Special issue : driving and community mobility (II) - interventions to enable driving

The first part of our Special Issue on ‘Driving and community mobility’ (British Journal of Occupational Therapy 78 (2)) focused on the assessment of drivers with health or age-related declines, and revealed over 25 years of research evidence that occupational therapists can use to help determine an individual’s fitness-to-drive. The focus of this second part of our Special Issue is on occupational therapy interventions that support access to the community. What happens when an individual’s driving skills are impaired due to either congenital or acquired disabilities or the health declines associated with normal ageing

Special issue : driving and community mobility (I) - clinical assessment of fitness to drive

As guest editors for this Special Issue on driving and community mobility we were delighted by the extremely good response to the call and thank the many peer reviewers who worked tirelessly to identify strong research for publication. We had sufficient high quality international studies to fill two issues, of which this is the first. The second will be published later this year, although the papers will appear online as a ‘virtual issue’ before that. Special Issue part one focuses on approaches to assessment related to the occupation of driving and community mobility, while part two presents approaches to intervention. We start this issue with the gold standard approach to identifying research evidence: A systematic review. The review presents methods and assessments used to assess fitness to drive after a mild traumatic head injury (Baker and Unsworth, 2015) and identifies the means and time-scales that can be used when making complex clinical judgements concerning resumption of driving

Clinical assessment of fitness-to-drive : positioning occupational therapy for workforce development

Driving, as an instrumental activity of daily living, is a valued form of community mobility; it not only offers independence and freedom but also facilitates occupational engagement and social inclusion. In the recent Department of Health guidance for commissioners (Department of Health 2012), driving assessment is rightly placed within the remit of occupational therapists

Using Social Judgment Theory Method to examine how experienced occupational therapy driver assessors use information to make fitness-to-drive recommendations

Introduction: As people with a range of disabilities strive to increase their community mobility, occupational therapy driver assessors are increasingly required to make complex recommendations regarding fitness-to-drive. However, very little is knownabout how therapists use information to make decisions. The aim of this study was to model how experienced occupational therapy driver assessors weight and combine information when making fitness-to-drive recommendations and establish their level of decision agreement. Method: Using Social Judgment Theory method, this study examined how 45 experienced occupational therapy driver assessors from the UK, Australia and New Zealand made fitness-to-drive recommendations for a series of 64 case scenarios. Participants completed the task on a dedicated website, and data were analysed using discriminant function analysis and an intraclass correlation coefficient. Results: Accounting for 87% of the variance, the cues central to the fitness-to-drive recommendations made by assessors are the client’s physical skills, cognitive and perceptual skills, road law craft skills, vehicle handling skills and the number of driving instructor interventions. Agreement (consensus) between fitness-to-drive recommendations was very high: intraclass correlation coefficient¼.97, 95% confidence interval .96–.98).Conclusion: Findings can be used by both experienced and novice driver assessors to reflect on and strengthen the fitness-to-drive recommendations made to clients

A randomised controlled trial to test the effectiveness of decision training on assessors' ability to determine optimal fitness-to-drive recommendations for older or disabled drivers

Background: Driving licensing jurisdictions require detailed assessments of fitness-to-drive from occupational therapy driver assessors (OTDAs). We developed decision training based on the recommendations of expert OTDAs, to enhance novices' capacity to make optimal fitness-to-drive decisions. The aim of this research was to determine effectiveness of training on novice occupational therapists' ability to make fitness-to-drive decisions. Methods: A double blind, parallel, randomised controlled trial was conducted to test the effectiveness of decision training on novices' fitness-to-drive recommendations. Both groups made recommendations on a series of 64 case scenarios with the intervention group receiving training after reviewing two thirds of the cases; the control group, at this same point, just received a message of encouragement to continue. Participants were occupational therapy students on UK and Australian pre-registration programmes who individually took part online, following the website instructions. The main outcome of training was the reduction in mean difference between novice and expert recommendations on the cases. Results: Two hundred eighty-nine novices were randomised into intervention; 166 completed the trial (70 in intervention; 96 in control). No statistical differences in scores were found pre-training. Post training, the control group showed no significant change in recommendations compared to the experts (t(96) = -.69; p =.5), whereas the intervention group exhibited a significant change (t(69) = 6.89; p < 0.001). For the intervention group, the mean difference compared with the experts' recommendations reduced with 95% CI from -.13 to.09. Effect size calculated at the post-training demonstrated a moderate effect (d =.69, r =.32). Conclusions: Novices who received the decision training were able to change their recommendations whereas those who did not receive training did not. Those receiving training became more able to identify drivers who were not fit-to-drive, as measured against experts' decisions on the same cases. This research demonstrated that novice occupational therapists can be trained to make decisions more aligned to those of expert OTDAs. The decision training and cases have been launched as a free training resource at www.fitnesstodrive.com. This can be used by novice driver assessors to increase their skill to identify drivers who are, and are not fit-to-drive, potentially increasing international workforce capacity in this growing field of practice. © 2018 The Author(s)

A systematic review of evidence for fitness-to-drive among people with the mental health conditions of schizophrenia, stress/anxiety disorder, depression, personality disorder and obsessive compulsive disorder

© 2017 The Author(s). Background: Limited evidence exists regarding fitness-to-drive for people with the mental health conditions of schizophrenia, stress/anxiety disorder, depression, personality disorder and obsessive compulsive disorder (herein simply referred to as 'mental health conditions'). The aim of this paper was to systematically search and classify all published studies regarding driving for this population, and then critically appraise papers addressing assessment of fitness-to-drive where the focus was not on the impact of medication on driving. Methods: A systematic search of three databases (CINAHL, PSYCHINFO, EMBASE) was completed from inception to May 2016 to identify all articles on driving and mental health conditions. Papers meeting the eligibility criteria of including data relating to assessment of fitness-to-drive were critically appraised using the American Academy of Neurology and Centre for Evidence-Based Medicine protocols. Results: A total of 58 articles met the inclusion criteria of driving among people with mental health conditions studied, and of these, 16 contained data and an explicit focus on assessment of fitness-to-drive. Assessment of fitness-to-drive was reported in three ways: 1) factors impacting on the ability to drive safely among people with mental health conditions, 2) capability and perception of health professionals assessing fitness-to-drive of people with mental health conditions, and 3) crash rates. The level of evidence of the published studies was low due to the absence of controls, and the inability to pool data from different diagnostic groups. Evidence supporting fitness-to-drive is conflicting. Conclusions: There is a relatively small literature in the area of driving with mental health conditions, and the overall quality of studies examining fitness-to-drive is low. Large-scale longitudinal studies with age-matched controls are urgently needed in order to determine the effects of different conditions on fitness-to-drive

Predicting fitness-to-drive following stroke using the Occupational Therapy – Driver Off Road Assessment Battery

Introduction: It is difficult to determine if, or when, individuals with stroke are ready to undergo on-road fitness-to-drive assessment. The Occupational Therapy – Driver Off Road Assessment Battery was developed to determine client suitability to resume driving. The predictive validity of the Battery needs to be verified for people with stroke. Aim: Examine the predictive validity of the Occupational Therapy – Driver Off Road Assessment Battery for on-road performance among people with stroke. Method: Off-road data were collected from 148 people post stroke on the Battery and the outcome of their on-road assessment was recorded as: fit-to-drive or not fit-to-drive. Results: The majority of participants (76%) were able to resume driving. A classification and regression tree (CART) analysis using four subtests (three cognitive and one physical) from the Battery demonstrated an area under the curve (AUC) of 0.8311. Using a threshold of 0.5, the model correctly predicted 98/112 fit-to-drive (87.5%) and 26/36 people not fit-to-drive (72.2%). Conclusion: The three cognitive subtests from the Occupational Therapy – Driver Off Road Assessment Battery and potentially one of the physical tests have good predictive validity for client fitness-to-drive. These tests can be used to screen client suitability for proceeding to an on-road test following stroke.Implications for Rehabilitation:Following stroke, drivers should be counseled (including consideration of local legislation) concerning return to driving.The Occupational Therapy – Driver Off Road Assessment Battery can be used in the clinic to screen people for suitability to undertake on road assessment.Scores on four of the Occupational Therapy – Driver Off Road Assessment Battery subtests are predictive of resumption of driving following stroke. © 2018 Informa UK Limited, trading as Taylor & Francis Grou

Development of the International Expert Advisory Panel on Community Health and Transport (I-CHaT) to coordinate research on transport mobility

Editorial: British Journal of Occupational Therapy 2018, Vol. 81(5) 245–246 During the past 10 years, there has been a major shift in our understanding of the nexus between transportation and health. Health concerns evolved from road safety alone to encompass a broader view of the important relationships between transportation mobility and engagement in out-of-home activities. Occupational therapists have a leading role in this area, reflecting the American Occupational Therapy Association (2014) Occupational Therapy Practice Framework that includes driving and community mobility as an important Instrumental Activity of Daily Living

Linking people and activities through community mobility: An international comparison of the mobility patterns of older drivers and non-drivers

Community mobility using private and public transportation is important for maintaining health, social participation and living well in later life. This international cross-sectional cohort study (N = 246) reported on the health and driving status of older adults from seven countries where the mobility patterns of drivers and non-drivers were compared in terms of city and rural areas, weather, as well as their respective differences in the number of out-of-home places accessed and quality of life. Older adults participated in a semi-structured interview and completed four standardised instruments: the EQ-5D-5L, modified PULSES health profile, modified Transportation Questionnaire, and the Transport - Participation in Activities and Places Outside the Home. Results suggested inclement weather and place of residence negatively impacted out-of-home activities but did not increase use of public transportation. Drivers accessed more out-of-home activities than non-drivers, suggesting higher community participation among this group, and quality of life was generally high among all participants, but slightly higher for drivers. Findings indicate that a complex myriad of factors can influence community mobility in older adults and further investigations are needed to understand patterns of transport in later life, particularly with regard to those factors that promote and maintain transport mobility, and relationships between transport mobility, community participation and quality of life.</p