Age-related medical conditions such as Parkinson's disease (PD) compromise driver fitness. Results from studies are unclear on the specific driving errors that underlie passing or failing an on-road assessment. In this study, we determined the between-group differences and quantified the on-road driving errors that predicted pass or fail on-road outcomes in 101 drivers with PD (mean age = 69.38 ± 7.43) and 138 healthy control (HC) drivers (mean age = 71.76 ± 5.08). Participants with PD had minor differences in demographics and driving habits and history but made more and different driving errors than HC participants. Drivers with PD failed the on-road test to a greater extent than HC drivers (41% vs. 9%), χ²(1) = 35.54, HC N = 138, PD N = 99, p < .001. The driving errors predicting on-road pass or fail outcomes (95% confidence interval, Nagelkerke R² =.771) were made in visual scanning, signaling, vehicle positioning, speeding (mainly underspeeding, t(61) = 7.004, p < .001, and total errors. Although it is difficult to predict on-road outcomes, this study provides a foundation for doing so.

Driving errors that predict on-road outcomes for persons with multiple sclerosis (PwMS) are not well studied. The objective of this study was to determine whether adjustment-to-stimuli and gap acceptance errors significantly predict passing/failing a standardized on-road assessment of PwMS. Thirty-seven participants completed visual ability and visual attention assessments, and participated in an on-road assessment, where seven types of driving errors and pass/fail outcomes were determined. Adjustment-to-stimuli (No.) and gap acceptance errors (commit/did not commit) significantly predicted passing/failing the on-road assessment, with an area under the curve of 91.6% ( p < .0001). With no gap acceptance errors committed, five adjustment-to-stimuli errors optimally determined pass/fail outcomes in PwMS. Furthermore, with no adjustment to stimuli errors committed, committing any gap acceptance errors also optimally determined pass/fail outcomes in PwMS. Further research may focus on visual, cognitive, and/or motor impairments underlying adjustment-to-stimuli and gap acceptance errors for eventual development of rehabilitation strategies for PwMS.

In persons with MS and impaired processing speed, impairment on the BVMTR-IR should lead clinicians to address fitness-to-drive.

The purpose of this translational research article is to illustrate how general practice occupational therapists have the skills and knowledge to address driving as a valued occupation using an algorithm based on the Occupational Therapy Practice Framework: Domain and Process (2nd ed.; American Occupational Therapy Association, 2008b). Evidence to support the model is offered by a research study. Participants were compared on their performance of complex instrumental activities of daily living (IADLs) and a behind-thewheel driving assessment. A significant relationship was found between the process skills from the performance assessment and whether the driver passed, failed, or needed restrictions as indicated by the behind-the-wheel assessment. The evidence suggests that occupational therapists using observational performance evaluation of IADLs can assist in determining who might be an at-risk driver. The algorithm addresses how driver rehabilitation specialists can be used most effectively and efficiently with general practice occupational therapy practitioners meeting the needs of senior drivers.

The impact of visual and visual-cognitive impairments on fitness to drive in persons with multiple sclerosis (PwMS) are not well studied. We quantified visual correlates of fitness to drive in 30 PwMS. PwMS completed visual ability and visual attention assessments, and a standardized on-road assessment, and were compared with 145 older volunteer drivers. PwMS (vs. older volunteer drivers) made more total ( W = 12,139, p = .03) and critical driving errors (predictive of crashes) in adjustment to stimuli ( W = 11,352, p < .0001), vehicle positioning ( W = 11,449, p < .0001), and wide lane turns ( W = 9,932, p < .0001). PwMS who failed (vs. passed) made more total ( W = 325, p = .04), adjustment to stimuli ( W = 321.5, p = .02), and gap acceptance errors ( W = 333, p = .03). For PwMS, adjustment to stimuli errors moderately correlated with visual acuity (ρ = .50, p = .006), and gap acceptance errors moderately correlated with visual processing speed (ρ = .40, p = .03). Visual-cognitive impairments may be indicative of critical driving errors and help identify PwMS at-risk for fitness to drive.

Although used across North America, many on-road studies do not explicitly document the content and metrics of on-road courses and accompanying assessments. This article discusses the development of the University of Western Ontario's on-road course, and elucidates the validity of its accompanying on-road assessment. We identified main components for developing an on-road course and used measurement theory to establish face, content, and initial construct validity. Five adult volunteer drivers and 30 drivers with multiple sclerosis participated in the study. The road course had face and content validity, representing 100% of roadway components determined through a content validity matrix and index. The known-groups method showed that debilitated drivers (vs. not debilitated), made more driving errors ( W = 463.50, p = .03), and failed the on-road course, indicating preliminary construct validity of the on-road assessment. This research guides and empirically supports a process for developing a road course and its assessment.

Polytrauma, including mild traumatic brain injury, posttraumatic stress disorder, and orthopedic conditions, is common among combat veterans (CVs) from Operations Enduring Freedom and Iraqi Freedom. Medical conditions, coupled with deployment-related training, may affect CVs' fitness to drive and contribute to post-deployment crash and injury risks. However, empirical interventions are lacking. Therefore, the study purpose was to examine the efficacy of an occupational therapy driving intervention (OT-DI) with pre and post testing of CVs. Using a DriveSafety 250 simulator, Occupational Therapy-Driver Rehabilitation Specialists recorded driving errors. Eight CVs (mean age = 39.83, SD = 7.80) received three OT-DI sessions, which incorporated strategies to address driving errors and visual search retraining. We determined baseline driving errors (mean = 31.63, SD = 8.96) were double the number of posttest errors (mean = 15.38, SD = 9.71). At posttesting, a significant (p < 0.05) decrease was noted for total errors and lane maintenance. Despite study constraints, preliminary data support the efficacy of the OT-DI.

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