Date Presented 04/21/21
This study examined the relationship of clinical and road portions of Vanderbilt University Medical Center's driver evaluation. Data were collected retrospectively on adults with mild cognitive impairment or dementia. Findings revealed a significant relationship between the driving recommendation and the road assessment scores but not the clinical scores. Results indicated a need for OT practitioners to explore clinical assessment methods to more accurately predict road performance for determining fitness-to-drive recommendations.
Primary Author and Speaker: Susan L. Iliff
Contributing Authors: Patricia Bowyer
PURPOSE: In the United States, approximately 5.7 million people are diagnosed with dementia (American Speech, n.d). The symptoms caused by these conditions directly impact the ability of older adults to effectively participate in the occupation of driving. Occupational therapists (OTs) have extensive knowledge and skills related to driving as an instrumental activity of daily living (‘The Occupational Therapy Role in Driving,' n.d.) OTs specializing in the field of driver rehabilitation make life-altering recommendations about driving to patients and their families. These recommendations are based on performance on both clinical assessments and on-road assessments. Although a moderate degree of research has focused on standardized clinical batteries to predict driver safety (Fields & Unsworth, 2017), on-road assessment generally continues to be ‘the gold standard' (Lane et al., 2014). However, on-road assessments are less structured and vary from program to program in route features and requirements. It is advised that on-road assessments of driver rehab programs be standardized in order for occupational therapists to ensure the highest degree of accuracy when making this all-too-important recommendation for fitness-to-drive (Classen et al., 2017). The purpose of this study was to examine associative factors between clinical and road portions of Vanderbilt University Medical Center (VUMC)'s comprehensive driver evaluation. The study also aimed to determine the relationship of components of the driving assessment with final driving recommendations. Research questions: 1) Are scores on the clinical assessment associated with performance on the road assessment? 2) Are different components of the driver assessment more associated with final driving recommendation than others?
DESIGN: The study uses a descriptive, correlational, and comparative-cross sectional research design. Study participants (n = 10) were individuals older than 60 years of age with a diagnosis of MCI or dementia. They were patients who had been referred to Vanderbilt Driver Rehab Program for a medically-based driver assessment. Participants had valid driver licenses. Participants with significant comorbidities were excluded.
METHODS: Data were obtained retrospectively using medical records of older adults with a diagnosis of MCI or dementia. Statistical tests included the Kruskal Wallis test, Chi-squared analysis, and Spearman correlation. Analyses using these tests were calculated to establish associations between variables on the clinical assessment, the road assessment, and the final driving recommendation.
RESULTS: Findings revealed no clear significant relationships between the clinical assessment and the final driving recommendation. The total number of clinical deficits was inversely correlated with final recommendation (rs = -0.69, p = .109). The Maze Test time was inversely correlated with final recommendation of driving (rs = -0.78, p = .008). For the road test, the number of physical interventions and critical errors positively associated with the final driving recommendations (rs = 0.81, p = .005; rs = 0.74, p = .014, respectively).
CONCLUSION: Road assessment measures were more closely associated with final driving recommendations than clinical assessment measures. Revision of VUMC's clinical assessment protocol is recommended. Consideration of other assessment tools with higher predictive validity for road performance would more accurately determine strengths and weaknesses of the individual's driving skills prior to the road assessment. More broadly, OT practitioners need to advocate for inclusion of the road assessment portion before making the final life-changing recommendation.
References
Classen, S., Krasniuk, S., Alvarez, Monahan, M., Morrow, S. A., & Danter, T. (2017). Development and validity of Western University’s on-road assessment. Occupational Therapy Journal of Research: Occupation, Participation and Health, 37(1), 14-29. https://doi.org/10.1177/1539449216672859
Fields, S. M. and Unsworth, C. A. (2017). 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. Australian Occupational Therapy Journal, (64), 328-33
Lane A., Green, E., Dickerson, A. E., Schold, D. E., Rolland, B., Stohler, J. T. (2014). Driver rehabilitation programs: Defining program models, services and expertise. Occupational Therapy in Health Care, (28), 177–187. https://doi.org/10.3109/07380577.2014.903582
The occupational therapy role in driving and community mobility across the lifespan. (n.d.). Retrieved from www.aota.org/About-Occupational-Therapy/Professionals/PA/Facts/Driving-Community-Mobility.aspx
