Assessing fitness to drive after stroke: A survey investigating current practice among occupational therapists in Ireland

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

Attitudes to Interprofessional Education Among Health Science Students Engaging in a Multidisciplinary Workshop Series

Introduction: Interprofessional education (IPE) provides an opportunity for students from single-professions to interact with other disciplines. Student attitude to IPE can impact engagement and change in attitude may provide an indicator of the impact of IPE. This study examines pre-workshop attitudes to IPE and change in attitude following a series of three IPE workshops. Methods: Preworkshop attitudes were examined using the Readiness for Interprofessional Learning Scale (RIPLS) and the Interprofessional Education Perception Scale (IEPS). The IEPS was repeated at the start of Workshop 1 and at the end of Workshop 3. Data were analyzed using linear regression analysis and linear mixed methods for repeated measures. Results: 405 students participated (pre-workshop n=122; workshop 1 n=244; workshop 3 n=236). Pre-workshop attitudinal scores were high. While male gender and studying medicine negatively predicted attitude across some domains, previous experience of a joint patient treatment session on clinical placement positively predicted attitude in the domain of Perception of Actual Cooperation (standardised Beta 0.283, p=0.005). Attitude to IPE improved across all domains of the IEPS from online preparation to the end of workshop 3 (pCompetency and Autonomy, and in the domain of Perceived Need for Cooperation improved only following online preparation, while the domain of Perception of Actual Cooperation improved following both online preparation and participation in the workshops. Discussion: The results presented reflect positively on student readiness for IPE. Attitudes were further improved following engagement in a structured series of IPE workshops

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

An exploration of the process of assessing fitness to drive after stroke within an Irish context of practice

THESIS 9832Determining fitness to drive after stroke within the Irish context of practice is a process lacking in agreed protocols or guidelines. Despite international research and recommended gold standard practice, actual practice on the ground remains individualised with many therapists unsure and lacking confidence in addressing this issue with their stroke patients. This is also an area of practice that has not been researched prospectively in the Irish context, and there are no Irish based research studies to guide its development. Currently, in Ireland, occupational therapy involvement is limited to the clinical based off-road assessment, and the on-road assessment is conducted by an on-road assessor either working in a private capacity or within one voluntary organisation

Recommendations on developing an on-road fitness-to-drive route and test that incorporates an assessment for higher cognitive functioning

Purpose – The purpose of this study was to provide an outline of the process of developing an on-road driving test route and rating form. Comprehensive evaluation of medical fitness to drive should comprise of an off-road and an on-road assessment. Much research attention has focussed on the off-road phase of assessment, while there is less standardisation evident in the completion and measurement of the on-road phase of fitness-to-drive assessment. Design/methodology/approach – A scholarship of practice approach was used to inform the development of an on-road test route and an associated generic on-road assessment tool that was guided by research evidence and best practice recommendations. Findings – A step-by-step guide, outlining seven recommended phases in the development of an on-road route for the assessment of fitness to drive that aligns with best practice recommendations, was developed. A preliminary generic on-road assessment tool (the Maynooth–Trinity Driving Test) that includes higher-order cognition alongside element of strategic, tactical and operational driving ability was developed and piloted alongside the newly developed on-road test route. Originality/value – This paper offers an overview of an approach to developing evidence-based on-road test routes and an associated generic assessment tool that may assist occupational therapists and on-road driving assessors establish a standard practice for testing on-road behaviour as part of a comprehensive approach to evaluate fitness to drive

A systematic review of effective interventions and strategies to support the transition of older adults from driving to driving retirement/cessation

Background and Objectives: In most western countries, older adults depend on private cars for transportation and do not proactively plan for driving cessation. The objective of this review was to examine current research studies outlining effective interventions and strategies to assist older adults during their transition from driver to driving retirement or cessation. Research Design and Methods: A search was completed across 9 databases using key words and MeSH terms for drivers, cessation of driving, and older adult drivers. Eligibility screening of 9,807 titles and abstracts, followed by a detailed screening of 206 papers, was completed using the Covidence platform. Twelve papers were selected for full-text screen and data extraction, comprising 3 papers with evidence-based intervention programs and 9 papers with evidence-informed strategies. Results: Three papers met the research criteria of a controlled study for programs that support and facilitate driving cessation for older adults. Nine additional studies were exploratory or descriptive, which outlined strategies that could support older drivers, their families, and/or healthcare professionals during this transition. Driving retirement programs/toolkits are also presented. Discussion and Implications: The driver retirement programs had promising results, but there were methodological weaknesses within the studies. Strategies extracted contributed to 6 themes: Reluctance and avoidance of the topic, multiple stakeholder involvement is important, taking proactive approach is critical, refocus the process away from assessment to proactive planning, collaborative approach to enable “ownership” of the decision is needed, and engage in planning alternative transportation should be the end result. Meeting the transportation needs of older adults will be essential to support aging in place, out-of-home mobility, and participation, particularly in developed countries where there is such a high dependency on private motor vehicles. © The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America