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Barco PP, Wallendorf M, Rutkoski K, Dolan K, Rakus D, Johnson A, Carr DB. Validity and Reliability of the Traffic Sign Naming Test (TSNT) and Written Exam for Driving Decisions (WEDD) as Measures of Fitness to Drive Among Older Adults. Am J Occup Ther 2020; 74:7403205090p1-7403205090p10. [PMID: 32365315 DOI: 10.5014/ajot.2020.034389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Occupational therapists need valid and reliable tools to help determine fitness to drive of older drivers with medical conditions such as dementia. OBJECTIVE To establish the validity and reliability of the Traffic Sign Naming Test (TSNT) and Written Exam for Driving Decisions (WEDD) as measures of fitness to drive of adults with and without dementia. DESIGN Cross-sectional. SETTING Washington University Medical School in St. Louis in collaboration with the Rehabilitation Institute of St. Louis. PARTICIPANTS Older drivers diagnosed with dementia (n = 130) and without dementia (n = 34). Drivers with dementia required a physician referral indicating a medical need for a driving evaluation, a diagnosis of dementia, and an Alzheimer Detection 8 score of 2. Drivers without dementia were required to be age 55 yr or older and not meet criteria for dementia. OUTCOMES AND MEASURES Participants completed a comprehensive driving evaluation (CDE) that included clinical measures of vision, motor, and cognition; TSNT; and WEDD. The outcome measure was performance on a standardized on-road assessment. RESULTS The TSNT's interrater reliability was determined to be strong (κ = .80). The TSNT and WEDD demonstrated convergent validity with cognitive measures (p < .001) and discriminant validity with visual and motor measures in the CDE. The TSNT (area under the curve [AUC] = .74) and WEDD (AUC = .71) had fair ability to predict failure on a standardized on-road assessment. CONCLUSION AND RELEVANCE TSNT and WEDD are recommended for use by occupational therapists in combination with other performance measures when determining fitness to drive or need for a CDE. WHAT THIS ARTICLE ADDS The TSNT and WEDD can be included as screening tools (in addition to other performance measures) to assist clinicians in determining which clients need to be referred for a CDE. The TSNT and WEDD can also be included as part of a CDE to assist driving rehabilitation specialists in making final recommendations regarding fitness to drive. The scores generated from the TSNT and WEDD address driving knowledge in a way that may be more understandable to clients and more relatable to skills needed to actually drive.
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Affiliation(s)
- Peggy P Barco
- Peggy P. Barco, OTD, BSW, OTR/L, SCDCM, CDRS, FAOTA, is Associate Professor, Program in Occupational Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, MO;
| | - Michael Wallendorf
- Michael Wallendorf, PhD, is Research Statistician, Division of Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - Kathleen Rutkoski
- Kathleen Rutkoski, OTR/L, is Research Assistant, Program in Occupational Therapy and Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Kathleen Dolan
- Kathleen Dolan, OT/L, is Occupational Therapist, Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Danielle Rakus
- Danielle Rakus, MSOT, OTR/L, is Occupational Therapist, Cheyenne Regional Medical Center Acute Rehab Unit, Cheyenne, WY
| | - Ann Johnson
- Ann Johnson is Clinical Research Coordinator, Center for Clinical Studies, Washington University School of Medicine, St. Louis, MO
| | - David B Carr
- David B. Carr, MD, is Professor, Department of Medicine and Neurology, Washington University School of Medicine, St. Louis, MO
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Unsworth CA, Russell K, Lovell R, Woodward M, Browne M. Effect of Navigation Problems, Assessment Location, and a Practice Test on Driving Assessment Performance for People with Alzheimer's Disease. J Alzheimers Dis 2019; 67:1035-1043. [PMID: 30776013 DOI: 10.3233/jad-181069] [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: 11/15/2022]
Abstract
BACKGROUND People with Alzheimer's disease may be required to undertake clinical and on-road assessments to determine fitness to drive. The manner in which on-road assessments are conducted with drivers who do and do not have navigational problems may affect the outcome. OBJECTIVES Investigate the effect of 1) navigational difficulties, 2) location of assessment (un/familiar area) and assessment order, and 3) undertaking a second assessment (practice), on passing an on-road driving assessment. METHODS Forty-three drivers undertook an Occupational Therapy-Driver Assessment Off Road Assessment (OT-DORA) Battery which included the Drive Home Maze Test (DHMT). Participants with/without a history of navigational problems were randomly allocated into three groups: 1) Unfamiliar/then familiar area assessment; 2) Unfamiliar/unfamiliar; 3) familiar/unfamiliar. An on-road assessment protocol was used including over 100 expected behaviors at nominated points along the directed route. For familiar area assessments, the driver self-navigated from their home to shops and services. A pass/fail decision was made for each assessment. RESULTS A generalized linear mixed effects model showed neither location, nor practice affected passing the on-road assessment. Participants with navigational problems were six times less likely to pass regardless of route familiarity and direction method, and the DHMT was a significant negative predictor of passing. CONCLUSION Drivers with Alzheimer's disease who have navigational problems and are slow to complete the DHMT are unlikely to pass an on-road assessment. However, navigation and maze completion skills may be a proxy for an underlying cognitive skill underpinning driving performance.
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Affiliation(s)
- Carolyn A Unsworth
- School of Health, Medical and Applied Sciences, Central Queensland University, Melbourne, VIC, Australia
| | - Kay Russell
- Austin Health, Heidelberg West, VIC, Australia
| | - Robin Lovell
- Swinburne University of Technology, Melbourne, Australia
| | | | - Matthew Browne
- School of Health, Medical and Applied Sciences, Central Queensland University, Melbourne, VIC, Australia
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Unsworth CA, Baker A, Lannin N, Harries P, Strahan J, Browne M. Predicting fitness-to-drive following stroke using the Occupational Therapy - Driver Off Road Assessment Battery. Disabil Rehabil 2018; 41:1797-1802. [PMID: 29488407 DOI: 10.1080/09638288.2018.1445784] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Introduction: It is difficult to determine if, or when, individuals with stroke are ready to undergo on-road fitness-to-drive assessment. The Occupational Therapy - Driver Off Road Assessment Battery was developed to determine client suitability to resume driving. The predictive validity of the Battery needs to be verified for people with stroke. Aim: Examine the predictive validity of the Occupational Therapy - Driver Off Road Assessment Battery for on-road performance among people with stroke. Method: Off-road data were collected from 148 people post stroke on the Battery and the outcome of their on-road assessment was recorded as: fit-to-drive or not fit-to-drive. Results: The majority of participants (76%) were able to resume driving. A classification and regression tree (CART) analysis using four subtests (three cognitive and one physical) from the Battery demonstrated an area under the curve (AUC) of 0.8311. Using a threshold of 0.5, the model correctly predicted 98/112 fit-to-drive (87.5%) and 26/36 people not fit-to-drive (72.2%). Conclusion: The three cognitive subtests from the Occupational Therapy - Driver Off Road Assessment Battery and potentially one of the physical tests have good predictive validity for client fitness-to-drive. These tests can be used to screen client suitability for proceeding to an on-road test following stroke. Implications for Rehabilitation: Following stroke, drivers should be counseled (including consideration of local legislation) concerning return to driving. The Occupational Therapy - Driver Off Road Assessment Battery can be used in the clinic to screen people for suitability to undertake on road assessment. Scores on four of the Occupational Therapy - Driver Off Road Assessment Battery subtests are predictive of resumption of driving following stroke.
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Affiliation(s)
- Carolyn A Unsworth
- a School of Health Medical and Applied Science , Central Queensland University , Bundaberg , Australia.,b School of Health Sciences , Jonkoping University , Jonkoping , Sweden.,c College of Science Health and Engineering , La Trobe University , Bundoora , Australia
| | - Anne Baker
- d Department of Occupational Therapy , Australian Catholic University , Melbourne , Australia
| | - Natasha Lannin
- c College of Science Health and Engineering , La Trobe University , Bundoora , Australia.,e Department of Occupational Therapy , Alfred Health , Melbourne , Australia.,f Rehabilitation Studies Unit , University of Sydney , Sydney , Australia
| | - Priscilla Harries
- g School of Health Sciences and Social Care , Brunel University London , London, UK
| | | | - Matthew Browne
- a School of Health Medical and Applied Science , Central Queensland University , Bundaberg , Australia
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Unsworth C, Chan SP. Determining fitness to drive among drivers with Alzheimer’s disease or cognitive decline. Br J Occup Ther 2015. [DOI: 10.1177/0308022615604645] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Fitness to drive skills progressively deteriorate following a diagnosis of Alzheimer’s disease/cognitive decline. Occupational therapists require standardised assessments to help them make recommendations to clients and licensing authorities regarding client fitness to drive. This research aimed to determine whether drivers in the early stages of Alzheimer’s disease/cognitive decline can drive safely, and if this could be predicted using the occupational therapy – driver off-road assessment battery (OT-DORA Battery). Method Drivers with Alzheimer’s disease/cognitive decline were assessed by one of nine driver assessors over 18 months. Client data were collected on the OT-DORA Battery and following on-road assessment; the outcome was recorded as pass, pass with conditions, or fail. Results A total of 63 clients were assessed, and n = 40 (63.5%) were passed as fit to drive, of whom 33(83%) had at least one condition placed on their licence. Client age and scores on four subtests of the OT-DORA Battery were predictive of outcome. Conclusion A diagnosis of Alzheimer’s disease/cognitive decline should not automatically preclude driving. Scores on four of the subtests from the OT-DORA Battery may be used to help determine whether a client is fit to drive or not fit to drive, or whether a client should be referred for specialist occupational therapy driver assessment.
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Affiliation(s)
- Carolyn Unsworth
- Professor of Occupational Therapy, School of Human, Health and Social Sciences, CQ University, Melbourne, Australia
- Adjunct Professor, Jönköping University, Sweden
- Adjunct Professor of Occupational Therapy, Curtin University, Perth, Australia
- Adjunct Professor of Occupational Therapy, La Trobe University Melbourne, Australia
| | - Siew-Pang Chan
- Assistant Director, Yong Loo Lin School of Medicine, National University of Singapore
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Baker A, Unsworth CA, Lannin NA. Determining fitness to drive: A systematic review of the methods and assessments used after mild traumatic brain injury. Br J Occup Ther 2015. [DOI: 10.1177/0308022614562405] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction Limited evidence is available to support knowledge of the time-frame and capacity for fitness to drive after mild traumatic brain injury. The aim of this systematic review was to identify what methods and assessments are, or could be used to determine fitness to drive for this population. Method We undertook a systematic search of six electronic databases. Two authors rated all studies for methodological content and quality, and standardised data were extracted. Narrative analysis was conducted to understand the content of eligible studies. Findings A total of 2022 articles were retrieved; seven articles met the inclusion criteria. Self-reported questionnaires, non-standardised assessments, questionnaires completed by next-of-kin, and simulator tests were the primary methods used to determine fitness to drive. Only one assessment has been used to aid recommendations about fitness to drive in the acute hospital setting. Six additional standardised assessments were identified that have the potential to predict fitness to drive in this population group; however, these assessments require further psychometric testing prior to use. Conclusion While a variety of methods and assessments are currently used, there is little research evidence to suggest when individuals are able to return to driving after mild traumatic brain injury. Research is urgently required to determine a consistent and standardised approach to assessing fitness to drive following mild traumatic brain injury.
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Affiliation(s)
- Anne Baker
- Doctoral Candidate, La Trobe University, Bundoora, Victoria, Australia
| | - Carolyn A Unsworth
- Professor, La Trobe University, Bundoora, Victoria, Australia
- Professor, Jönköping University, Jönköping, Sweden
- Professor, Curtin University, Bentley, Perth, Australia
- Professor, Central Queensland University, Melbourne, Victoria, Australia
| | - Natasha A Lannin
- Associate Professor, La Trobe University, Bundoora, Victoria, Australia
- Associate Professor, Alfred Health, Prahran, Victoria, Australia
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Unsworth CA, Baker A, Taitz C, Chan SP, Pallant JF, Russell KJ, Odell M. Development of a standardised Occupational Therapy--Driver Off-Road Assessment Battery to assess older and/or functionally impaired drivers. Aust Occup Ther J 2011; 59:23-36. [PMID: 22272880 DOI: 10.1111/j.1440-1630.2011.00979.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Research has been conducted over several years to develop a new off-road assessment battery referred to as the Occupational Therapy - Driver Off-Road Assessment Battery. This article documents the development of the Battery, and provides preliminary research evidence to support its content and predictive validity. METHODS Literature reviews and a focus group with nine driver assessor occupational therapists were undertaken, as well as data collection using the Occupational Therapy - Driver Off-Road Assessment Battery with 246 clients. A Classification and Regression Tree model was constructed to ascertain the predictive validity of the Battery, with fitness-to-drive as the outcome. RESULTS Twenty-one physical, 13 sensory and seven assessments of cognition/perception were identified as being reflective of the skills required for driving. Following rating of their psychometric properties, the best assessments were presented to focus group members. The driver assessors supported the inclusion of several assessments and encouraged the development of new assessments. A draft version of the Occupational Therapy - Driver Off-Road Assessment Battery was tested and found to have excellent predictive validity for client on-road performance of 82.6%. The Classification and Regression Tree model showed that client performance on tests included in the Battery should be used together, rather than in isolation, to support fitness-to-drive recommendations. CONCLUSION This research identified the most suitable physical, sensory and cognitive assessments to include in the Occupational Therapy - Driver Off-Road Assessment Battery, and provided support for its validity. The development of this standardised battery assists driver assessors to accurately and consistently assess and report the off-road driving capacity of clients.
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Affiliation(s)
- Carolyn A Unsworth
- Department of Occupational Therapy, La Trobe University, Melbourne, Australia.
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