Abstract
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.
Highlights
Stroke is the third leading cause of death in Ireland and the leading cause of acquired disability and impairment, with over 7,000 people hospitalised post stroke each year (Irish Heart Foundation, 2015)
Off-road driving assessment Almost all of the respondents (n = 46, 98 per cent) reported that they consistently ask about driving during their initial interview with stroke patients
Not asked in the survey, the findings suggest that a proportion of therapists appear to refer clients post stroke for on-road assessment without first completing an occupational therapy off-road assessment
Summary
Stroke is the third leading cause of death in Ireland and the leading cause of acquired disability and impairment, with over 7,000 people hospitalised post stroke each year (Irish Heart Foundation, 2015). Aside from the obvious physical and sensory deficits which can occur post stroke, it is often the higher level thinking skills such as awareness and insight, executive functions, judgment, problem solving and reasoning that can result in concern regarding returning to driving or driving cessation (Stapleton et al, 2015; O’Dwyer and O’ Neill, 2007). An Irish patient and carer survey found that 29 per cent of their sample of 139 people ceased driving after stroke (Irish Heart Foundation, 2008). Some US-based studies with slightly larger samples of stroke survivors reported a much higher rate of cessation of driving after stroke; results suggesting 70 per cent of their sample ceased driving (Aufman et al, 2013; Fisk et al, 1997)
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