Understanding the needs of hand control users, driver rehabilitation specialists, and dealers/installers

Professional reasoning of occupational therapy driver rehabilitation interventions

INTRODUCTION

Driver-trained occupational therapists are advanced practitioners who work with people to help maintain their independence and autonomy through driving. There is a lack of investigation of professional reasoning processes for why interventions are recommended by driver-trained occupational therapists. This research project sought to explore the reasoning of driver-trained occupational therapists when they plan, implement, and reflect on driver rehabilitation interventions.

METHODS

In-depth semistructured interviews (n = 7) and one focus group (n = 5) were conducted with 12 experienced driver-trained occupational therapists, comprising a wide range of experience, client populations, and licensing jurisdictions. Data were analysed using a modified template analysis approach.

RESULTS

Seven higher order modes that reflect professional reasoning theory and hierarchical models were evident in the work of the driver-trained occupational therapists, with no new modes of reasoning emerging. Ethical reasoning regarding the balance of safety versus client independence was an overarching shared framework, with therapists mostly using interactive and conditional reasoning in practice. Twenty-three second-level themes were identified that exemplify how the reasoning modes operate in practice. Therapists described assessment activity even when solely asked about intervention, indicating the importance of assessment to intervention design. The full hierarchy of reasoning was evident during the rehabilitation phase.

CONCLUSION

These findings elucidate the application of professional reasoning in advanced occupational therapy practices and could support driver-trained occupational therapists in making driving rehabilitation recommendations if used in reflective practices.

Identifying current driver rehabilitation practices for clients with physical impairments

Introduction

Driving is an important occupation that influences a person’s ability to access community resources and participate in meaningful activities. Occupational therapists and other clinicians who are trained as driver rehabilitation specialists provide interventions to improve function and independence in driving. The objective of this study was to examine consistency of adaptive driving equipment prescription and driver retraining recommendations for clients with physical impairment and identify factors that influence driver rehabilitation recommendations.

Methods

Clinicians practicing in Canada and the United States were surveyed electronically. Data were analyzed using descriptive statistics and content analysis.

Results

Out of 36 respondents, the majority (97.2%) were occupational therapists. Completion of in-clinic (97.0%) and on-road (84.4%) evaluations were consistent among the majority of respondents, yet components comprising evaluations varied. Fewer respondents were in agreement in equipment recommendations for secondary controls. Respondents emphasized the importance of clinical reasoning skills when making equipment and intervention recommendations.

Conclusion

Further development of clinical guidelines and advanced training in driver rehabilitation may be beneficial to facilitate clinical reasoning and improve consistency of practice.