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Dickerson AE, Wu Q, Houston H, Cassidy T, Touchinsky S. Establishing the Predictive Validity of the Assessment of Motor and Process Skills for Driving Performance Outcomes. Am J Occup Ther 2024; 78:7805205040. [PMID: 39141779 DOI: 10.5014/ajot.2024.050687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024] Open
Abstract
IMPORTANCE Although the Assessment of Motor and Process Skills (AMPS) is an excellent tool for evaluating the functional performance of instrumental activities of daily living (IADLs), a limited number of studies have used the AMPS for decisions regarding the IADL of fitness to drive and community mobility. OBJECTIVE To determine the specificity and sensitivity of the AMPS as a tool for determining a person's fitness to drive. DESIGN Cross-sectional observational design. SETTING Three driving rehabilitation programs in three states. PARTICIPANTS Participants were 388 community-living adults (M age = 68.74 yr, SD = 11.53); 196 adults were recruited before completing a comprehensive driving evaluation, and 192 were recruited in two other studies of older drivers. OUTCOME AND MEASURES AMPS and results of comprehensive driving evaluation or on-road assessment. RESULTS Using a logistical regression, AMPS Motor and Process Skills scores yielded a sensitivity of 84.6% and a specificity of 88.8%. The odds ratio of the AMPS Motor Skills score was .347; for the AMPS Process Skills score, it was .014. Using cross-validations, the model with AMPS Motor and Process scores produced a cross-validation area under the curve of .918, with sensitivity and specificity of 84.6% and 88.4%, respectively, and a probability greater than .334 was used for predicting a fail or drive-with-restriction evaluation. CONCLUSIONS AND RELEVANCE The AMPS Motor and Process Skills scores revealed significant differences between those who failed or had driving restrictions and with those who passed the driving evaluation, which supported the AMPS as an effective tool for predicting fitness to drive. Plain-Language Summary: This study demonstrates how the Assessment of Motor and Process Skills (AMPS), as a top-down occupational therapy assessment tool, can be used to differentiate between medically at-risk drivers who are likely to pass a comprehensive driving evaluation and those who are likely to fail or need restrictions. AMPS will assist occupational therapy practitioners in determining who is most appropriate to receive driving rehabilitation services and/or when to refer a person for a comprehensive driving evaluation.
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Affiliation(s)
- Anne E Dickerson
- Anne E. Dickerson, PhD, OTR/L, SCDCM, FAOTA, FGSA, is Professor and Director, Research for Older Adult Driver Initiative (ROADI), Department of Occupational Therapy, East Carolina University, Greenville, NC;
| | - Qiang Wu
- Qiang Wu, PhD, is Professor, Department of Public Health, East Carolina University, Greenville, NC
| | - Helen Houston
- Helen Houston, MS, OTR/L, is Occupational Therapy Clinical Specialist, ECU Health Medical Center, Greenville, NC
| | - Therese Cassidy
- Therese Cassidy, OTD, OTR/L, CDRS, is CEO, Fitness to Drive-Health Promotions Partners, Colorado Springs, CO
| | - Susan Touchinsky
- Susan Touchinsky, OTR/L, SCDCM, CDRS, is Owner, Adaptive Mobility Services, LLC, Orwigsburg, PA
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Fahmi A, Garon M, Ribon-Demars A, Dubois L, Caouette M, Lamontagne MÈ, Beaulieu-Bonneau S. Learning to drive with neurological conditions: profile of users of an adapted driver training program and cognitive factors associated with success. Disabil Rehabil 2024; 46:3869-3877. [PMID: 37728095 DOI: 10.1080/09638288.2023.2258332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE To describe the sociodemographic and cognitive profile of participants enrolled in an adapted driving program for individuals with neurological conditions, to explore the association between cognitive functioning and driving program outcome, and to describe driving habits after program completion. METHODS This study combined retrospective chart review and cross-sectional data collection. RESULTS The sample included 71 participants with neurological disorders (aged 15-56 years, M = 22.2 ± 8.6; 39% women). Driving program was either successful (47%), failed (7%), discontinued (34%), or ongoing (13%). Among 35 participants with complete neuropsychological and driving program outcome data, those who successfully completed the program showed better attention functioning, and better performance relative to global functioning for attention, executive functions, and working memory, compared to those who discontinued/failed the program. Among 21 participants who completed a telephone questionnaire on average 3.7 years after program enrollment, 67% obtained their driver's license and drove regularly. Participants reported high levels of satisfaction with the program. CONCLUSION These results suggest that approximately half of the persons enrolled in a driver training program designed for learners with neurological conditions, obtain a driver's license; and that attention, and to a lesser extent executive functioning and working memory, are related to driving program success.IMPLICATIONS FOR REHABILITATIONIn individual with neurological conditions, learning how to drive can be challenging.An adapted driver training program, involving collaboration between driving instructors and healthcare professionals, simplification of theoretical learning, and increasing driving practice opportunities, can be effective, both in terms of licensing success and client satisfaction.Conducting a pre-driving program neuropsychological assessment, with identification of cognitive strengths and weaknesses, can provide valuable information for clinicians and driving instructors for optimizing training and predicting outcome.Better performance in attention, and better relative to global cognitive functioning in attention, executive functions, and working memory, are related to higher success rate of an adapted driving program.
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Affiliation(s)
- Adam Fahmi
- École de psychologie, Faculté des sciences sociales, Université Laval, Québec, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Mathieu Garon
- Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre hospitalier universitaire de Sherbrooke; Sherbrooke, QC, Canada
| | - Alexandra Ribon-Demars
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Laurie Dubois
- École de psychologie, Faculté des sciences sociales, Université Laval, Québec, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Martin Caouette
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Département de psychoéducation, Université du Québec à Trois-Rivières; Trois-Rivières, QC, Canada
| | - Marie-Ève Lamontagne
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- École des sciences de la réadaptation, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Simon Beaulieu-Bonneau
- École de psychologie, Faculté des sciences sociales, Université Laval, Québec, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
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Brière-Dulude S, Melgares L, Labourot J, Deslauriers T, Gélinas I, Layani G, Vachon B. [Sondage sur les pratiques des médecins de famille et sur la collaboration interprofessionnelle avec des ergothérapeutes en GMF quant au dépistage des conducteurs à risque]. Can J Aging 2024; 43:266-274. [PMID: 37960933 DOI: 10.1017/s0714980823000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
Cette étude a sondé 46 médecins de famille québécois quant à leurs pratiques pour l'évaluation et le dépistage des conducteurs à risque afin 1) de mieux comprendre leur niveau de compétence perçu; 2) de recenser les difficultés rencontrées dans le processus de prise de décision et 3) de documenter leurs besoins et attitudes quant à une collaboration plus étroite avec les ergothérapeutes. Les participants (femmes : 84,8 %; moyenne d'expérience : 15,7 (±12,1) ans) ont répondu à un sondage en ligne de 30 questions. Les résultats de cette étude démontrent que malgré un certain confort à effectuer l'évaluation et le dépistage des conducteurs à risque, les médecins ne se considèrent pas comme les professionnels les mieux qualifiés pour ce faire. Ils reconnaissent également le rôle que jouent les ergothérapeutes dans le dépistage de cette clientèle et l'intervention auprès d'elle. Ils voient ainsi la pertinence d'avoir accès aux services de ces professionnels en soins de première ligne.
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Affiliation(s)
| | - Lucas Melgares
- École de réadaptation, Université de Montréal, 7077 Av du Parc, Montréal, QCH3N 1X7
| | - Justine Labourot
- École de réadaptation, Université de Montréal, 7077 Av du Parc, Montréal, QCH3N 1X7
| | - Tania Deslauriers
- École de réadaptation, Université de Montréal, 7077 Av du Parc, Montréal, QCH3N 1X7
| | - Isabelle Gélinas
- School of Physical and Occupational Therapy, Université McGill, Davis House l 3654 Prom. Sir William Osler l Montreal, QuebecH3G 1Y5
| | - Géraldine Layani
- Département de médecine de famille et de médecine d'urgence, Université de Montréal, 2900, boul. Édouard-Montpetit, Montréal (Québec) H3T 1J4
| | - Brigitte Vachon
- École de réadaptation, Université de Montréal, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7077 Av du Parc, Montréal, QCH3N 1X7
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Peterson CM, Leslie A, Flannagan CA, Nelson TF. On the road to retirement: Predicting nighttime driving difficulty and cessation using self-reported health factors. JOURNAL OF TRANSPORT & HEALTH 2024; 34:101724. [PMID: 38855420 PMCID: PMC11160935 DOI: 10.1016/j.jth.2023.101724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Introduction Older drivers now expect to drive longer than previous cohorts and will make up about 25% of licensed U.S. drivers by 2050. Identifying early predictors of nighttime driving difficulty, a precursor to driving retirement, can inform screening procedures and timely linkage to interventions supporting driving or transitioning to driving cessation. Methods We examined self-reported physical and mental health baseline predictors of greater nighttime driving difficulty in five and ten years using weighted multivariate logistic analyses of 2261 drivers, aged 57 to 85, from the National Social Life, Health, and Aging Project (NSHAP). Transition matrix models describe probabilities of having greater, lesser, or the same nighttime driving difficulty after five years based on baseline driving conditions and the significant logistic model factors. We built a transition matrix tool that offers users the ability to calculate expected probabilities of change in nighttime driving difficulty based on the identified salient factors. Results Five-year predictors of greater nighttime driving difficulty included perceived poor physical health (OR = 3.75), limitations to activities of daily living (ADLs; OR = 1.97), and clinical levels of depressive and anxiety symptoms (OR = 1.63; OR = 1.71). Excellent physical health (OR = 0.52), mental health (OR = 0.60), and any frequency of physical activity compared to 'never' were protective (OR = 0.37-0.51). Physical health, walking pain, and limitations to ADLs were predictive at ten-years. Transition models showed physical health and anxiety were most indicative of greater nighttime driving difficulty at 5-years for those reporting no difficulty at baseline, but limitations to ADLs were more predictive otherwise. Conclusions Lay practitioners could capitalize on the use of self-report screening measures to identify older adults who may experience near-term nighttime driving difficulty. Earlier identification may better guide long-term driving retirement planning or engagement in appropriate health interventions. The transition matrix modeling tool is freely available to facilitate development and validation of related measures.
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Affiliation(s)
- Colleen M. Peterson
- Transportation Research Institute, University of Michigan, Ann Arbor, MI, USA
| | - Andrew Leslie
- Transportation Research Institute, University of Michigan, Ann Arbor, MI, USA
| | | | - Toben F. Nelson
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, USA
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Krasniuk S, Crizzle AM. Using Serial Trichotomization to Determine Fitness to Drive in Medically At-Risk Drivers. Am J Occup Ther 2024; 78:7801205020. [PMID: 38215305 DOI: 10.5014/ajot.2024.050134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
IMPORTANCE Clinical tests that identify fit and unfit drivers with 100% sensitivity and specificity would reduce uncertainty and improve efficiency of occupational therapists performing comprehensive driving evaluations (CDEs). OBJECTIVE To examine whether serial trichotomization of clinical tests predicts pass-fail outcomes with 100% sensitivity and specificity in a sample of medically at-risk drivers and in drivers with and without cognitive impairment (CI) referred for a CDE. DESIGN Retrospective data collection and analysis of scores on the Montreal Cognitive Assessment; Trail Making Test, Part A and Part B; and the Useful Field of View® Subtests 1 to 3 and outcomes on the CDE (pass-fail or indeterminate requiring lessons and retesting). Receiver operating characteristic curves of clinical tests were performed to determine 100% sensitivity and specificity cut points in predicting CDE outcomes. Clinical tests were arranged in order from most to least predictive to identify pass-fail and indeterminate outcomes. SETTING A driving assessment clinic. PARTICIPANTS Among 142 medically at-risk drivers (M age = 69.2 yr, SD = 14.1), 66 with CI, 46 passed and 39 failed the CDE; 57 were indeterminate. OUTCOMES AND MEASURES On-road pass-fail outcomes. RESULTS Together, the six clinical tests predicted 62 pass and 49 fail outcomes in the total sample; 21 pass and 34 fail outcomes in participants with CI; and 58 pass and 14 fail outcomes in participants without CI. CONCLUSIONS AND RELEVANCE Serial trichotomization of clinical tests increases the accuracy of making informed decisions and reduces the number of drivers undergoing unnecessary on-road assessments. Plain-Language Summary: Clinical tests and their cut points that identify fit and unfit drivers vary substantially across settings and research studies. Serial trichotomization is one method that could help control for this variation by combining clinical test scores showing 100% sensitivity and specificity to identify pass (fit drivers) and fail outcomes (unfit drivers) and to reduce the number of drivers undergoing unnecessary on-road assessments.
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Affiliation(s)
- Sarah Krasniuk
- Sarah Krasniuk, PhD, MSc, is Postdoctoral Fellow, School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alexander M Crizzle
- Alexander M. Crizzle, PhD, MPH, CE, is Associate Professor and Director, Driving Research and Simulation Laboratory, School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada;
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Buele J, Varela-Aldás JL, Palacios-Navarro G. Virtual reality applications based on instrumental activities of daily living (iADLs) for cognitive intervention in older adults: a systematic review. J Neuroeng Rehabil 2023; 20:168. [PMID: 38110970 PMCID: PMC10729470 DOI: 10.1186/s12984-023-01292-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND In recent years, the use of virtual reality (VR) as a complementary intervention in treating cognitive impairment has significantly increased. VR applications based on instrumental activities of daily living (iADL-VR) could offer a promising approach with greater ecological validity for intervention in groups with cognitive impairments. However, the effectiveness of this approach is still debated. OBJECTIVE This systematic review aims to synthesize the effects of iADL-VR interventions to rehabilitate, train, or stimulate cognitive functions in healthy adults and people with mild cognitive impairment (MCI) and different types of dementia. METHODS A systematic search was performed in the Scopus, PubMed, IEEE Xplore, Web of Science, and APA PsycNet databases until September 2022 and repeated in April 2023. The selected studies met the search terms, were peer-reviewed, included an iADL-VR intervention, and were written in English. Descriptive, qualitative studies, reviews, cognitive assessment, non-intervention studies, those unrelated to VR or iADL, those focused on motor aspects, and non-degenerative disorders were excluded. The PEDro scale was used to assess the methodological quality of the controlled studies. To present and synthesize the results, we organized the extracted data into three tables, including PEDro scores, participant characteristics, and study characteristics. RESULTS Nineteen studies that met the inclusion and exclusion criteria were included. The total sample reached 590 participants, mostly women (72.67%). Approximately 30% were diagnosed with Alzheimer's disease or dementia, and 20% had mild cognitive impairment. Variables such as authors and year of publication, study design, type of intervention and VR applied, duration of the intervention, main findings, and conclusions were extracted. Regarding demographic characteristics, the sample size, age, sex, years of education, neurological diagnosis, dropouts, and the city and country where the intervention took place were recorded. Almost all studies showed improvements in some or all the outcomes after the intervention, generally greater in the iADL-VR group than in the control group. CONCLUSION iADL-VR interventions could be beneficial in improving the performance of cognitive functions in older adults and people with MCI and different types of dementia. The ecological component of these tasks makes them very suitable for transferring what has been learned to the real world. However, such transfer needs to be confirmed by further studies with larger and more homogeneous samples and longer follow-up periods. This review had no primary funding source and was registered with PROSPERO under registration ID: 375166.
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Affiliation(s)
- Jorge Buele
- SISAu Research Group, Facultad de Ingeniería, Industria y Producción, Universidad Indoamérica, Ambato, Ecuador
- Department of Electronic Engineering and Communications, University of Zaragoza, Teruel, Spain
| | - José Luis Varela-Aldás
- Centro de Investigaciones de Ciencias Humanas y de la Educación (CICHE), Universidad Indoamérica, Ambato, Ecuador
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Czarnolewski MY. Everyday Spatial Behavioral Questionnaire 11 Component Model. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-12. [PMID: 37844191 DOI: 10.1080/23279095.2023.2267711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
The present work builds on prior research to develop the Everyday Spatial Behavioral Questionnaire (ESBQ or EBQ), a measure of self-reported difficulty in performing familiar activities that involve spatial thinking. A principal component analysis and confirmatory factor analysis were employed to identify reliable categories of everyday spatial behaviors. A test of measurement invariance was employed across two independent samples of college students to validate an 11-Component Model as a representation of the ESBQ. The model met criteria necessary to represent a strong model in terms of the ESBQ having the same structure and meaning in both samples. Both samples had eight of the 11 sub-scales with Cronbach alphas greater than .7, while for five of these eight sub-scales Cronbach alphas were greater than .8. Alphas were lower in the second sample than the first. The scales require construct and criterion-related validity assessment.
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Torpil B, İldiz MK. The Effectiveness of a Digital Game-Based Intervention on Hazard Perception and Visual Skills in Novice Drivers: A Single Blind, Randomized Controlled Trial. Occup Ther Health Care 2023; 38:78-91. [PMID: 37204048 DOI: 10.1080/07380577.2023.2212303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/06/2023] [Indexed: 05/20/2023]
Abstract
Novice drivers show poorer performance than experienced drivers in terms of visual skills and hazard perception. This study aimed at evaluating the effectiveness of a digital game-based intervention on hazard perception and visual skills in novice drivers. Forty-six novice drivers (6 men, 40 women) were randomized to the intervention group (n = 23; 20.79 ± 0.81 years) or control (n = 23; 20.65 ± 0.93 years) group. The intervention group received a game-based intervention in addition to a hazard perception training, whereas the control group received only the hazard perception training. Hazard perception and visual skills were assessed in both groups before and after the 14-day interventions. Between-group comparisons revealed significantly greater improvements in visual short time memory, visual closure, visual discrimination, figure-ground and total scores in the game-based group than in the control group (p < 0.05 for all). Our results showed that 14 days of game-based intervention enhanced hazard perception and visual skills in novice drivers. Using game-based interventions in driving rehabilitation is recommended to improve hazard perception and visual skills of novice drivers.
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Affiliation(s)
- Berkan Torpil
- Occupational Therapy Department, Faculty of Gülhane Health Sciences, University of Health Sciences Turkey, Ankara, Turkey
| | - Mehmet Kaan İldiz
- Occupational Therapy Department, Faculty of Health Sciences, Atlas University, İstanbul, Turkey
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Krasniuk S, Crizzle AM, Toxopeus R, Mychael D, Prince N. Clinical Tests Predicting On-Road Performance in Older Drivers with Cognitive Impairment. Can J Occup Ther 2023; 90:44-54. [PMID: 35950229 PMCID: PMC9923206 DOI: 10.1177/00084174221117708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The Trail Making Test Part B (Trails B) and Useful Field of View® (UFOV) can predict on-road outcomes in drivers with cognitive impairment (CI); however, studies have not included drivers referred for comprehensive driving evaluations (CDEs), who typically have more severe CI. Purpose. We determined the predictive ability of Trails B and UFOV on pass/fail on-road outcomes in drivers with CI (Montreal Cognitive Assessment <26) referred for CDEs. Method. Retrospective data collection from two driving assessments centers (N = 100, mean age = 76.2 ± 8.8 years). Findings. The Trails B (area under the curve [AUC] = .70) and UFOV subtests 2 (AUC = .73) and 3 (AUC = .76) predicted pass/fail outcomes. A cut-point ≥467 ms on UFOV subtest 3 better-predicted pass/fail outcomes with 78.9% sensitivity and 73.5% specificity. In comparison, a cut-point ≥3.58 min on Trails B had lower sensitivity (73.7%) and specificity (61.8%). Implications. The UFOV subtest 3 may be more useful than the Trails B for predicting pass/fail outcomes in drivers with more severe CI referred for CDEs.
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Affiliation(s)
| | - Alexander M. Crizzle
- Alexander Crizzle, School of Public Health,
University of Saskatchewan, Saskatoon, SK, Canada.
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Dickerson A, Gartz Taylor R, Register J, Miller M. The Impact of Age, Sex, and Position on Visual-Motor Processing Speed and Reaction Time as Measured by the Vision Coach TM. Occup Ther Health Care 2023; 38:26-41. [PMID: 36803627 DOI: 10.1080/07380577.2023.2176965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/01/2023] [Indexed: 02/22/2023]
Abstract
Occupational therapists are in a unique position to screen and evaluate fitness to drive with both visual-motor processing speed and reaction time being important factors to consider when determining fitness to drive. This study uses the Vision CoachTM to investigate the differences in visual-motor processing speed and reaction time across age and sex of healthy adults. It also explores whether the position of sitting or standing made any difference. The results showed no difference between male/female or standing/sitting positions. However, there was a statistically significant difference between age groups, with older adults demonstrating slower visual-motor processing speed and reaction times. These findings can be used for future studies to explore the impact of injury or disease on visual-motor processing speed and reaction times and its relation to fitness to drive.
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Affiliation(s)
- Anne Dickerson
- Occupational Therapy, East Carolina University, Greenville, NC, USA
| | | | - Joshua Register
- Occupational Therapy, East Carolina University, Greenville, NC, USA
| | - Megan Miller
- Occupational Therapy, East Carolina University, Greenville, NC, USA
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Penna V, Dickerson A, Wu Q. Visual-Motor Processing Speed and Reaction Time Differences between Medically-At-Risk Drivers and Healthy Controls. Occup Ther Health Care 2023; 38:42-58. [PMID: 36786776 DOI: 10.1080/07380577.2023.2177790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023]
Abstract
This cross-sectional study compared visual-motor processing speed and reaction times between medically-at-risk drivers and normal controls to determine if the time in seconds distinguished between drivers who pass, fail, or need restrictions based on a road test. The medically-at-risk drivers' data (N = 35, 28-89 years) were collected as part of a comprehensive driving evaluation and coded by diagnosis (e.g., cognitive, neurological, medical) and driving outcome. The healthy control (N = 121, 21-79 years) data were collected in previous studies. The Vision Coach™ Full Field 60 task was used to collect reaction times in seconds between the two groups. Independent t-tests showed a significant difference (p < .001) in trial times between healthy controls and medically-at-risk adults. No significant difference (p = .141) was found between the three diagnoses groups. The resulting scores from the Vision Coach™ demonstrated a significant different (p < .001) between those who were determined fit to drive without restrictions and those who were determined not fit to drive after a comprehensive driving evaluation, showing the potential to be used as a screening tool for determining driving risk.
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Affiliation(s)
- Victoria Penna
- Department of Occupational Therapy, East Carolina University, Greenville, NC, USA
| | - Anne Dickerson
- Department of Occupational Therapy, East Carolina University, Greenville, NC, USA
| | - Qiang Wu
- Department of Public Health, East Carolina University, Greenville, NC, USA
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12
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Krasniuk S, Mychael D, Crizzle AM. Driving Errors Predicting Pass/Fail On-Road Assessment Outcomes Among Cognitively Impaired Older Drivers. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023; 43:144-153. [PMID: 35337241 PMCID: PMC9729977 DOI: 10.1177/15394492221076494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Older drivers with cognitive impairment (CI)/dementia make significantly more driving errors than healthy controls; however, whether driving errors are predictive of pass/fail outcomes in older drivers with CI/dementia are unclear. This study determined the driving errors that predicted failing an on-road assessment in drivers with CI. We retrospectively collected comprehensive driving evaluation data of 80 participants (76.1 ± 9.3 years) from an Ontario driving assessment center. Adjustment to stimuli (area under the curve [AUC] = 0.88), lane maintenance (AUC = 0.84), and speed regulation errors (AUC = 0.85) strongly predicted pass/fail outcomes. Worse performance on the Trails B (time) and Useful Field of View® (Subtest 2, Subtest 3, and risk index) were significantly correlated with adjustment to stimuli (p < .05), lane maintenance (p < .05), and speed regulation errors (p < .05). Adjustment to stimuli, lane maintenance, and speed regulation errors may be critical indicators of failing an on-road assessment in older drivers with CI. Prioritizing these errors may help identify at-risk drivers.
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Affiliation(s)
| | | | - Alexander M. Crizzle
- University of Saskatchewan, Saskatoon, Canada,Alexander M. Crizzle, Associate Professor and Director of the Driving Research & Simulation Laboratory, School of Public Health, University of Saskatchewan, 104 Clinic Road, Saskatoon, Saskatchewan, Canada S7N 2Z4.
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Cheal B, Bundy A, Patomella AH, Kuang H, Scanlan JN. Predicting Fitness to Drive for Medically At-Risk Drivers Using Touchscreen DriveSafe DriveAware. Am J Occup Ther 2023; 77:24004. [PMID: 36716210 DOI: 10.5014/ajot.2023.050048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
IMPORTANCE Occupational therapists require valid cognitive fitness-to-drive tools to advise drivers in this high-stakes area. OBJECTIVE To examine the psychometric properties and predictive validity of data gathered with the touchscreen DriveSafe DriveAware (DSDA). DESIGN Prospective study that compared a screening tool with a criterion standard. SETTING Ten community- and hospital-based driver assessment clinics in Australia and New Zealand. PARTICIPANTS Older and cognitively impaired drivers (N = 134) ages 18 to 91 years (Mage= 68) who were referred for an assessment to determine the impact of a medical condition on driving. The inclusion criteria were a valid driver's license, vision within license authority guidelines, completion of at least 1 year of high school, and English as a first language. OUTCOMES AND MEASURES The results of the touchscreen DSDA, a standardized assessment of awareness of the driving environment and one's own driving abilities, were compared with those of a standardized occupational therapist-administered on-road assessment. RESULTS Rasch analysis provided evidence for the construct validity and internal reliability of data gathered with the touchscreen DSDA. Optimal upper and lower cutoff scores were set to trichotomize drivers into three categories: likely to pass an on-road assessment, likely to fail an on-road assessment, and further testing required. Specificity of the touchscreen DSDA was 86%, and sensitivity was 91%; positive predictive value was 83%, negative predictive value was 92%, and overall accuracy of classification was 88%. CONCLUSIONS AND RELEVANCE Evidence supports the utility of the touchscreen DSDA for accurately predicting which participants require on-road assessment. What This Article Adds: The touchscreen DSDA is a promising screen for occupational therapists and other health professionals to use in conjunction with other clinical indicators to determine whether drivers require further assessment.
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Affiliation(s)
- Beth Cheal
- Beth Cheal, PhD, is Lecturer, Occupational Therapy Program, School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia. At the time of the research, Cheal was PhD Student, Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia;
| | - Anita Bundy
- Anita Bundy, ScD, is Professor and Head, Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado, and Honorary Professor, Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ann-Helen Patomella
- Ann-Helen Patomella, PhD, is Associate Professor and Head, Division of Occupational Therapy, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden. At the time of the research, Patomella was Lecturer, Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Haijiang Kuang
- Haijiang Kuang, PhD, is Senior Psychometrician, Pearson Clinical Australia, Sydney, New South Wales, Australia
| | - Justin Newton Scanlan
- Justin Newton Scanlan, PhD, is Associate Professor, Occupational Therapy, Centre for Disability Research and Policy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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14
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‘…it's hard to prepare yourself, it's like a death’: barriers and facilitators to older people discussing and planning for driving retirement. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Driving is the preferred mode of transport for many older drivers, providing mobility to maintain independence and quality of life. The loss of driving privilege has negative psychosocial consequences, including depression. Early discussions and planning for driving retirement are therefore essential. Driving retirement, however, is typically a taboo topic for older drivers and their support networks. To understand why discussions and planning about driving retirement are avoided, 43 semi-structured interviews were conducted with older drivers in New South Wales, Australia. Drawing on Löckenhoff's ageing and decision-making framework, thematic analysis of transcripts offers insights into why discussions and planning for driving retirement are avoided or facilitated. The findings reveal most older drivers had not discussed or planned for driving retirement. Barriers to discussing and planning for driving retirement included: perceptions of loss, change, death and denial. Facilitators to discussing or planning for driving retirement included: declining health and driving confidence, medical advice, age or car accident. Driving retirement in car-dependent societies is a major life event, symbolising an end-of-life stage for many older people. This paper calls for strategies to encourage early and regular discussions about driving retirement with older drivers. To support older drivers’ transition to driving retirement, an understanding of the value and meaning placed on driving in the context of the individuals' identity and lifestyle is recommended.
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15
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Isler Y, Schwab S, Wick R, Lakämper S. Strong evidence for age as the single most dominant predictor of medically supervised driving test-mini mental status test outcomes provide only weak but significant moderate additional predictive value. BMC Geriatr 2022; 22:247. [PMID: 35331147 PMCID: PMC8951702 DOI: 10.1186/s12877-022-02951-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/15/2022] [Indexed: 12/03/2022] Open
Abstract
Background With age, medical conditions impairing safe driving accumulate. Consequently, the risk of accidents increases. To mitigate this risk, Swiss law requires biannual assessments of the fitness to drive of elderly drivers. Drivers may prove their cognitive and physical capacity for safe driving in a medically supervised driving test (MSDT) when borderline cases, as indicated by low performance in a set of four cognitive tests, including e.g. the mini mental status test (MMST). Any prognostic, rather than indicative, relations for MSDT outcomes have neither been confirmed nor falsified so far. In order to avoid use of unsubstantiated rules of thumb, we here evaluate the predictive value for MSDT outcomes of the outcomes of the standard set of four cognitive tests, used in Swiss traffic medicine examinations. Methods We present descriptive information on age, gender and cognitive pretesting results of all MSDTs recorded in our case database from 2017 to 2019. Based on these retrospective cohort data, we used logistic regression to predict the binary outcome MSDT. An exploratory analysis used all available data (model 1). Based on the Akaike Information Criterion (AIC), we then established a model including variables age and MMST (model 2). To evaluate the predictive value of the four cognitive assessments, model 3 included cognitive test outcomes only. Receiver operating characteristics (ROC) and area under the curve (AUC) allowed evaluating discriminative performance of the three different models using independent validation data. Results Using N = 188 complete data sets of a total of 225 included cases, AIC identified age (p < 0.0008) and MMST (p = 0.024) as dominating predictors for MSDT outcomes with a median AUC of 0.71 (95%-CI 0.57–0.85) across different training and validation splits, while using the four cognitive test results exclusively yielded a median AUC of 0.55 (95%-CI 0.40–0.71). Conclusions Our analysis provided strong evidence for age as the single most dominant predictor of MSDT outcomes. Adding MMST provides only weak additional predictive value for MSDT outcomes. Combining the results of four cognitive test used as standard screen in Swiss traffic medicine alone, proved to be of poor predictive value. This highlights the importance of MSDTs for balancing between the mitigation of risks by and the right to drive for the elderly.
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Affiliation(s)
- Yannik Isler
- Institute for Forensic Medicine, Traffic Medicine, University of Zürich, Andreasstrasse 15, 8050, Zürich, Switzerland
| | - Simon Schwab
- Center for Reproducible Science, University of Zürich, Hirschengraben 84, 8001, Zürich, Switzerland.,Epidemiology, Biostatistics and Prevention Institute, Hirschengraben 84, 8001, Zürich, Switzerland
| | - Regula Wick
- Institute for Forensic Medicine, Traffic Medicine, University of Zürich, Andreasstrasse 15, 8050, Zürich, Switzerland
| | - Stefan Lakämper
- Institute for Forensic Medicine, Traffic Medicine, University of Zürich, Andreasstrasse 15, 8050, Zürich, Switzerland.
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16
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Faraji Y, Tan-Burghouwt MT, Bredewoud RA, van Nispen RMA, van Rijn LJR. Predictive Value of the Esterman Visual Field Test on the Outcome of the On-Road Driving Test. Transl Vis Sci Technol 2022; 11:20. [PMID: 35297979 PMCID: PMC8944391 DOI: 10.1167/tvst.11.3.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose As the prevalence of age-related visual field disorders and the number of older drivers are rising, clear criteria on visual field requirements for driving are important. This article explores the predictive value of the Esterman visual field in relation to the outcome of an on-road driving test. Methods A retrospective chart review was performed for driver's license applicants who, based on their visual field, performed an on-road driving test. Cases (N = 101) with a failed on-road driving test were matched with 101 controls with a passed outcome. The Esterman visual field was divided in regions, and the number of points missed per region was counted. Logistic regression models and receiver operating characteristic (ROC) curves were computed for each region. Results Most regions presented a significantly increased odds for failing the driving test when more points were missed. The odds ratio for the whole visual field was 2.52 (95% confidence interval, 1.53–4.14, P < 0.001) for all the participants. However, ROC curves failed to reveal distinct fail–pass criteria based on the number of points missed, as revealed by a large amount of overlap between cases and controls. Conclusions These findings confirm the relation between visual field damage and impaired driving performance. However, the Esterman visual field results were not conclusive for predicting the driving performance of the individual driver with visual field defects. Translational Relevance In our group of participants, the number of on-road driving tests cannot be further reduced by a more detailed definition of fail–pass criteria, based on the Esterman visual field test.
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Affiliation(s)
- Yasmin Faraji
- Amsterdam UMC, Ophthalmology, Amsterdam Public Health, Vrije Universiteit, Amsterdam, The Netherlands
| | | | | | - Ruth M A van Nispen
- Amsterdam UMC, Ophthalmology, Amsterdam Public Health, Vrije Universiteit, Amsterdam, The Netherlands
| | - Laurentius J René van Rijn
- Amsterdam UMC, Ophthalmology, Amsterdam Public Health, Vrije Universiteit, Amsterdam, The Netherlands.,Department of Ophthalmology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Savoie C, Lavallière M, Voyer P, Bouchard S. Road safety of older drivers and the nursing profession: A scoping review. Int J Older People Nurs 2022; 17:e12452. [DOI: 10.1111/opn.12452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 11/05/2021] [Accepted: 12/30/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Camille Savoie
- Faculté des Sciences Infirmières Université Laval Quebec City Quebec Canada
| | - Martin Lavallière
- Département des Sciences de la Santé Université du Québec à Chicoutimi Chicoutimi Quebec Canada
| | - Philippe Voyer
- Faculté des Sciences Infirmières Université Laval Quebec City Quebec Canada
| | - Suzanne Bouchard
- Faculté des Sciences Infirmières Université Laval Quebec City Quebec Canada
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18
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Handajani Y, Butterfill E, Hengky A, Sugiyono S, Lamadong V, Turana Y. Sarcopenia and impairment in global cognitive, delayed memory, and olfactory function, among community-dwelling adults, in Jakarta, Indonesia: Active aging study. Tzu Chi Med J 2022. [DOI: 10.4103/tcmj.tcmj_175_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Spargo C, Laver K, Adey-Wakeling Z, Berndt A, George S. Mild cognitive impairment and fitness to drive: An audit of practice in a driving specialist clinic in Australia. Australas J Ageing 2021; 41:282-292. [PMID: 34939739 DOI: 10.1111/ajag.13024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 10/08/2021] [Accepted: 10/24/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe current practice and outcomes relating to fitness to drive for people with mild cognitive impairment (MCI) attending a specialist driving clinic. METHODS Retrospective medical record audit from a driving fitness assessment clinic at a tertiary medical centre, South Australia, from 2015 to 2019. RESULTS Of 100 notes audited, n = 40 had a documented diagnosis of MCI and n = 60 had subjective cognitive concerns characteristic of MCI. Participants mean age was 80.0 years (SD 6.7), and mean Mini-Mental State Examination score was 26.1 (SD 2.1). Medical practitioners completed a comprehensive initial assessment relating to medical fitness to drive, considering scores from a cognitive assessment battery and non-cognitive factors (driving history, current driving needs, vision, physical abilities and collateral from family). After the initial assessment, most participants (84%) were referred for a practical on-road assessment, before receiving a final driving recommendation. Over half of participants continued driving (51%), most with conditions, while 35% ceased driving. Outcomes for the remaining 14% are unknown as we were unable to determine whether the practical assessment (11%) or lessons (3%) were completed. CONCLUSIONS Driving outcomes for people with MCI with questionable driving capabilities are variable, with both cognitive and non-cognitive factors important in guiding medical fitness to drive recommendations. There is a need for more driving clinics to provide in-depth assessment for people with MCI who demonstrate uncertain driving capabilities and improved support for decision-making in other non-driving specialist settings.
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Affiliation(s)
- Claire Spargo
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Zoe Adey-Wakeling
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,Flinders Medical Centre, Rehabilitation Aged and Palliative Care, Adelaide, South Australia, Australia
| | - Angela Berndt
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Stacey George
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
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20
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Maxwell H, Weaver B, Gagnon S, Marshall S, Bédard M. The Validity of Three New Driving Simulator Scenarios: Detecting Differences in Driving Performance by Difficulty and Driver Gender and Age. HUMAN FACTORS 2021; 63:1449-1464. [PMID: 32644820 DOI: 10.1177/0018720820937520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE We explored the convergent and discriminant validity of three driving simulation scenarios by comparing behaviors across gender and age groups, considering what we know about on-road driving. BACKGROUND Driving simulators offer a number of benefits, yet their use in real-world driver assessment is rare. More evidence is needed to support their use. METHOD A total of 104 participants completed a series of increasingly difficult driving simulation scenarios. Linear mixed models were estimated to determine if behaviors changed with increasing difficulty and whether outcomes varied by age and gender, thereby demonstrating convergent and discriminant validity, respectively. RESULTS Drivers adapted velocity, steering, acceleration, and gap acceptance according to difficulty, and the degree of adaptation differed by gender and age for some outcomes. For example, in a construction zone scenario, drivers reduced their mean velocities as congestion increased; males drove an average of 2.30 km/hr faster than females, and older participants drove more slowly than young (5.26 km/hr) and middle-aged drivers (6.59 km/hr). There was also an interaction between age and difficulty; older drivers did not reduce their velocities with increased difficulty. CONCLUSION This study provides further support for the ability of driving simulators to elicit behaviors similar to those seen in on-road driving and to differentiate between groups, suggesting that simulators could serve a supportive role in fitness-to-drive evaluations. APPLICATION Simulators have the potential to support driver assessment. However, this depends on the development of valid scenarios to benchmark safe driving behavior, and thereby identify deviations from safe driving behavior. The information gained through simulation may supplement other forms of assessment and possibly eliminate the need for on-road testing in some situations.
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Affiliation(s)
| | - Bruce Weaver
- 7890 Lakehead University, Thunder Bay, ON, Canada
| | | | - Shawn Marshall
- 27337 University of Ottawa and Ottawa Hospital, ON, Canada
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21
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Hwang HS, Choi SY. Development of an Android-Based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) App: Mixed Methods Study. JMIR Mhealth Uhealth 2021; 9:e25310. [PMID: 33934068 PMCID: PMC8277309 DOI: 10.2196/25310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/16/2021] [Accepted: 05/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background Self-report assessments for elderly drivers are used in various countries for accessible, widespread self-monitoring of driving ability in the elderly population. Likewise, in South Korea, a paper-based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) has been developed. Here, we implemented the SAFE-DR through an Android app, which provides the advantages of accessibility, convenience, and provision of diverse information, and verified its reliability and validity. Objective This study tested the validity and reliability of a mobile app-based version of a self-report assessment for elderly persons contextualized to the South Korean culture and compared it with a paper-based test. Methods In this mixed methods study, we recruited and interviewed 567 elderly drivers (aged 65 years and older) between August 2018 and May 2019. For participants who provided consent, the app-based test was repeated after 2 weeks and an additional paper-based test (Driver 65 Plus test) was administered. Using the collected data, we analyzed the reliability and validity of the app-based SAFE-DR. The internal consistency of provisional items in each subdomain of the SAFE-DR and the test-retest stability were analyzed to examine reliability. Exploratory factor analysis was performed to examine the validity of the subdomain configuration. To verify the appropriateness of using an app-based test for older drivers possibly unfamiliar with mobile technology, the correlation between the results of the SAFE-DR app and the paper-based offline test was also analyzed. Results In the reliability analysis, Cronbach α for all items was 0.975 and the correlation of each item with the overall score ranged from r=0.520 to r=0.823; 4 items with low correlations were removed from each of the subdomains. In the retest after 2 weeks, the mean correlation coefficient across all items was r=0.951, showing very high reliability. Exploratory factor analysis on 40 of the 44 items established 5 subdomains: on-road (8 items), coping (16 items), cognitive functions (5 items), general conditions (8 items), and medical health (3 items). A very strong negative correlation of –0.864 was observed between the total score for the app-based SAFE-DR and the paper-based Driver 65 Plus with decorrelation scales. The app-based test was found to be reliable. Conclusions In this study, we developed an app-based self-report assessment tool for elderly drivers and tested its reliability and validity. This app can help elderly individuals easily assess their own driving skills. Therefore, this assessment can be used to educate drivers and for preventive screening for elderly drivers who want to renew their driver’s licenses in South Korea. In addition, the app can contribute to safe driving among elderly drivers.
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Affiliation(s)
- Ho Sung Hwang
- Department of Occupational Therapy, Wonkwang University Gwangju Medical Center, Gwangju, Republic of Korea
| | - Seong-Youl Choi
- Department of Occupational Therapy, Gwangju Women's University, Gwangju, Republic of Korea
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22
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Scott H, Unsworth C, Browne M. Fitness to drive practices among non-driver trained occupational therapists in an Australian community-based rehabilitation setting. Aust Occup Ther J 2021; 68:363-373. [PMID: 33949698 DOI: 10.1111/1440-1630.12733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 03/13/2021] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Driving is a valued occupation given the independence and freedom it provides. Safe driving performance can be impacted by medical conditions, change in functional status and ageing processes. Occupational therapy driver assessors (OTDAs) provide invaluable driving recommendations; however, this requires specialist training for the therapist and is costly for clients. The number of OTDAs is not expected to meet the growing demand for expert services in this area, and little is known about the practices that non- OTDAs use to assist clients with returning to driving. The aims of this study were to investigate the practices of non-OTDAs in a community-based rehabilitation setting in Australia with respect to knowledge, confidence and skills in assessments, recommendations and outcomes for clients as part of the return to driving process. METHODS A descriptive study including medical record audits between April and September 2019 and staff surveys were completed at a large metropolitan community-based rehabilitation facility. Descriptive statistics and thematic analysis were used to summarise data. RESULTS A total of 102 client medical records were audited, and 13 clinician surveys were completed. Medical record audits identified that return to driving was not consistently addressed by occupational therapists. Clinician surveys outlined a lack of knowledge and confidence of return to driving processes and available assessment tools to guide this process. CONCLUSION All occupational therapists have an ethical obligation to address driving as an activity of daily living; however, non-OTDAs report that they are not equipped for this role. This may negatively impact on driver safety, independence and overall health and well-being of clients in community-based rehabilitation. Further research is indicated to develop evidence-based driving resources to support best practice of non-OTDAs.
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Affiliation(s)
- Hayley Scott
- School of Health, Federation University, Churchill, Vic., Australia.,Occupational Therapy Department, Western Health, Melbourne, Vic., Australia
| | - Carolyn Unsworth
- School of Health, Federation University, Churchill, Vic., Australia.,School of Primary and Allied Health Care, Monash University, Frankston, Vic., Australia.,School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, Qld, Australia.,Healthcare Sciences, James Cook University, Townsville, Qld, Australia
| | - Matthew Browne
- School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, Qld, Australia
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Chau E, Nishi A, Kristalovich L, Holowaychuk A, Mortenson WB. Establishing the Predictive Validity of the ScanCourse for Assessing On-Road Driving Performance. Am J Occup Ther 2021; 75:7501205120p1-7501205120p8. [PMID: 33399060 DOI: 10.5014/ajot.2021.041608] [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 Scanning the environment is critical for driving safety. The ScanCourse is a functional assessment that assesses a person's ability to scan the environment for visual information while in motion. Measurement properties for the ScanCourse have been reported; however, its predictive validity is unknown. OBJECTIVE To determine the predictive validity of the ScanCourse for on-road driving performance and establish clinical cutoff scores. DESIGN Retrospective chart reviews were conducted over a 6-mo period. SETTING Four Canadian driver rehabilitation programs. PARTICIPANTS Charts from patients with neurological or vision conditions were eligible if they contained ScanCourse and on-road driving evaluation results between September 1, 2008, and August 30, 2018. Three hundred twenty-five charts were included for analysis. OUTCOMES AND MEASURES Area under the curve (AUC) analysis was used to determine the predictive validity of ScanCourse scores for on-road outcomes; cutoff scores were established by optimizing sensitivity and specificity. RESULTS The ScanCourse had an AUC of .702. The optimal cutoff score was 18/20 with a sensitivity of 76.7% and a specificity of 47.1%. CONCLUSIONS AND RELEVANCE Assessing the scanning abilities of at-risk drivers who intend to return to driving after sustaining an injury can help identify safety risks and inform interventions. The ScanCourse was found to have acceptable discriminatory ability for on-road driving performance. This study provides evidence supporting its continued use as a screening tool to assess driver fitness with an identified optimal cutoff score for clinical use. WHAT THIS ARTICLE ADDS Measuring the predictive ability of the ScanCourse assessment in relation to on-road driving performance provides occupational therapists with an evidence-based clinical tool to assist with screening fitness to drive among at-risk people.
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Affiliation(s)
- Eric Chau
- Eric Chau, BKin, MOT, OT, is Occupational Therapist, Private Practice, Vancouver, British Columbia, Canada. At the time of the research, Chau was Graduate Student, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam Nishi
- Adam Nishi, BKin, MOT, OT, is Occupational Therapist, Private Practice, Vancouver, British Columbia, Canada. At the time of the research, Nishi was Graduate Student, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Kristalovich
- Lisa Kristalovich, BMR(OT), MRSc, OT, is Clinical Instructor, Department of Occupational Science and Occupational Therapy, University of British Columbia, and Occupational Therapist, GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
| | - Ana Holowaychuk
- Ana Holowaychuk, MScOT (C), is Occupational Therapist, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - W Ben Mortenson
- W. Ben Mortenson, BScOT, MSc, PhD, OT, is Associate Professor, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Principal Investigator, International Collaboration on Repair Discoveries, Blusson Spinal Cord Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada; and Principal Investigator, Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada;
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Johnston BJ, O'Donnell JM, Manuguerra M, Davidson AS. Test-retest reliability of touchscreen DriveSafe DriveAware. Aust Occup Ther J 2020; 68:106-114. [PMID: 33368324 DOI: 10.1111/1440-1630.12706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This prospective study examines the test-retest reliability of touchscreen DriveSafe DriveAware (DSDA). In a future study, the authors intend assessing the usefulness of DSDA to measure progress of patients undergoing treatment for neurological conditions. Evidence of test-retest reliability is required first. METHODS Australian adults with current driver's licences (N = 39) aged 20 to 91 years (Mage = 58) recruited from a convenience sample were assessed with DSDA. The assessment was repeated 6 weeks, 6 months, and 12 months later to match planned assessments of patients undergoing neurosurgical treatment in future research. DSDA classification, DriveSafe subtest score, and DriveAware subtest scores were analysed as a whole sample, and in three age groups. RESULTS DSDA classification and DriveAware scores were consistent over repeated tests. DriveSafe scores increased between test 1 and 2 (p = .006), and thereafter no significant change from test 2 to 4. DriveSafe scores of older participants (70+ years) increased between test 1 and 2 more notably than younger participants' scores. No DriveSafe scores decreased over time. CONCLUSION DSDA classification and DriveAware scores demonstrated test-retest reliability for all age groups. DriveSafe scores did not demonstrate test-retest reliability between test 1 and 2 for participants 70+ years. However, DriveSafe scores demonstrated test-retest reliability after test 2, possibly indicating an initial learning effect for the DriveSafe score only. The authors posit that this result may have been influenced by older adults' reduced familiarity with iPad technology at first assessment. Further longitudinal research is required to confirm whether these results are consistent in a sample population with diagnosed cognitive impairment. Future research will assess whether repeated assessment of DSDA may be useful for monitoring and screening cognitive fitness to drive in patients who have undergone neurosurgical treatment and whether declining scores may indicate cognitive changes in ability to drive.
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Affiliation(s)
- Belinda J Johnston
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Joan M O'Donnell
- Occupational Therapy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Maurizio Manuguerra
- Department of Mathematics and Statistics, Faculty of Science and Engineering, Macquarie University, Sydney, NSW, Australia
| | - Andrew S Davidson
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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Tinella L, Lopez A, Caffò AO, Grattagliano I, Bosco A. Spatial Mental Transformation Skills Discriminate Fitness to Drive in Young and Old Adults. Front Psychol 2020; 11:604762. [PMID: 33343475 PMCID: PMC7745720 DOI: 10.3389/fpsyg.2020.604762] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/02/2020] [Indexed: 12/11/2022] Open
Abstract
Literature on driving research suggests a relationship between cognition and driving performance in older and younger drivers. There is little research on adults and driving, despite them being the largest age cohort behind the wheel. Among the cognitive domains, visuospatial abilities are expected to be highly predictive of driving skills and driving fitness. The relationship between specific spatial mental transformation skills (i.e., object and self-based ones) and driving performance has not yet been examined. The present study aimed to investigate the relationship between overall cognitive functioning, self and object-based spatial mental transformation skills, and driving performance in a sample of younger and older adult drivers. Participants were comprised of one hundred younger and 83 older adult Italian drivers. Participants completed a computerized driving test assessing traffic stress resilience, visual and motor reaction time, and the ability to obtain an overview of the traffic scenario (DT, vRT, mRT, and ATAV respectively in the Shufried®-Vienna Test System-DRIVESC). The Mental Rotation Test (MRT) and the Object Perspective Taking Test (OPT) were administered in order to assess object-based and self-based spatial mental transformation skills. The Montreal Cognitive Assessment Test (MoCA) was administered control for global cognitive functioning. The effects of education and gender were also controlled in the analysis. The results of the present study suggested that: (1) The effect of age, favoring younger participants, was found in DT, vRT, mRT, and ATAVT tests. (2) The effect of global cognitive functioning was found in DT and ATAV tests. (3) The effect of the spatial mental transformation tests was found in DT, vRT (MRT only), and ATAVT (OPT only) tests. Taken together, these results suggest the specific contribution of spatial mental transformation skills in the execution of complex behaviors connected to the fitness to drive. Prospectively, the results of the present study relating spatial mental transformation skills and driving processes may be a valuable source of knowledge for researchers dealing with the relationship between cognitive resources and navigation aids.
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Affiliation(s)
- Luigi Tinella
- Department of Educational Sciences, Psychology, Communication, University of Studies of Bari, Bari, Italy
| | - Antonella Lopez
- Department of Educational Sciences, Psychology, Communication, University of Studies of Bari, Bari, Italy
| | - Alessandro Oronzo Caffò
- Department of Educational Sciences, Psychology, Communication, University of Studies of Bari, Bari, Italy
| | - Ignazio Grattagliano
- Department of Educational Sciences, Psychology, Communication, University of Studies of Bari, Bari, Italy
| | - Andrea Bosco
- Department of Educational Sciences, Psychology, Communication, University of Studies of Bari, Bari, Italy
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The Predictors of Driving Cessation among Older Drivers in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197206. [PMID: 33019748 PMCID: PMC7579101 DOI: 10.3390/ijerph17197206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 12/03/2022]
Abstract
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.
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Ryvicker M, Bollens-Lund E, Ornstein KA. Driving Status and Transportation Disadvantage Among Medicare Beneficiaries. J Appl Gerontol 2020; 39:935-943. [PMID: 30362863 PMCID: PMC6486463 DOI: 10.1177/0733464818806834] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Transportation disadvantage may have important implications for the health, well-being, and quality of life of older adults. This study used the 2015 National Health Aging Trends Study, a nationally representative study of Medicare beneficiaries aged 65 and over (N = 7,498), to generate national estimates of transportation modalities and transportation disadvantage among community-dwelling older adults in the United States. An estimated 10.8 million community-dwelling older adults in the United States rarely or never drive. Among nondrivers, 25% were classified as transportation disadvantaged, representing 2.3 million individuals. Individuals with more chronic medical conditions and those reliant on assistive devices were more likely to report having a transportation disadvantage (p < .05). Being married resulted in a 50% decreased odds of having a transportation disadvantage (p < .01). Some individuals may be at higher risk for transportation-related barriers to engaging in valued activities and accessing care, calling for tailored interventions such as ride-share services combined with care coordination strategies.
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Holowaychuk A, Parrott Y, Leung AWS. Exploring the Predictive Ability of the Motor-Free Visual Perception Test (MVPT) and Trail Making Test (TMT) for On-Road Driving Performance. Am J Occup Ther 2020; 74:7405205070p1-7405205070p8. [PMID: 32804625 DOI: 10.5014/ajot.119.040626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Resuming driving after a change in functional ability is challenging for patients with a neurological condition. Although a combination of assessment tools has been suggested for use in driving evaluation, resources and availability of tools have been a problem. OBJECTIVE To examine the predictive ability of two commonly used tools, the Motor-Free Visual Perception Test (MVPT) and the Trail Making Test, Parts A and B (TMTA and TMTB), on on-road driving performance. DESIGN Retrospective chart review of 82 patient charts between 2015 and 2016. SETTING Local rehabilitation hospital. PARTICIPANTS Eighty-two patients with a primary neurological diagnosis (general neurological condition, n = 13; spinal cord injury, n = 11; stroke, n = 58). OUTCOMES AND MEASURES MVPT, TMTA, and TMTB. RESULTS Among the patients, 36 passed and 46 failed the on-road evaluation. The TMTA and TMTB scores were significantly different between those who passed or failed the on-road evaluation. Logistic regression analyses revealed that the TMTB completion time was the only significant predictor of on-road driving performance (for the all-patient model, 66% prediction accuracy, -2 log-likelihood [LL] = 93.47, exp β = 0.98; for the stroke-only model, 76% prediction accuracy, -2LL = 59.61, exp β = 0.97). CONCLUSIONS AND RELEVANCE Our findings suggest that the TMTB is a better predictor of on-road driving performance for patients with a neurological condition than the MVPT. The findings shed light on the importance of selecting proper tools when assessing driving performance. Future prospective studies with a wider array of predictive variables are recommended to support the present findings. WHAT THIS ARTICLE ADDS Occupational therapists should revisit the use of the MVPT in driving assessment and consider multiple assessment tools when evaluating and predicting driving performance.
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Affiliation(s)
- Ana Holowaychuk
- Ana Holowaychuk, MSc, OT(C), is Occupational Therapist, Department of Occupational Therapy, Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Yolan Parrott
- Yolan Parrott, MSc, OT(C), is Occupational Therapist, Department of Occupational Therapy, Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Ada W S Leung
- Ada W. S. Leung, PhD, OT(C), is Associate Professor, Department of Occupational Therapy, Faculty of Rehabilitation Medicine, and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada;
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Anstey KJ, Eramudugolla R, Huque MH, Horswill M, Kiely K, Black A, Wood J. Validation of Brief Screening Tools to Identify Impaired Driving Among Older Adults in Australia. JAMA Netw Open 2020; 3:e208263. [PMID: 32585021 PMCID: PMC7301240 DOI: 10.1001/jamanetworkopen.2020.8263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE There is an urgent need to develop evidence-based assessments to identify older individuals who may be unsafe drivers. OBJECTIVE To validate 8 off-road brief screening tests to predict on-road driving ability and to identify which combination of these provides the best prediction of older adults who will not pass an on-road driving test. DESIGN, SETTING, AND PARTICIPANTS This prognostic study was conducted between October 31, 2013, and May 10, 2017, using the criterion standard for screening tests, an on-road driving test, with analysis conducted from August 1, 2019, to April 2, 2020. A volunteer sample of older drivers was recruited from community advertisements, rehabilitation and driver assessment clinics, and an optometry clinic in Canberra and Brisbane, Australia. EXPOSURES Off-road driver screening measures, including the Useful Field of View, DriveSafe/DriveAware, Multi-D battery, Trails B, Maze test, Hazard Perception Test, DriveSafe Intersection test, and 14-item Road Law test. MAIN OUTCOMES AND MEASURES Classification as unsafe on a standardized 50-minute on-road driving assessment administered by a driving instructor and an occupational therapist masked to the participant's clinical diagnosis and off-road test performance. RESULTS A total of 560 drivers aged 63 to 94 years (mean [SD] age, 74.7 [6.2] years]; 350 [62.5%] men) were assessed. Logistic regression and receiver operating characteristic analyses indicated the area under the curve was largest for a multivariate model comprising the Multi-D, Useful Field of View, and Hazard Perception Test, with an area under the curve of 0.89 (95% CI, 0.85-0.94), sensitivity of 80.4%, and specificity of 84.1% for predicting unsafe drivers. The Multi-D battery was the most accurate individual assessment and had an area under the curve of 0.85 (95% CI, 0.79-0.90), sensitivity of 77.1%, and specificity of 82.1%. The multivariate model had sensitivity of 83.3% and specificity of 91.8% in the cognitively impaired group and sensitivity of 87.5% and specificity of 70.8% in the visually impaired group. CONCLUSIONS AND RELEVANCE These findings suggest that off-road screening tests can reliably identify older drivers with a strong probability of failing an on-road driving test. Implementation of these measures could enable better targeting of resources for managing older driver licensing and support injury prevention strategies in this group.
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Affiliation(s)
- Kaarin J. Anstey
- School of Psychology, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, Australia
| | - Ranmalee Eramudugolla
- School of Psychology, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, Australia
| | - Md Hamidul Huque
- School of Psychology, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, Australia
| | - Mark Horswill
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Kim Kiely
- School of Psychology, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, Australia
| | - Alex Black
- Centre for Vision and Eye Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Joanne Wood
- Centre for Vision and Eye Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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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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Wallis KA, Matthews J, Spurling GK. Assessing fitness to drive in older people: the need for an evidence-based toolkit in general practice. Med J Aust 2020; 212:396-398.e1. [PMID: 32335920 DOI: 10.5694/mja2.50588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Geoffrey K Spurling
- Discipline of General Practice, University of Queensland, Brisbane, QLD.,Southern Queensland Centre of Excellence in Aboriginal and Torres Strait, Islander Primary Health Care, Queensland Health, Brisbane, QLD
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Masterson EE, Moreland BL, Strogatz DS, Kasper JD, Mielenz TJ. Utilization of driving and other transportation rehabilitation in the National Health and Aging Trends Study. Disabil Health J 2020; 13:100911. [PMID: 32111571 DOI: 10.1016/j.dhjo.2020.100911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/15/2020] [Accepted: 02/13/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND As people age, their mobility begins to decrease. In an effort to maintain mobility, this population can seek out rehabilitation services with the goal of improving their driving. However, it is unclear who has sought out rehabilitation for this purpose. OBJECTIVE To better understand, identify, and describe the characteristics of older adults who utilize rehabilitation with the purpose of improved driving. METHODS Data was analyzed from the fifth round of the National Health and Aging Trends study (NHATS), which is made up of Medicare beneficiaries over the age of 65 that are community-dwelling. Rehabilitation utilization specifically for improved driving and other transportation was analyzed. Adjusted weighted logistic regression was conducted to better understand and identify the characteristics of the study population that received rehabilitation services for the purpose of improved driving ability. RESULTS Nineteen percent (N = 1,335) of this cohort received rehabilitation in the past year. Of those, 10% (N = 128) received rehabilitation to specifically improve driving and 2% (N = 25) did so to improve other transportation. Older adults who were single, separated, or never married were less likely to use rehabilitation for improving driving ability, compared to older adults who were married (OR: 0.29; 95% CI: 0.11-0.80). CONCLUSION Older adults who are married were more likely to report they wanted to improve their driving ability with rehabilitation. The role of rehabilitation services to improve driving among older adults will play a key role in the coming years as older adults strive to maintain their independence.
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Affiliation(s)
- Erin E Masterson
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 West 168th Street, New York, NY, USA.
| | - Briana L Moreland
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 West 168th Street, New York, NY, USA.
| | - David S Strogatz
- The Mary Imogene Bassett Hospital, Research Institute, One Atwell Road, Cooperstown, NY, USA.
| | - Judith D Kasper
- Johns Hopkins University, Bloomberg School of Public Health, Department of Health Policy and Management, 624 North Broadway, Baltimore, MD, 21205, USA.
| | - Thelma J Mielenz
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 West 168th Street, New York, NY, USA.
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Romero-Ayuso D, Castillero-Perea Á, González P, Navarro E, Molina-Massó JP, Funes MJ, Ariza-Vega P, Toledano-González A, Triviño-Juárez JM. Assessment of cognitive instrumental activities of daily living: a systematic review. Disabil Rehabil 2019; 43:1342-1358. [PMID: 31549907 DOI: 10.1080/09638288.2019.1665720] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE Cognitive instrumental activities of daily living are particularly related to executive functions, such as scheduling appointments, monthly payments, managing the household economy, shopping or taking the bus. The aim of this systematic review was to determine the available tests for the assessment of executive functions with ecological validity to predict individuals' functioning. MATERIALS AND METHODS An electronic search was conducted in MEDLINE, Cochrane Central, PsyCInfo and IEEE Xplore until May 2019, in addition to a manual search. The PRISMA criteria and the Covidence platform were used to select articles and extract data. RESULTS After applying the search selection criteria, 76 studies were identified. They referred to 110 tools to assess instrumental activities of daily living. Those that have received most attention are related to menu preparation and shopping. Performance-based measures are the most widely used traditional methods. Most tests were aimed at the adult population with acquired brain damage, cognitive impairment or dementia. There was a predominance of tests based on the Multiple Errands Test paradigm. CONCLUSIONS In recent years, it has increased the number of tools that assess the instrumental activities of daily living based on technologies such as personal or environmental sensors and serious games.IMPLICATIONS FOR REHABILITATIONAssessment of Instrumental Activities of Daily Living through performance-based measures is especially useful for the early detection of dysfunctions or preclinical disability.Difficulties in performing instrumental activities of daily living are closely associated with deficits in executive functions and prospective memory.Activities of Daily Living can be understood as multitasks.The use of virtual reality-based tests was shown to be sensitive to the detection of cognitive deficits in Activities of Daily Living.An advantage of using virtual reality in assessments is that it can help to predict the level of personal autonomy in patients who are in an institutional environment and could be a first approximation to the real environment.
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Affiliation(s)
- Dulce Romero-Ayuso
- Division of Occupational Therapy, Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | | | - Pascual González
- LoUISE Research Group, Computing Systems Department, University of Castilla-La Mancha, Albacete, Spain
| | - Elena Navarro
- LoUISE Research Group, Computing Systems Department, University of Castilla-La Mancha, Albacete, Spain
| | - José Pascual Molina-Massó
- LoUISE Research Group, Computing Systems Department, University of Castilla-La Mancha, Albacete, Spain
| | - M Jesús Funes
- Mind, Brain and Behaviour Research Center (CIMCYC) and Department of Experimental Psychology, University of Granada, Granada, Spain
| | - Patrocinio Ariza-Vega
- Division of Occupational Therapy, Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,Rehabilitation and Traumatology Service, Virgen de Las Nieves University Hospital of Granada, Granada, Spain
| | - Abel Toledano-González
- Department of Psychology, Faculty of Occupational Therapy, Speech Therapy and Nursing, University of Castilla-La Mancha, Ciudad Real, Spain
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William H H, Kinder CM, Lodha N, Smith BW. Is simulator-based driver rehabilitation missing motion feedback? IEEE Int Conf Rehabil Robot 2019; 2019:631-636. [PMID: 31374701 DOI: 10.1109/icorr.2019.8779414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Currently, driver rehabilitation involves use of fixed-base simulators. Such simulators are used infrequently and with little success. We hypothesize that the absence of motion feedback may be limiting the therapeutic effectiveness of driving simulation. During real, motor vehicle driving, the driver receives motion feedback that provides rich and real-time information about acceleration, deceleration and turning of the vehicle. Thus, motion feedback may be a key missing component that could dramatically increase the clinical pragmatism of simulator-based driver rehabilitation. In this pilot study, six young adult drivers participated in simulated driving tasks with or without motion feedback. Participants who received motion feedback completed faster laps on a racetrack and committed fewer driving infractions on a highway. They reported being more motivated and aware of the pressure of high speed driving. Particularly, they experienced substantially fewer symptoms of simulator sickness, a primary impedient to widespread use of driving simulators for driver rehabilitation. These preliminary finding motivate a full investigation of the impacts of motion feedback during simulated driving, and of the efficacy of lower cost, two degree of freedom driving simulators for clinical use.
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Stack AH, Duggan O, Stapleton T. Assessing fitness to drive after stroke. IRISH JOURNAL OF OCCUPATIONAL THERAPY 2018. [DOI: 10.1108/ijot-03-2018-0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
The assessment of fitness to drive after stroke is an emerging area of occupational therapy practice in Ireland. Despite this, little is known about occupational therapists’ evaluation practices, and there are no internationally agreed clinical guidelines to inform best practice. The purpose of this paper is to investigate occupational therapy evaluation practices for fitness to drive after stroke in Ireland.
Design/methodology/approach
This is a cross-sectional study design targeting occupational therapists working with people after stroke using an online survey. Summary and descriptive statistics were used to analyse the returned surveys.
Findings
In total, 47 occupational therapists participated. Off-road driving assessment was completed by 68 per cent of respondents. Functional assessment and non-driving-specific assessments were most widely used and perceived to be the most useful in informing the off-road assessment. A total of 89 per cent referred clients for on-road assessments; however, some referred without first completing an off-road assessment. The therapists who completed formal post graduate education/training in driving assessment reported greater confidence and competence in their skills and ability to assess fitness to drive. A vast majority of participants agreed that clinical guidelines regarding best practice in this area would be beneficial.
Research limitations/implications
A majority of occupational therapists are assessing fitness to drive after stroke in Ireland with non-driving-specific assessments and functional observations; however, there are many gaps and wide variations between services. Education/training in evaluating fitness to drive after stroke is recommended. The development of clinical guidelines to inform practice would facilitate a consistent approach nationally.
Originality/value
This is the first study completed in Ireland to investigate occupational therapy evaluation practices for fitness to drive after stroke.
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Abstract
Clinical assessment of fitness to drive can be a challenging part of primary care of older adults. There are no guidelines on screening for driver safety, so it falls to provider judgment on when to assess older drivers. This review offers recommendations on when to assess for driver safety based on red flag conditions, medications, acute events, and patient or family concerns. It reviews how to assess for visual, cognitive, and neuromuscular impairments and what to do as next steps for at-risk drivers once they are identified. Laws regarding driver reporting are also reviewed.
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Affiliation(s)
- Emily Morgan
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Mail Code L-475, 3181 South West Sam Jackson Park Road, Portland, OR 97239, USA.
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St-Hilaire A, Parent C, Potvin O, Bherer L, Gagnon JF, Joubert S, Belleville S, Wilson MA, Koski L, Rouleau I, Hudon C, Macoir J. Trail Making Tests A and B: regression-based normative data for Quebec French-speaking mid and older aged adults. Clin Neuropsychol 2018; 32:77-90. [DOI: 10.1080/13854046.2018.1470675] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Alexandre St-Hilaire
- Centre de recherche CERVO, Institut universitaire en santé mentale de Québec, Québec, Canada
| | - Camille Parent
- Centre de recherche CERVO, Institut universitaire en santé mentale de Québec, Québec, Canada
- École de psychologie, Université Laval, Québec, Canada
| | - Olivier Potvin
- Centre de recherche CERVO, Institut universitaire en santé mentale de Québec, Québec, Canada
| | - Louis Bherer
- Department de médecine, Université de Montréal, Montréal, Canada
- Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal, Canada
- Centre de recherche, Institut de Cardiologie de Montréal, Montréal, Canada
| | - Jean-François Gagnon
- Département de psychologie, Université du Québec à Montréal, Montréal, Canada
- Centre d’Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada
| | - Sven Joubert
- Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal, Canada
- Département de psychologie, Université de Montréal, Montréal, Canada
| | - Sylvie Belleville
- Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal, Canada
- Département de psychologie, Université de Montréal, Montréal, Canada
| | - Maximiliano A. Wilson
- Centre de recherche CERVO, Institut universitaire en santé mentale de Québec, Québec, Canada
- Département de réadaptation, Université Laval, Québec, Canada
| | - Lisa Koski
- Département de neurologie, Université McGill, Montréal, Canada
- Neurorehabilitation Research Centre, Montréal, Canada
| | - Isabelle Rouleau
- Département de psychologie, Université du Québec à Montréal, Montréal, Canada
- Centre de recherche, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Carol Hudon
- Centre de recherche CERVO, Institut universitaire en santé mentale de Québec, Québec, Canada
- École de psychologie, Université Laval, Québec, Canada
| | - Joël Macoir
- Centre de recherche CERVO, Institut universitaire en santé mentale de Québec, Québec, Canada
- Département de réadaptation, Université Laval, Québec, Canada
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Chen YT, Gélinas I, Mazer B. Determining Older Adults' Fitness-to-Drive: Comparing the Standard On-road Driving Evaluation and the Naturalistic Driving Observation. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2018. [DOI: 10.1080/02703181.2018.1440042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Yu-Ting Chen
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - Isabelle Gélinas
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - Barbara Mazer
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
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McNamara A, John Barr C, Bond MJ, George S. A pilot study: Can the UFOV assessment be used as a repeated measure to determine timing of on-road assessment in stroke? Aust Occup Ther J 2018; 66:5-12. [PMID: 29460955 DOI: 10.1111/1440-1630.12456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND/AIMS Useful Field of View scores are predictive of on-road performance post-stroke. No objective data exist to determine if the Useful Field of View (UFOV) assessment can be used as a repeated measure in the post-stroke population to determine timing of occupational therapy on-road assessment as recovery occurs. The aims of this study were to determine whether there is a practice effect if the UFOV is administered at one, two and three months' post-stroke and to assess optimal time post-stroke to refer to an on-road assessment. METHOD Forty-two participants, 17 men (40.5%), with a mean age of 71 years (SD 9.33) were randomly allocated to 1. Assessment group - UFOV at one, two and three months' post-stroke, 2. Control group-UFOV at three months' post-stroke. Parametric and non-parametric tests were utilised depending on data distribution. RESULTS No significance was found between; three months' subtest 1 (P = 0.463), three months' subtest 2 (P = 0.729) and three months' subtest 3 (P = 0.534) between the assessment and control groups. Both group's scores were combined to examine pass/fail rates of UFOV assessment to indicate timing of referral to on-road assessments. At one month, 16.9% stroke survivors passed the UFOV, when reassessed at three months 69.1% passed and 28.6% again failed. CONCLUSION Improvements in scores at one month intervals over three months are due to improvements in abilities assessed by the UFOV as no practice effect was found to influence scores. UFOV scores performed at monthly intervals post-stroke can be used to guide the timing of an occupational therapy on-road assessment, with an increased likelihood of passing, as recovery occurs. This repeated use of the UFOV assessment can assist referral practices that best utilise driving rehabilitation programmes. Larger studies need to be conducted to confirm these results.
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Affiliation(s)
- Annabel McNamara
- College of Nursing and Health Sciences, Rehabilitation and Aged Studies Unit, Bedford Park, South Australia, Australia
| | - Christopher John Barr
- College of Nursing and Health Sciences, Rehabilitation and Aged Studies Unit, Bedford Park, South Australia, Australia
| | - Malcolm J Bond
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Stacey George
- College of Nursing and Health Sciences, Rehabilitation and Aged Studies Unit, Bedford Park, South Australia, Australia
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40
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Lenardt MH, Garcia ACKC, Binotto MA, Carneiro NHK, Lourenço TM, Cechinel C. Non-frail elderly people and their license to drive motor vehicles. Rev Bras Enferm 2018; 71:350-356. [PMID: 29412293 DOI: 10.1590/0034-7167-2016-0675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/03/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyse the link between the non-frailty condition and the results of driving license for elderly people to drive motor vehicles. METHOD cross-sectional study with data collection in the sample period from August 2015 to March 2016. Study performed with 347 elderlies (≥60 years). RESULTS 180 (51.9%) of the participants were classified as non-frail. 48 (26.7%) of them were considered capable to drive, 121 (67.2%) capable to drive with restrictions and 11 (6.1%) temporarily uncapable. No significant relation was found between the non-frailty conditions and the results of the motor vehicles driving license study (p=0.557). CONCLUSION The absence of physical frailty does not necessarily points out that the elderly are able to drive motor vehicles. Tracking the frailty subsidizes preventive interventions, which seek to interfere positively in the act of driving. This is an unprecedented study in nursing and it highlights an essential field for the performance of gerontological nursing.
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Affiliation(s)
- Maria Helena Lenardt
- Universidade Federal do Paraná, Postgraduate Program in Nursing Curitiba. Paraná, Brazil
| | | | - Maria Angélica Binotto
- Universidade Federal do Paraná, Postgraduate Program in Nursing Curitiba. Paraná, Brazil
| | | | - Tânia Maria Lourenço
- Universidade Federal do Paraná, Postgraduate Program in Nursing Curitiba. Paraná, Brazil
| | - Clovis Cechinel
- Universidade Federal do Paraná, Postgraduate Program in Nursing Curitiba. Paraná, Brazil
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41
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Betz ME, Haukoos JS, Schwartz R, DiGuiseppi C, Kandasamy D, Beaty B, Juarez-Colunga E, Carr DB. Prospective Validation of a Screening Tool to Identify Older Adults in Need of a Driving Evaluation. J Am Geriatr Soc 2018; 66:357-363. [PMID: 29231960 PMCID: PMC5809263 DOI: 10.1111/jgs.15222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To prospectively validate and refine the 5-item "CRASH" screening tool for identifying older drivers needing a behind-the-wheel (BTW) test. DESIGN Prospective observational study. SETTING Geriatric and internal medicine primary care clinics affiliated with a tertiary care hospital and a local BTW program. PARTICIPANTS Cognitively intact drivers aged 65 and older (N = 315). MEASUREMENTS Participants completed baseline questionnaire (including CRASH tool) and assessments and BTW test (evaluator blinded to questionnaire results) and participated in 1-month telephone follow-up. Analysis included descriptive statistics and examination of predictive ability of the CRASH tool to discriminate normal (pass) from abnormal (conditional pass or fail) on the BTW test, with logistic regression and CART techniques for tool refinement. RESULTS Two hundred sixty-six participants (84%) had a BTW test; of these, 17% had a normal rating and 83% an abnormal rating. Forty-five percent of those with an abnormal score were advised to limit driving under particular conditions. Neither the CRASH tool nor its individual component variables were significantly associated with the summary BTW score; in refined models with other variables, the best-performing tool had approximately 67% sensitivity and specificity for an abnormal BTW score. Most participants found the BTW test useful and were willing to pay a median of $50. At 1-month follow-up, no participants had stopped driving. CONCLUSION The CRASH screening tool cannot be recommended for use in clinical practice. Findings on older adults' perceived utility of the BTW test and the stability of driving patterns at 1-month follow-up could be useful for future research studies and for design of older driver programs.
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Affiliation(s)
- Marian E. Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jason S. Haukoos
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Denver Health Medical Center, Denver, Colorado, USA
| | - Robert Schwartz
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado; Eastern Colorado VA Geriatric Research Education and Clinical Center
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Deepika Kandasamy
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Brenda Beaty
- Adult and Child Center for Health Outcomes Research and Delivery Science, Aurora, Colorado, Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Elizabeth Juarez-Colunga
- Adult and Child Center for Health Outcomes Research and Delivery Science, Aurora, Colorado, Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - David B. Carr
- Division of Geriatrics and Nutritional Science, Department of Medicine and Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
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42
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Fontenot JL, Bona MD, Kaleem MA, McLaughlin WM, Morse AR, Schwartz TL, Shepherd JD, Jackson ML. Vision Rehabilitation Preferred Practice Pattern®. Ophthalmology 2018; 125:P228-P278. [DOI: 10.1016/j.ophtha.2017.09.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/26/2017] [Indexed: 11/29/2022] Open
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Allison CD, Lane A. Risk of Motor Vehicle Collision and Driving Impairment with Dementia: Clinical Implications. Am J Geriatr Psychiatry 2017; 25:1391-1392. [PMID: 28729140 DOI: 10.1016/j.jagp.2017.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 06/14/2017] [Indexed: 11/24/2022]
Affiliation(s)
| | - Amy Lane
- University of Pittsburgh, Pittsburgh, PA
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44
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Dickerson AE, Molnar L, Bedard M, Eby DW, Classen S, Polgar J. Transportation and Aging: An Updated Research Agenda for Advancing Safe Mobility. J Appl Gerontol 2017; 38:1643-1660. [PMID: 29165017 DOI: 10.1177/0733464817739154] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This article discusses what is currently known about three important topics related to older driver safety and mobility: screening and evaluation, education and training interventions, and in-vehicle technology. Progress is being made to improve the safe mobility of older adults in these key areas; however, significant research gaps remain. This article advances the state of knowledge by identifying these gaps, and proposing further research topics will improve the lives of older adults. In addition, we discuss several themes that emerged from the review, including the need for multidisciplinary, community-wide solutions; large-scale, longitudinal studies; improved education/training for both older adults themselves and the variety of stakeholders involved in older adult transportation; and programs and interventions that are flexible and responsive to individual needs and differences.
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Affiliation(s)
| | - Lisa Molnar
- UMTRI, University of Michigan, Ann Arbor, MI, USA
| | | | - David W Eby
- UMTRI, University of Michigan, Ann Arbor, MI, USA
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45
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Rogers JC, Holm MB. Functional assessment in mental health: lessons from occupational therapy. DIALOGUES IN CLINICAL NEUROSCIENCE 2017. [PMID: 27489454 PMCID: PMC4969701 DOI: 10.31887/dcns.2016.18.2/jrogers] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Occupational therapists have been conducting functional assessments since World War I, and this accumulated experience has taught us several critical lessons. First, a comprehensive profile of a patient's functioning requires multiple assessment methods. Second, assessment content and measurement constructs must change with the times. Third, technology can enhance and extend functional assessment. Fourth, performance-based assessments of everyday activities can also be used to measure body functions/impairments. However, while deconstructing activities into body functions/impairments is possible, the results do not reflect patients' abilities to integrate the cognitive, motor, sensory and affective functions necessary to complete a complex activity. Finally, the differential complexity of everyday activities that a patient can master or successfully complete can also provide a ruler with which to measure progress.
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Affiliation(s)
- Joan C Rogers
- Professors Emeritus, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Margo B Holm
- Professors Emeritus, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
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46
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Fields SM, Unsworth CA. Revision of the Competency Standards for Occupational Therapy Driver Assessors: An overview of the evidence for the inclusion of cognitive and perceptual assessments within fitness-to-drive evaluations. Aust Occup Ther J 2017; 64:328-339. [DOI: 10.1111/1440-1630.12379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Sally M. Fields
- Occupational Therapy; School of Health; Medical and Applied Sciences; Central Queensland University; Melbourne Victoria Australia
- Faculty of Health Sciences and Medicine; Bond University; Gold Coast Queensland Australia
| | - Carolyn A. Unsworth
- Occupational Therapy; School of Health; Medical and Applied Sciences; Central Queensland University; Melbourne Victoria Australia
- Department of Rehabilitation; School of Health Sciences; Jönköping University; Jönköping Sweden
- Faculty of Health Sciences; Curtin University; Bentley Western Australia Australia
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Gibbons C, Smith N, Middleton R, Clack J, Weaver B, Dubois S, Bédard M. Using Serial Trichotomization With Common Cognitive Tests to Screen for Fitness to Drive. Am J Occup Ther 2017; 71:7102260010p1-7102260010p8. [PMID: 28218592 DOI: 10.5014/ajot.2017.019695] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to illustrate the use of serial trichotomization with five common tests of cognition to achieve greater precision in screening for fitness to drive. METHOD We collected data (using the Montreal Cognitive Assessment, Motor-Free Visual Perception Test, Clock-Drawing Test, Trail Making Test Part A and B [Trails B], and an on-road driving test) from 83 people referred for a driving evaluation. We identified cutpoints for 100% sensitivity and specificity for each test; the driving test was the gold standard. Using serial trichotomization, we classified drivers as either "Pass," "Fail," or "Indeterminate." RESULTS Trails B had the best sensitivity and specificity (66.3% of participants correctly classified). After applying serial trichotomization, we correctly identified the driving test outcome for 78.3% of participants. CONCLUSION A screening strategy using serial trichotomization of multiple test results may reduce uncertainty about fitness to drive.
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Affiliation(s)
- Carrie Gibbons
- Carrie Gibbons, MPH, is Research Coordinator, Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, ON, Canada
| | - Nathan Smith
- Nathan Smith, MPH, is Research Assistant, Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada
| | - Randy Middleton
- Randy Middleton, MScOT, is Occupational Therapist, St. Joseph's Hospital, St. Joseph's Care Group, Thunder Bay, ON, Canada
| | - John Clack
- John Clack, MScOT, is Occupational Therapist, St. Joseph's Hospital, St. Joseph's Care Group, Thunder Bay, ON, Canada
| | - Bruce Weaver
- Bruce Weaver, MSc, is Research Associate, Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada, and Assistant Professor, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Sacha Dubois
- Sacha Dubois, MPH, is Research Statistician, Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, ON, Canada; Adjunct Professor, Lakehead University, Thunder Bay, ON, Canada; and Assistant Professor, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Michel Bédard
- Michel Bédard, PhD, is Professor, Lakehead University and Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Director, Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada; and Scientific Director, Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, ON, Canada;
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Svetina M. The reaction times of drivers aged 20 to 80 during a divided attention driving. TRAFFIC INJURY PREVENTION 2016; 17:810-814. [PMID: 26980290 DOI: 10.1080/15389588.2016.1157590] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 02/19/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Many studies addressing age-related changes in driving performance focus on comparing young vs. older drivers, which might lead to the biased conclusion that driving performance decreases only after the age of 65. The main aim of the study was to show that changes in driving performance are progressive throughout the adult years. METHODS A sample of 351 drivers aged 20 to 80 was assessed for their reaction times while driving between road cones. The drivers were exposed to 2 conditions varying according to task complexity. In single task conditions, the drivers performed a full stopping maneuver at a given signal; in dual task conditions, the drivers were distracted before the signal for stopping maneuver was triggered. Reaction times were compared across conditions and age groups. RESULTS The results showed that both reaction times and variability of driving performance increased progressively between the ages of 20 and 80. The increase in both reaction times and variability was greater in the complex task condition. The high-performing quarter of elderly drivers performed equally well or better than younger drivers did. CONCLUSIONS The data clearly supported the claim that driving performance changes steadily across age groups: both mean reaction time and interindividual variability progressively increase with age. In addition, a significant group of older drivers was identified who did not show the expected age-related decrease in performance. The findings have important implications, suggesting that in relation to driving, aging is a progressive phenomenon and may lead to variety of driving performance; age-related studies of driving performance should put more emphasis on investigating changes across the whole driver age range rather than only comparing younger and older drivers.
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Affiliation(s)
- Matija Svetina
- a Faculty of Arts, University of Ljubljana , Ljubljana , Slovenia
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49
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Bowers AR. Driving with homonymous visual field loss: a review of the literature. Clin Exp Optom 2016; 99:402-18. [PMID: 27535208 DOI: 10.1111/cxo.12425] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 02/02/2016] [Accepted: 02/26/2016] [Indexed: 01/13/2023] Open
Abstract
Driving is an important rehabilitation goal for patients with homonymous field defects (HFDs); however, whether or not people with HFDs should be permitted to drive is not clear. Over the last 15 years, there has been a marked increase in the number of studies evaluating the effects of HFDs on driving performance. This review of the literature provides a much-needed summary for practitioners and researchers, addressing the following topics: regulations pertaining to driving with HFDs, self-reported driving difficulties, pass rates in on-road tests, the effects of HFDs on lane position and steering stability, the effects of HFDs on scanning and detection of potential hazards, screening for potential fitness to drive, evaluating practical fitness to drive and the efficacy of interventions to improve driving of persons with HFDs. Although there is clear evidence from on-road studies that some people with HFDs may be rated as safe to drive, others are reported to have significant deficits in skills important for safe driving, including taking a lane position too close to one side of the travel lane, unstable steering and inadequate viewing (scanning) behaviour. Driving simulator studies have provided strong evidence of a wide range in compensatory scanning abilities and detection performance, despite similar amounts of visual field loss. Conventional measurements of visual field extent (in which eye movements are not permitted) do not measure such compensatory abilities and are not predictive of on-road driving performance. Thus, there is a need to develop better tests to screen people with HFDs for visual fitness to drive. We are not yet at a point where we can predict which HFD patient is likely to be a safe driver. Therefore, it seems only fair to provide an opportunity for individualised assessments of practical fitness to drive either on the road and/or in a driving simulator.
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Affiliation(s)
- Alex R Bowers
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
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50
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Bédard M, Campbell S, Riendeau J, Maxwell H, Weaver B. Visual-cognitive tools used to determine fitness-to-drive may reflect normal aging. Clin Exp Optom 2016; 99:456-61. [PMID: 27489121 DOI: 10.1111/cxo.12433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 03/10/2016] [Accepted: 04/29/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Scores on many visual-cognitive tools are proposed as indicators of fitness-to-drive. A purported feature of some tools and one believed to be important is that they are 'age-independent'. Specifically, scores are not correlated with age and poor scores represent a pathological process rather than normal aging. Yet, we know that several cognitive abilities are associated with age. One potential reason for the apparent age-independence of some tools is that focusing on older drivers leads to 'range restriction', a statistical issue that reduces the magnitude of correlations when values for one variable are restricted to a smaller range than naturally occurs. Hence, the purpose of this study was to investigate whether age is correlated with scores on visual-cognitive tests when we examine the full age range. METHODS We recruited 114 drivers aged 18 to 89 years (mean: 42.30 ± 26.50 years). Participants completed several visual-cognitive tools often used to examine fitness-to-drive (Trail Making Tests A and B, Attention Network Test and 'useful field of view'). RESULTS Correlations between age and test scores for drivers 65 years and older only ranged from 0.03 to 0.48. With the whole age range, correlations ranged from 0.56 to 0.84. We also compared ordinary Pearson correlations among visual-cognitive tests scores to the corresponding partial correlations after removing the effect of age. Whereas ordinary Pearson correlations ranged from 0.40 to 0.69, partial correlations ranged from 0.01 to 0.30. CONCLUSION Test scores may reflect age-associated normal biological changes. These results have implications for predicting fitness-to-drive among older drivers and suggest caution in using these scores.
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Affiliation(s)
- Michel Bédard
- Center for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada.,Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.,Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, Ontario, Canada
| | - Stephanie Campbell
- Center for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
| | - Julie Riendeau
- Center for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
| | - Hillary Maxwell
- Center for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
| | - Bruce Weaver
- Center for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada.,Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
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