Practices Used by Occupational Therapists and Others in Driving Assessment Centers for Determining Fitness-to-Drive: A Case-Based Approach

Abstract

Aims: The purpose of this study was to examine practices used in driver assessment centers for determining fitness-to-drive (FTD) an automobile using a casebased approach. Methods: Each assessor (N = 46; 89% of whom were occupational therapists) identified if and how they would assess each of the following cases: (1) a 35year-old man with paraplegia; (2) a 53-year-old woman post stroke; (3) an 82-year-old man involved in a collision; and (4) a 33-year-old woman with schizophrenia. Results: Over 90% would assess cases 2 and 3, but only 72% and 62% would assess cases 4 and 1, respectively. The average number of off-road tests they would use ranged from 1 to 24 and was highest for case 2 (14 ± 4.6) and lowest for case 1 (10.6 ± 3.4). Over 75% of respondents indicated they would do an on-road test in all four cases. Conclusions: This case-based approach provided further insight into how FTD assessments and ensuing recommendations are tailored for different clientele.

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

“…The emphasis was therefore on the person’s meta-cognitive functions related to self-regulation, risk taking behaviour and on-road driving ability, rather than on the effects of medication or the medical condition itself. Similar results were reported by Vrkljan, Myers, Blanchard, Crizzle, and Marshall [ 46 ], with occupational therapists in the study also in favour of the use of an on-road assessment to inform decision making in clients with a mental health conditions. The on-road assessment was used and seen by most participants as the most valid means of making fitness-to-drive recommendations, over-riding clinic-based test results (including simulation), in cases where the clinic-based test had indicated negative results.…”

“…Both professionals also considered medication side effects, psychiatric symptoms, cognition and judgement when assessing fitness-to-drive • Occupational therapists administered pen and paper test when assessing driving ability with people with mental health issues; however, the finding was not significant in predicting road performance due to small numbers. CEBM: Level 5 AAN: Class IV Vrkljan (2015) [ 46 ]; Canada; Y To identify assessment tools and procedures used by assessors to determine fitness-to-drive, outcomes and recommendations using four case scenarios inclusive of one scenario of a 33 year old woman with schizophrenia (case#4) N = 46 assessors in Canada Quantitative: National Questionnaire • 33 assessors (71.7%) would assess driving ability for a client with schizophrenia. • Cognition was identified as a primary issue by 71% of the respondents for a client with schizophrenia.…”

“…The 16 studies were re-classified based on the data each study provided about assessing fitness-to-drive as follows: 1) factors impacting on the ability to drive safely among people with mental health conditions ( n = 7) [ 8 , 36 – 41 ] capability and perception of health professionals assessing fitness-to-drive of people with mental health conditions ( n = 5) [ 42 – 46 ] and 3) crash rates ( n = 4) [ 47 – 50 ].…”

“…While psychiatrists may focus on the impact of medication on fitness-to-drive, occupational therapists are able to take clients for on-road driving tests and have been noted to emphasise the driver’s physical status, cognitive skills, impulsivity levels and driving history [ 44 , 46 ] to assist determine fitness-to-drive. Focussing on impulsivity levels may be regarded as important, since impulsivity can be related to risk taking behaviours and difficulty self-regulating; characteristics present in the profile of those drivers most likely to crash [ 38 , 48 , 49 ].…”

Development of the Saskatchewan Psychiatric Occupational Therapy Driving Screen

“…Because medications can have a profound impact on a person's functioning, it was important to incorporate this factor into the framework (Dun et al, 2015a;Me´nard et al, 2006;Me´nard and Korner-Bitensky, 2008;Me´nard et al, 2012;Unsworth, 2010;Vrkljan et al, 2015). Pharmacy support was enlisted to develop a medication reference guide.…”