarify the risks involved in driving following CBD use and assist in ensuring the safe use of CBD by drivers.

Changes in beliefs during driver training and their association with risky driving

OBJECTIVE

Researchers continue to seek reasons for novice drivers' over-representation in crashes. Evidence on how early interventions might mitigate this global phenomenon remains inconclusive. This study explores changes in novice drivers' beliefs during pre-licensure training and within their first one-year independent provisional license period, and how these changes might help to predict subsequent risky driving.

METHOD

A sample of novice drivers (N = 175) from Lithuania participated in a three-wave longitudinal study. They completed questionnaires when beginning driver training (T1), at the end of their training (T2), and after one year of independent driving (T3). The Attitudes towards Risky Driving Questionnaire, the Adelaide Driving Self Efficacy Scale, the Driving Cognitions Questionnaire, the Driver Behaviour Questionnaire, and the Social Desirability Scale were used.

RESULTS

Reported driving self-efficacy increased and fear of driving decreased from the beginning to the end of driver training and after one-year follow-up in both men and women. Road safety attitudes changed in the risk-unfavourable direction from T1 to T2. However, at T3 these attitudes returned to the initial level for men. Female novice drivers reported the same level of safety attitudes at T2 and T3. Risky attitudes, driving self-efficacy, and fear of driving predicted reported driving errors and violations.

CONCLUSIONS

Reported psychological changes occurred during the driver training period and in the first year of independent driving. It is recommended that special attention should be paid to a group of novices who experienced safety compromising changes in attitudes, driving self-efficacy, and fear of driving during training and in the first year of their driving career.

Who uses a mobile phone while driving for food delivery? The role of personality, risk perception, and driving self-efficacy

INTRODUCTION

The existing literature on mobile phone use while driving (MPUWD) mainly targets the participants from general population and the young adults, however, few studies pay attention to this form of distracted driving with samples in professional contexts. The present study aims to bridge the gap by identifying the extent of and the motives behind making use of mobile phones while driving for food dispatch among deliveryman.

METHOD

The snowball sampling was used to collect the data (N = 317) through a self-reported questionnaire, including demographics, personality traits, risk perception, driving self-efficacy, and mobile phone use while driving.

RESULTS

Descriptive analysis for the assessed MPUWD behaviors showed that 96.3% (N = 315) of food deliveryman undertook the MPUWD behaviors, though disproportionate distribution among these behaviors existed. Structural equation modeling analysis displayed that psychoticism and driving self-efficacy directly predicted the MPUWD behaviors. The mediating role of driving self-efficacy was verified with the findings that driving self-efficacy completely mediated the relationships that between risk perception and MPUWD behaviors and that between extraversion and MPUWD behaviors, as well as partially mediated the correlation between psychoticism and MPUWD behaviors.

CONCLUSIONS

The present study confirms the prevalence of MPUWD behaviors among food deliveryman. The SEM estimates and bootstrap estimates suggest that personality traits and perceived risk perception per se display limited predicting utility to MPUWD behaviors among food deliveryman, whereas driving self-efficacy and the proposed predictors together well illustrate the assessed MPUWD behaviors among food deliveryman. Practical Applications: These findings imply that developing and implementing intervention efforts in a concerted way would curb these behaviors effectively.

User experiences and perspectives of a driving simulator intervention for individuals with acquired brain injury: A qualitative study

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.

Personal and Clinical Factors Associated with Older Drivers' Self-Awareness of Driving Performance

Most older adults perceive themselves as good drivers; however, their perception may not be accurate, and could negatively affect their driving safety. This study examined the accuracy of older drivers' self-awareness of driving ability in their everyday driving environment by determining the concordance between the perceived (assessed by the Perceived Driving Ability [PDA] questionnaire) and actual (assessed by electronic Driving Observation Schedule [eDOS]) driving performance. One hundred and eight older drivers (male: 67.6%; age: mean = 80.6 years, standard deviation [SD] = 4.9 years) who participated in the study were classified into three groups: underestimation (19%), accurate estimation (29%), and overestimation (53%). Using the demographic and clinical functioning information collected in the Candrive annual assessments, an ordinal regression showed that two factors were related to the accuracy of self-awareness: older drivers with better visuo-motor processing speed measured by the Trail Making Test (TMT)-A and fewer self-reported comorbid conditions tended to overestimate their driving ability, and vice versa.

Cannabidiol (CBD) content in vaporized cannabis does not prevent tetrahydrocannabinol (THC)-induced impairment of driving and cognition

BACKGROUND

The main psychoactive component of cannabis, delta-9-tetrahydrocannabinol (THC), can impair driving performance. Cannabidiol (CBD), a non-intoxicating cannabis component, is thought to mitigate certain adverse effects of THC. It is possible then that cannabis containing equivalent CBD and THC will differentially affect driving and cognition relative to THC-dominant cannabis.

AIMS

The present study investigated and compared the effects of THC-dominant and THC/CBD equivalent cannabis on simulated driving and cognitive performance.

METHODS

In a randomized, double-blind, within-subjects crossover design, healthy volunteers (n = 14) with a history of light cannabis use attended three outpatient experimental test sessions in which simulated driving and cognitive performance were assessed at two timepoints (20-60 min and 200-240 min) following vaporization of 125 mg THC-dominant (11% THC; < 1% CBD), THC/CBD equivalent (11% THC, 11% CBD), or placebo (< 1% THC/CBD) cannabis.

RESULTS/OUTCOMES

Both active cannabis types increased lane weaving during a car-following task but had little effect on other driving performance measures. Active cannabis types impaired performance on the Digit Symbol Substitution Task (DSST), Divided Attention Task (DAT) and Paced Auditory Serial Addition Task (PASAT) with impairment on the latter two tasks worse with THC/CBD equivalent cannabis. Subjective drug effects (e.g., "stoned") and confidence in driving ability did not vary with CBD content. Peak plasma THC concentrations were higher following THC/CBD equivalent cannabis relative to THC-dominant cannabis, suggesting a possible pharmacokinetic interaction.

CONCLUSIONS/INTERPRETATION

Cannabis containing equivalent concentrations of CBD and THC appears no less impairing than THC-dominant cannabis, and in some circumstances, CBD may actually exacerbate THC-induced impairment.

Escala de Autoeficácia para dirigir: construção e avaliação preliminar das propriedades psicométricas

Resumo Este trabalho relata a construção da Escala de Autoeficácia para dirigir e a verificação preliminar de suas propriedades psicométricas. Na primeira etapa, procedeu-se com o levantamento sobre o tema culminando na elaboração de 20 itens, os quais foram ampliados após avaliação de juízes. A etapa seguinte consistiu no estudo piloto com a aplicação dos 25 itens resultantes em 40 motoristas. Os resultados indicaram a necessidade de algumas adequações e a construção de mais dez itens. Na última etapa, o instrumento foi aplicado em 500 motoristas em processo de renovação da Carteira Nacional de Habilitação, com idades entre 23 e 78 anos, sendo 60,40% deles do sexo masculino. Após a análise fatorial, a escala foi reduzida para 15 itens alocados em um único fator, com variância explicada de 41,75% e fidedignidade adequada (α = 0,91). Sugere-se que sejam realizados novos estudos com a escala a fim de ampliar as evidências de validade.

Assessment tools predicting fitness to drive in older adults: a systematic review

This systematic review synthesizes the research on screening and assessment tools used to determine older adults' fitness to drive. After a comprehensive search of the literature targeting tools commonly used by occupational therapists, 64 studies were reviewed and synthesized. The evidence demonstrated that a single tool measuring cognition, vision, perception, or physical ability individually is not sufficient to determine fitness to drive. Although some tools have stronger evidence than others, this review supports using different and focused assessment tools together for specific medical conditions. Results indicate that behind-the-wheel assessment remains the gold standard for driving evaluation; however, emerging evidence for observation of complex instrumental tasks of daily living and driving simulation supports further investigation with these tools.

Mobility and safety issues in drivers with dementia

Although automobiles remain the mobility method of choice for older adults, late-life cognitive impairment and progressive dementia will eventually impair the ability to meet transport needs of many. There is, however, no commonly utilized method of assessing dementia severity in relation to driving, no consensus on the specific types of assessments that should be applied to older drivers with cognitive impairment, and no gold standard for determining driving fitness or approaching loss of mobility and subsequent counseling. Yet, clinicians are often called upon by patients, their families, health professionals, and driver licensing authorities to assess their patients' fitness-to-drive and to make recommendations about driving privileges. We summarize the literature on dementia and driving, discuss evidenced-based assessments of fitness-to-drive, and outline the important ethical and legal concerns. We address the role of physician assessment, referral to neuropsychology, functional screens, dementia severity tools, driving evaluation clinics, and driver licensing authority referrals that may assist clinicians with an evaluation. Finally, we discuss mobility counseling (e.g. exploration of transportation alternatives) since health professionals need to address this important issue for older adults who lose the ability to drive. The application of a comprehensive, interdisciplinary approach to the older driver with cognitive impairment will have the best opportunity to enhance our patients' social connectedness and quality of life, while meeting their psychological and medical needs and maintaining personal and public safety.

Self-Efficacy to Drive While Intoxicated: Insights into the Persistence of Alcohol-Impaired Driving

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.

Transport, driving and ageing

Transport 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.

Age-related Differences in Attentional Failures during Driving

Older drivers experience increasing risks of vehicle crashes. This increase in crash risks has been associated with age-related declines in attention. To assess attentional failures during driving, we develop a self-report measure, the Attentional Failures during Driving Questionnaire (AFDQ). In this paper, we describe the development of the questionnaire and our preliminary effort to examine its reliability and validity via an online survey. The results demonstrated a high level of internal consistency of the questionnaire. In addition, we found that self-reported attentional failures during driving are not only associated with self-reported attentional and cognitive failures during other daily activities, but also related to unsafe driving behaviors and self-efficacy in driving. Our results also showed significant age-related differences in the AFDQ score: old-old drivers (age 75+) reported a higher level of attentional failures during driving than middle-aged drivers (age 25-64) and young-old drivers (age 65-74). These preliminary results indicate the potential use of AFDQ as a measure of attentional performance during driving for older drivers.

Re-conceptualising the reckless driving behaviour of young drivers

Reckless driving is a major contributing factor to road morbidity and mortality. While further research into the nature and impact of reckless driving, particularly among young people, is urgently needed, the measurement of reckless driving behaviour also requires increased attention. Three major shortcomings apparent in established measures of driver behaviour are that they do not target the full range of reckless driving behaviours, they measure characteristics other than driving behaviours, and/or they fail to categorise and label reckless driver behaviour based on characteristics of the behaviours themselves. To combat these shortcomings, this paper reports the development and preliminary validation of a new measure of reckless driving behaviour for young drivers. Exploratory factor analysis of self-reported driving data revealed four, conceptually distinct categories of reckless driving behaviour: those that increase crash-risk due to (a) distractions or deficits in perception, attention or reaction time (labelled "distracted"), (b) driving under the influence of drugs or alcohol (labelled "substance-use"), (c) placing the vehicle in an unsafe environment beyond its design expectations (labelled "extreme"), and (d) speed and positioning of the vehicle relative to other vehicles and objects (labelled "positioning"). Confirmatory factor analysis of data collected from a separate, community sample confirmed this four-factor structure. Multiple regression analyses found differences in the demographic and psychological variables related to these four factors, suggesting that interventions in one reckless driving domain may not be helpful in others.

Rehabilitation for improving automobile driving after stroke

BACKGROUND

Interventions to improve driving ability after stroke, including driving simulation and retraining visual skills, have limited evaluation of their effectiveness to guide policy and practice.

OBJECTIVES

To determine whether any intervention, with the specific aim of maximising driving skills, improves the driving performance of people after stroke.

SEARCH METHODS

We searched the Cochrane Stroke Group Trials register (August 2013), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2012, Issue 3), MEDLINE (1950 to October 2013), EMBASE (1980 to October 2013), and six additional databases. To identify further published, unpublished and ongoing trials, we handsearched relevant journals and conference proceedings, searched trials and research registers, checked reference lists and contacted key researchers in the area.

SELECTION CRITERIA

Randomised controlled trials (RCTs), quasi-randomised trials and cluster studies of rehabilitation interventions, with the specific aim of maximising driving skills or with an outcome of assessing driving skills in adults after stroke. The primary outcome of interest was the performance in an on-road assessment after training. SECONDARY OUTCOMES included assessments of vision, cognition and driving behaviour.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials based on pre-defined inclusion criteria, extracted the data and assessed risk of bias. A third review author moderated disagreements as required. The review authors contacted all investigators to obtain missing information.

MAIN RESULTS

We included four trials involving 245 participants in the review. Study sample sizes were generally small, and interventions, controls and outcome measures varied, and thus it was inappropriate to pool studies. Included studies were at a low risk of bias for the majority of domains, with a high/unclear risk of bias identified in the areas of: performance (participants not blinded to allocation), and attrition (incomplete outcome data due to withdrawal) bias. Intervention approaches included the contextual approach of driving simulation and underlying skill development approach, including the retraining of speed of visual processing and visual motor skills. The studies were conducted with people who were relatively young and the timing after stroke was varied.

PRIMARY OUTCOME

there was no clear evidence of improved on-road scores immediately after training in any of the four studies, or at six months (mean difference 15 points on the Test Ride for Investigating Practical Fitness to Drive - Belgian version, 95% confidence intervals (CI) 4.56 to 34.56, P value = 0.15, one study, 83 participants).

SECONDARY OUTCOMES

road sign recognition was better in people who underwent training compared with control (mean difference 1.69 points on the Road Sign Recognition Task of the Stroke Driver Screening Assessment, 95% CI 0.51 to 2.87, P value = 0.007, one study, 73 participants). Significant findings were in favour of a simulator-based driving rehabilitation programme (based on one study with 73 participants) but these results should be interpreted with caution as they were based on a single study. Adverse effects were not reported. There was insufficient evidence to draw conclusions on the effects on vision, other measures of cognition, motor and functional activities, and driving behaviour with the intervention.

AUTHORS' CONCLUSIONS

There was insufficient evidence to reach conclusions about the use of rehabilitation to improve on-road driving skills after stroke. We found limited evidence that the use of a driving simulator may be beneficial in improving visuocognitive abilities, such as road sign recognition that are related to driving. Moreover, we were unable to find any RCTs that evaluated on-road driving lessons as an intervention. At present, it is unclear which impairments that influence driving ability after stroke are amenable to rehabilitation, and whether the contextual or remedial approaches, or a combination of both, are more efficacious.

Evaluation of driving confidence in post-stroke older drivers in South Australia

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.

Driving assessment for maintaining mobility and safety in drivers with dementia

BACKGROUND

Demographic changes are leading to an increase in the number of older drivers: as dementia is an age-related disease, there is also an increase in the numbers of drivers with dementia. Dementia can impact on both the mobility and safety of drivers, and the impact of formal assessment of driving is unknown in terms of either mobility or safety. Those involved in assessment of older drivers need to be aware of the evidence of positive and negative effects of driving assessment. Cognitive tests are felt by some authors to have poor face and construct validity for assessing driving performance; extrapolating from values in one large-scale prospective cohort study, the cognitive test that most strongly predicted future crashes would, if used as a screening tool, potentially prevent six crashes per 1000 people over 65 years of age screened, but at the price of stopping the driving of 121 people who would not have had a crash.

PRIMARY OBJECTIVES

1. to assess whether driving assessment facilitates continued driving in people with dementia;2. to assess whether driving assessment reduces accidents in people with dementia.

SECONDARY OBJECTIVE

1. to assess the quality of research on assessment of drivers with dementia.

SEARCH METHODS

ALOIS, the Cochrane Dementia Group's Specialized Register was searched on 13 September 2012 using the terms: driving or driver* or "motor vehicle*" or "car accident*" or "traffic accident*" or automobile* or traffic. This register contains records from major healthcare databases, ongoing trial databases and grey literature sources and is updated regularly.

SELECTION CRITERIA

We sought randomised controlled trials prospectively evaluating drivers with dementia for outcomes such as transport mobility, driving cessation or motor vehicle accidents following driving assessment.

DATA COLLECTION AND ANALYSIS

Each review author retrieved studies and assessed for primary and secondary outcomes, study design and study quality.

MAIN RESULTS

No studies were found that met the inclusion criteria. A description and discussion of the driving literature relating to assessment of drivers with dementia relating to the primary objectives is presented.

AUTHORS' CONCLUSIONS

In an area with considerable public health impact for drivers with dementia and other road users, the available literature fails to demonstrate the benefit of driver assessment for either preserving transport mobility or reducing motor vehicle accidents. Driving legislation and recommendations from medical practitioners requires further research that addresses these outcomes in order to provide the best outcomes for both drivers with dementia and the general public.

Driving assessment for maintaining mobility and safety in drivers with dementia

BACKGROUND

Demographic changes are leading to an increase in the number of older drivers: as dementia is an age-related disease, there is also an increase in the numbers of drivers with dementia. Dementia can impact on both the mobility and safety of drivers, and the impact of formal assessment of driving is unknown in terms of either mobility or safety. Those involved in assessment of older drivers need to be aware of the evidence of positive and negative effects of driving assessment. Cognitive tests are felt by some authors to have poor face and construct validity for assessing driving performance; extrapolating from values in one large-scale prospective cohort study, the cognitive test that most strongly predicted future crashes would, if used as a screening tool, potentially prevent six crashes per 1000 people over 65 years of age screened, but at the price of stopping the driving of 121 people who would not have had a crash.

PRIMARY OBJECTIVES

1. to assess whether driving assessment facilitates continued driving in people with dementia; 2. to assess whether driving assessment reduces accidents in people with dementia.

SECONDARY OBJECTIVE

1. to assess the quality of research on assessment of drivers with dementia.

SEARCH METHODS

ALOIS, the Cochrane Dementia Group's Specialized Register was searched on 13 September 2012 using the terms: driving or driver* or "motor vehicle*" or "car accident*" or "traffic accident*" or automobile* or traffic. This register contains records from major healthcare databases, ongoing trial databases and grey literature sources and is updated regularly.

SELECTION CRITERIA

We sought randomised controlled trials prospectively evaluating drivers with dementia for outcomes such as transport mobility, driving cessation or motor vehicle accidents following driving assessment.

DATA COLLECTION AND ANALYSIS

Each review author retrieved studies and assessed for primary and secondary outcomes, study design and study quality.

MAIN RESULTS

No studies were found that met the inclusion criteria. A description and discussion of the driving literature relating to assessment of drivers with dementia relating to the primary objectives is presented.

AUTHORS' CONCLUSIONS

In an area with considerable public health impact for drivers with dementia and other road users, the available literature fails to demonstrate the benefit of driver assessment for either preserving transport mobility or reducing motor vehicle accidents. Driving legislation and recommendations from medical practitioners requires further research that addresses these outcomes in order to provide the best outcomes for both drivers with dementia and the general public.

Antecedents of self-regulation in driving among older drivers

Maintaining quality of life and wellbeing into advanced age is a major challenge to societies. Driving is one factor contributing to an ageing individual's independence. Understanding antecedents of driving-related self-regulation is important for designing interventions to preserve safe driving in old age. This paper reports on a study that investigated factors associated with two forms of self-regulation in driving (SRD) – avoidance of difficult driving conditions and voluntary cessation of driving – in a sample of 860 Israeli drivers aged 70 and over. We examined roles of health, vision, driving experience, driving-related self-efficacy (DRSE) and global self-esteem in SRD. Health and DRSE had direct effects on SRD, and effects of vision and driving experience were mediated by DRSE. Participants who had ceased driving were older, with poorer vision and health, and less driving confidence and experience than active drivers. Statistical analyses demonstrated that SRD is affected by a reduced sense of confidence due to an initial lower level of driving experience, compounded by deteriorating vision, and that older drivers are sensitive to factors affecting their ability to drive safely. Our results demonstrate that older drivers tend to self-regulate their driving. Programmes for older adults can be introduced for diagnosing driving capabilities, improving skills and confidence, and/or helping to develop self-regulation habits of avoiding driving in difficult conditions, and assisting drivers who must adjust to driving cessation.

Neck pain driving index: appropriateness of the rating scale and unidimensionality of the strategic, tactical, and operational levels

OBJECTIVE

To establish an appropriate scoring system using Rasch scores for the strategic, tactical, and operational levels of the Neck Pain Driving Index (NPDI) and to refine the NPDI by testing the unidimensionality of each driving performance level using Rasch analysis.

DESIGN

Cross-sectional.

SETTING

Tertiary institution.

PARTICIPANTS

Individuals with chronic whiplash-associated disorders (WAD) (N=123).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

The NPDI, which was developed to evaluate self-reported driving difficulty in people with chronic WAD.

RESULTS

On the basis of Rasch analyses, modifications were made to the response format, changing it from a 0 to 4 scale (0=no difficulty, 1=slight difficulty, 2=moderate difficulty, 3=great difficulty, 4=unable to drive because of the injury) to a 0 to 3 scale (0=no difficulty, 1=slight difficulty, 2=moderate difficulty, 3=great difficulty and unable to drive because of the injury). Unidimensionality of the strategic and operational levels was confirmed. Modification of the tactical level was necessary to ensure its unidimensionality. After removing the tasks "driving near (your) collision site," "driving in a bad weather condition," and "driving at night," unidimensionality of the 4-item tactical level was confirmed. A 9-item NPDI was established. A table converting raw total scores into Rasch scores was created for each level.

CONCLUSIONS

This study established the 9-item NPDI, and its 3 subsections (strategic, tactical, and operational levels) are unidimensional. The magnitude of self-reported driving difficulty at each of the 3 subsections can be assessed with the use of a 0 to 3 scale and Rasch scores.

The Neck Pain Driving Index (NPDI) for chronic whiplash-associated disorders: development, reliability, and validity assessment

BACKGROUND CONTEXT

Driving is a functional complaint of many individuals with chronic whiplash-associated disorders (WAD). Current driving scales do not include the most troublesome driving tasks for this group, which suggests that a new tool is required to assess perceived driving difficulty in this population.

PURPOSE

To develop a Neck Pain Driving Index (NPDI) to assess the degree of perceived driving difficulty for individuals with chronic WAD and evaluate the reliability and validity of the NPDI.

STUDY DESIGN

Descriptive/survey.

PATIENT SAMPLE

An external panel of 15 researchers/clinicians and 87 participants with chronic WAD.

OUTCOME MEASURES

The NPDI and a 0 to 10 numeric rating scale (NRS) of perceived driving difficulty (0, no difficulty and 10, maximum difficulty).

METHODS

Phase 1 included the construction of a preliminary NPDI and content validity assessment of question items by a 15-member external panel. Comprehension was evaluated by seven participants with chronic WAD. In Phase 2, the final version of the NPDI was developed via descriptive analysis and assessment of internal consistency using responses of 87 participants with chronic WAD. Subsequently, the convergent validity was assessed using NRS scores. Test-retest reliability at 1 month was investigated in 25 of the 87 participants. Psychometric properties of the driving tasks in the final NPDI were categorized by the external panel, based on the hierarchal Michon model of driving task performance levels. An additional symptom section was developed to better understand the reasons for driving difficulties.

RESULTS

The final NPDI included 12 driving tasks, which scored at least 80% on the content validity index (CVI), ensuring content validity. The NPDI demonstrated good internal consistency (α=0.80), convergent validity (ρ=0.51; p<.01), and test-retest reliability (intraclass correlation coefficient, 0.73; p<.01). As a result of the assessment of psychometric properties, driving tasks were categorized into the strategic (n=3), tactical (n=7), and operational (n=2) levels in the Michon model. The content validity of 11 symptoms (CVI ≥80%) was established by the external panel.

CONCLUSIONS

The NPDI was developed to assess the degree of perceived driving difficulty in the chronic whiplash population. Reliability and validity of the NPDI were ensured. The NPDI can be the entry point for discussions on driving difficulties between clinicians and patients with chronic WAD.

Measuring technology self efficacy: reliability and construct validity of a modified computer self efficacy scale in a clinical rehabilitation setting

PURPOSE

To describe a modification of the computer self efficacy scale for use in clinical settings and to report on the modified scale's reliability and construct validity.

METHODS

The computer self efficacy scale was modified to make it applicable for clinical settings (for use with older people or people with disabilities using everyday technologies). The modified scale was piloted, then tested with patients in an Australian inpatient rehabilitation setting (n = 88) to determine the internal consistency using Cronbach's alpha coefficient. Construct validity was assessed by correlation of the scale with age and technology use. Factor analysis using principal components analysis was undertaken to identify important constructs within the scale.

RESULTS

The modified computer self efficacy scale demonstrated high internal consistency with a standardised alpha coefficient of 0.94. Two constructs within the scale were apparent; using the technology alone, and using the technology with the support of others. Scores on the scale were correlated with age and frequency of use of some technologies thereby supporting construct validity.

CONCLUSIONS

The modified computer self efficacy scale has demonstrated reliability and construct validity for measuring the self efficacy of older people or people with disabilities when using everyday technologies. This tool has the potential to assist clinicians in identifying older patients who may be more open to using new technologies to maintain independence.

Development of the outcome expectancy scale for self-care among periodontal disease patients

RATIONALE

The theory of self-efficacy states that specific efficacy expectations affect behaviour. Two types of efficacy expectations are described within the theory. Self-efficacy expectations are the beliefs in the capacity to perform a specific behaviour. Outcome expectations are the beliefs that carrying out a specific behaviour will lead to a desired outcome.

OBJECTIVE

To develop and examine the reliability and validity of an outcome expectancy scale for self-care (OESS) among periodontal disease patients.

METHODS

A 34-item scale was tested on 101 patients at a dental clinic. Accuracy was improved by item analysis, and internal consistency and test-retest stability were investigated. Concurrent validity was tested by examining associations of the OESS score with the self-efficacy scale for self-care (SESS) score and plaque index score. Construct validity was examined by comparing OESS scores between periodontal patients at initial visit (group 1) and those continuing maintenance care (group 2).

RESULTS

Item analysis identified 13 items for the OESS. Factor analysis extracted three factors: social-, oral- and self-evaluative outcome expectancy. Cronbach's alpha coefficient for the OESS was 0.90. A significant association was observed between test and retest scores, and between the OESS and SESS and plaque index scores. Further, group 2 had a significantly higher mean OESS score than group 1.

CONCLUSION

We developed a 13-item OESS with high reliability and validity which may be used to assess outcome expectancy for self-care. A patient's psychological condition with regard to behaviour and affective status can be accurately evaluated using the OESS with SESS.

What people say about travelling outdoors after their stroke: a qualitative study

BACKGROUND/AIM

Reduced walking ability and loss of confidence are common after stroke. Many people cannot drive or use public transport, which can restrict participation. This qualitative study aimed to explore the experiences and attitudes of people following stroke to travelling outdoors early after hospital discharge.

METHODS

Two semi-structured interviews were conducted with 19 people post-stroke, all of whom were receiving rehabilitation to increase outdoor travel. Mean age was 68.6 years (SD 11.7years). Eight significant others also participated. Interviews were conducted at home (median 21 days post-discharge), with a second interview three months later. Questions focussed on common destinations, modes of travel including driving when relevant and factors that influenced outdoor travel. Qualitative data were analysed using constant comparative (grounded theory) methods, resulting in themes and categories.

RESULTS

People with stroke were categorised as either a hesitant or confident explorer, in relation to walking, catching public transport and driving. Factors influencing outdoor travel included their emotional disposition, having meaningful destinations, expectations of recovery and the sphere of influence, including family and therapists. These factors could have an enabling or restricting effect. A pre-stroke walking habit also positively contributed to outdoor travel. Gate-keeping by therapists, general practitioners and family members seemed to adversely affect travel.

CONCLUSIONS

  This emerging theory offers insights into the experiences and attitudes to outdoor travel of people who were ambulant and participating in community rehabilitation following a stroke. Future research could explore the experiences of people with more severe mobility, cognitive and communication problems.

Using the Rating Scale Model to Examine the Psychometric Properties of the Self-Efficacy Scale for Driver Competence

This study evaluated the psychometric properties of a self-report scale for assessing perceived driver competence, labeled the Self-Efficacy Scale for Driver Competence (SSDC), using item response theory analyses. Two samples of Swedish driving-license examinees (n = 795; n = 714) completed two versions of the SSDC that were parallel in content. Prior work, using classical test theory analyses, has provided support for the validity and reliability of scores from the SSDC. This study investigated the measurement precision, item hierarchy, and differential functioning for males and females of the items in the SSDC as well as how the rating scale functions. The results confirmed the previous findings; that the SSDC demonstrates sound psychometric properties. In addition, the findings showed that measurement precision could be increased by adding items that tap higher self-efficacy levels. Moreover, the rating scale can be improved by reducing the number of categories or by providing each category with a label.

Transportation and driving in longitudinal studies on ageing

BACKGROUND

the associations between transportation, driving and successful ageing are as yet poorly understood. As longitudinal studies are the best methodology for clarifying associations and relationships between health, ageing and environmental factors, we sought to determine how transportation is incorporated into longitudinal studies, and which aspects are assessed.

METHODS

of 55 longitudinal studies on ageing on the National Institute on Aging register, online survey instruments, where available, were scrutinised for references to transport. Where unavailable, principal investigators were contacted by mail/email/phone and asked to forward questions on transportation and driving. Questions were classified into (i) systems, (ii) resources, (iii) transport satisfaction and (iv) mobility needs.

RESULTS

of 55 studies, we could review 36 questionnaires (28 personal replies, 9 accessible online survey instruments). Sixteen had no reference to driving or transportation, 20 (61%) had public transport components and 12 (31%) included questions about driving. Questions covered systems (17), transportation needs (12), transportation resources (11) and transportation satisfaction (4).

CONCLUSION

transport is under-represented in ongoing longitudinal studies, with emphases on public transport, systems and resources, rather than driving and satisfaction. Future waves of studies could usefully review their survey instruments to better measure older people's preferences on transport options and satisfaction.

Effect of Simulator Training on Fitness-to-Drive After Stroke: A 5-Year Follow-up of a Randomized Controlled Trial

Background. No long-term studies have been reported on the effect of training programs on driving after stroke. Objectives. The authors’ primary aim was to determine the effect of simulator versus cognitive rehabilitation therapy on fitness-to-drive at 5 years poststroke. A second aim was to investigate differences in clinical characteristics between stroke survivors who resumed and stopped driving. Methods. In a previously reported randomized controlled trial, 83 stroke survivors received 15 hours of simulator training (n = 42) or cognitive therapy (n = 41). In this 5-year follow-up study, 61 participants were reassessed. Fitness-to-drive decisions were obtained from medical, visual, neuropsychological, and on-road tests; 44 participants (simulator group, n = 21; cognitive group, n = 23) completed all assessments. The primary outcome measures were fitness-to-drive decision and current driving status. Results. The authors found that 5 years after stroke, 18 of 30 participants (60%) in the simulator group were considered fit to drive, compared with 15 of 31 (48%) in the cognitive group ( P = .36); 34 of 61 (56%) participants were driving. Current drivers were younger ( P = .04), had higher Barthel scores ( P = .008), had less comorbidity ( P = .01), and were less severely depressed ( P = .02) than those who gave up driving. Conclusions. The advantage of simulator-based driving training over cognitive rehabilitation therapy, evident at 6 months poststroke, had faded 5 years later. Poststroke drivers were younger and less severely affected and depressed than nondrivers.

Occupational therapy practice in predriving assessment post stroke in the Irish context: findings from a nominal group technique meeting

PURPOSE

Practice in the area of predriving assessment for people with stroke varies, and research findings are not always easily transferred into the clinical setting, particularly when such assessment is not conducted within a dedicated driver assessment programme. This article explores the clinical predriving assessment practices and recommendations of a group of Irish occupational therapists for people with stroke.

METHOD

A consensus meeting of occupational therapists was facilitated using a nominal group technique (NGT) to identify specific components of cognition, perception, and executive function that may influence fitness to return to driving and should be assessed prior to referral for on-road evaluation. Standardised assessments for use in predriving assessment were recommended.

RESULTS

Thirteen occupational therapists speed of processing; perceptual components of spatial awareness, depth perception, and visual inattention; and executive components of planning, problem solving, judgment, and self-awareness. Consensus emerged for the use of the following standardised tests: Behavioural Assessment of Dysexecutive Syndrome (BADS), Test of Everyday Attention (TEA), Brain Injury Visual Assessment Battery for Adults (biVABA), Rivermead Perceptual Assessment Battery (RPAB), and Motor Free Visual Perceptual Test (MVPT).

CONCLUSION

Tests were recommended that gave an indication of the patient's underlying component skills in the area of cognition, perception, and executive functions considered important for driving. Further research is needed in this area to develop clinical practice guidelines for occupational therapists for the assessment of fitness to return to driving after stroke.

Establishing criterion validity of the Useful Field of View assessment and Stroke Drivers' Screening Assessment: comparison to the result of on-road assessment

OBJECTIVES

We sought to determine the criterion validity of the Useful Field of View (UFOV) assessment and Stroke Drivers' Screening Assessment (SDSA) through comparison to the results of on-road assessment.

METHOD

This was a prospective study with people with stroke. Outcome measures used were UFOV, SDSA, and the results of on-road assessment.

RESULTS

Both the results on UFOV (Divided Attention subtest, p<.01; Selective Attention subtest, p<.05) and SDSA (p<.05) were significantly related to the recommendation from on-road assessment. The Divided Attention subtest of the UFOV had the highest sensitivity value (88.9%).

CONCLUSIONS

UFOV and SDSA are valid assessments of driving ability for stroke. The Divided Attention subtest of the UFOV can guide decision making of occupational therapists in stroke driver rehabilitation and in determining those who require further assessment on road because they pose a safety risk. Screening assists people with stroke to decide whether they are ready to have an on-road assessment.

Driving styles among young novice drivers--the contribution of parental driving styles and personal characteristics

As part of the effort to ascertain why young drivers are more at risk for car crashes, attention has recently turned to the effects of family, including the intergenerational transmission of driving styles from parents to offspring. The current study sought to further understanding of the nature and aspects of the family influence with the help of Bowen's family systems theory. In Phase 1 of the prospective study, 130 young driving students completed questionnaires tapping personal and personality measures, and their parents completed driving-related instruments. In Phase 2, a year after the young drivers had obtained their driver's license, they were administered the same questionnaires their parents had previously completed. The results show significant correlations between the parents' driving styles and those of their offspring a year after licensure. Furthermore, differentiation of self and self-efficacy in newly acquired driving skills were found to moderate or heighten the similarity between the driving styles of parents and their offspring. For young drivers reporting anxiety in Phase 1, this was associated with a reported anxious driving style a year later. Among young female drivers, anxiety was also associated with a reckless and careless style. Higher sensation seeking was related to higher reckless driving among young male drivers. The findings are discussed in the context of adolescence and the role of the study variables in the development and intergenerational transmission of driving styles. In addition to its theoretical contribution to the realms of intergenerational transmission in general, and young drivers in particular, the study may have practical implications for both family therapy and the design of driving interventions.