Occupational Therapy Driver Assessors Research Articles

Education leads to increased adherence to the ‘Australian Competency Standards for Occupational Therapy Driver Assessors’

Background Occupational therapy competency standards provide an evidence-base to inform clinical best practice, however it is not known whether education about competency standards will increase occupational therapists’ adherence to their use. Aims/objectives To investigate if education about the ‘Australian Competency Standards for Occupational Therapy Driver Assessors’ leads to increased adherence to the competency standards in the clinical practice of occupational therapy driver assessors. Materials and methods A mixed methods multiple case study design was used to evaluate 5 occupational therapy driver assessors’ adherence to the competency standards. An audit of 25 client files and interviews were conducted to evaluate practice against the competency standards prior to an education session, followed by an audit of a further 25 files, interview and feedback after education. Results Qualitative and quantitative analyses suggest that education about the ‘Australian Competency Standards for Occupational Therapy Driver Assessors’ was associated with increased adherence to the competency standards in clinical practice. The results also support the use of competency standards in clinical practice. Conclusions and significance Competency standards can be used to inform and guide clinical practice, and individualised education and feedback of practice against the competency standards can increase occupational therapists’ adherence to these standards.

Survey of Occupational Therapy Driver Assessors' Rehabilitation Interventions With Older Drivers.

The rehabilitation strategies used by occupational therapy driver assessors with older drivers with age-related decline or health conditions are not well understood. The objective of the study was to describe driver rehabilitation interventions used by Australian driver assessors, identify factors that guide rehabilitation choices, and identify barriers and facilitators encountered. An online survey was emailed to 300 driver assessors. Descriptive statistics were used to summarize and to rank order participant responses. A total of 148 respondents selected from a combined total of 655 interventions. The four most common rehabilitation methods were (a) graded driving (18%, n = 118), (b) practicing specific maneuvers (17.7%, n = 116), (c) using a modified vehicle (16.9%, n = 111), and (d) graded driving in local areas only (15.1%, n = 99). The most common barrier limiting driver rehabilitation was cost (M = 2.92, SD = 1.24). The most frequently used driver rehabilitation method was on-road training. Practice can be enhanced by collating and evaluating resources, and ensuring effective interventions are more accessible.

Fitness to drive practices among non-driver trained occupational therapists in an Australian community-based rehabilitation setting.

Driving is a valued occupation given the independence and freedom it provides. Safe driving performance can be impacted by medical conditions, change in functional status and ageing processes. Occupational therapy driver assessors (OTDAs) provide invaluable driving recommendations; however, this requires specialist training for the therapist and is costly for clients. The number of OTDAs is not expected to meet the growing demand for expert services in this area, and little is known about the practices that non- OTDAs use to assist clients with returning to driving. The aims of this study were to investigate the practices of non-OTDAs in a community-based rehabilitation setting in Australia with respect to knowledge, confidence and skills in assessments, recommendations and outcomes for clients as part of the return to driving process. A descriptive study including medical record audits between April and September 2019 and staff surveys were completed at a large metropolitan community-based rehabilitation facility. Descriptive statistics and thematic analysis were used to summarise data. A total of 102 client medical records were audited, and 13 clinician surveys were completed. Medical record audits identified that return to driving was not consistently addressed by occupational therapists. Clinician surveys outlined a lack of knowledge and confidence of return to driving processes and available assessment tools to guide this process. All occupational therapists have an ethical obligation to address driving as an activity of daily living; however, non-OTDAs report that they are not equipped for this role. This may negatively impact on driver safety, independence and overall health and well-being of clients in community-based rehabilitation. Further research is indicated to develop evidence-based driving resources to support best practice of non-OTDAs.

The revision of competency standards for occupational therapy driver assessors in Australia: A mixed methods approach.

Competency standards outline the knowledge, skills, and attributes that are required for competent practice. This study describes the process followed to revise and validate the competency standards for occupational therapy driver assessors in order to guide clinical practice in this area of advanced occupational therapy practice. A mixed methods research approach was used in this study. In phase 1, three focus groups with driver assessors reviewed and suggested revisions to the competency standards for occupational therapy driver assessors. Phase 2 involved content validation with key stakeholders through a focus group with consumers, written feedback from Australian state, and territory driver licensing authorities, and a two-round Delphi process with Australian occupational therapy driver assessors. Forty-nine occupational therapy driver assessors participated in the phase 1 focus groups. Deductive content analysis of the transcripts provided data to revise the competency standards. Inductive analysis provided an in-depth understanding of the participants' views and was interpreted through six categories and their underlying subcategories: purposes and benefits; jurisdictional variations and practice diversity; language use; defining competent practice; challenging systems and processes; and competency standards content. Forty-eight occupational therapy driver assessors participated in the Delphi process. In Round 1, only 1 of the 164 competency standards and practice behaviours rated did not achieve the pre-determined 70% consensus rate. In Round 2, all statements achieved consensus, with the overall average consensus level obtained across the Round 2 statements at 96.8%. The revised Australian Competency Standards for Occupational Therapy Driver Assessors have been endorsed by Occupational Therapy Australia and released for clinical use. The methods described in this research provide a framework suitable for revision or development of competency standards in both other areas of occupational therapy practice and other health-care professions.

Occupational therapy driver assessments with mental health consumers: A mixed‐methods study

Driving is an important occupation, which enables other recovery goals for adult mental health consumers. Multidisciplinary clinicians can support consumers to engage in safe driving practices, which may include referral to a specialist occupational therapy driver assessor. There is presently limited evidence to inform us about the role of occupational therapy driver assessors in mental health and the impact of such services for consumers. Therefore, this study aimed to describe the reasons for referral and the recommendations resulting from driver assessments with adult consumers in a mental health setting and understand the experiences of driver assessors providing these services. A mixed-methods sequential design was employed in this study. Thirty driver assessments (n=27 consumers) were analysed to identify consumer demographics, assessment recommendations, impact on licence status and rehabilitation outcomes. Focus groups were then conducted with five occupational therapy driver assessors. Quantitative data were analysed descriptively using frequencies and means, while qualitative data were subjected to content analysis. The majority of consumers were diagnosed with psychotic disorders and presented with complex needs. The three primary reasons for referral were (a) cognitive or mental health concerns, (b) consumers directed by licencing authority to undertake driver assessment and (c) consumers wanting to resume driving after not driving for a significant time. Overall, 21 consumers (70%) were recommended to hold a driver licence after completion of an occupational therapy driver assessment. Qualitative themes about the experience of occupational therapy driver assessors included the reality of driver assessments; that outcomes are usually positive, and further support is needed for driver assessments. Driver assessments enable most consumers to return to driving. Occupational therapy driver assessors require greater support to perform this role, including dedicated time and peer support, to facilitate multidisciplinary clinicians and consumers to collaboratively achieve driving outcomes.

Vehicle Modification Prescription: Australian Occupational Therapy Consensus-Based Guidelines.

Vehicle modifications are often essential to ensure that drivers with disabilities can drive independently and safely. Occupational therapy driver assessors and driver rehabilitation specialists routinely prescribe vehicle modifications on the basis of individualized evaluations and support by rehabilitation interventions. After a literature review and consultation with stakeholders, we identified a resource gap in information to support an evidence-based process for vehicle modification prescription. Using an action research approach, we established content validity for draft guideline items and developed consensus-based draft guidelines for vehicle modification prescription that are ready for trialing by occupational therapy driver assessors. We also propose a practice model for vehicle modification prescription that is applicable to international contexts.

Trial of improved procedures for driver licence testing by occupational therapists

A draft manual for the Occupational Therapy Driving Test had previously been developed via a consultation process, setting out detailed specifications intended to improve the validity and reliability of the test and its consistency with other VicRoads licence tests. A trial was conducted to assess the feasibility, acceptability and effectiveness of the documented procedures and requirements. The trial involved (a) upgrading existing test routes to comply with the updated requirements, and (b) conducting licence tests using the updated procedures. Detailed written feedback was obtained from the occupational therapy driver assessors (OTs) who upgraded test routes and from the OTs who conducted the licence tests. Analysis of 156 feedback forms from 19 OTs revealed that the updated requirements resulted in a test that exceeded the preferred timeframe (35 minutes). The number of compulsory tasks required for all clients precluded sufficient time to conduct additional, clientspecific tasks with those clients who needed them. This led the project team to reduce the number of compulsory tasks, relax some constraints regarding task locations, and reclassify two previously compulsory tasks as client-specific (optional) tasks. Extra guidance was added to the manual covering various procedural and assessment issues, and supplementary documentation was developed to assist OTs to comply with VicRoads requirements. The updated test is expected to provide a valid test of driving skills, while offering greater reliability than previous OT licence reassessment procedures.

A randomised controlled trial to test the effectiveness of decision training on assessors\u2019 ability to determine optimal fitness-to-drive recommendations for older or disabled drivers

BackgroundDriving licensing jurisdictions require detailed assessments of fitness-to-drive from occupational therapy driver assessors (OTDAs). We developed decision training based on the recommendations of expert OTDAs, to enhance novices’ capacity to make optimal fitness-to-drive decisions. The aim of this research was to determine effectiveness of training on novice occupational therapists’ ability to make fitness-to-drive decisions.MethodsA double blind, parallel, randomised controlled trial was conducted to test the effectiveness of decision training on novices’ fitness-to-drive recommendations. Both groups made recommendations on a series of 64 case scenarios with the intervention group receiving training after reviewing two thirds of the cases; the control group, at this same point, just received a message of encouragement to continue. Participants were occupational therapy students on UK and Australian pre-registration programmes who individually took part online, following the website instructions. The main outcome of training was the reduction in mean difference between novice and expert recommendations on the cases.ResultsTwo hundred eighty-nine novices were randomised into intervention; 166 completed the trial (70 in intervention; 96 in control). No statistical differences in scores were found pre-training. Post training, the control group showed no significant change in recommendations compared to the experts (t(96) = −.69; p = .5), whereas the intervention group exhibited a significant change (t(69) = 6.89; p < 0.001). For the intervention group, the mean difference compared with the experts’ recommendations reduced with 95% CI from −.13 to .09. Effect size calculated at the post-training demonstrated a moderate effect (d = .69, r = .32).ConclusionsNovices who received the decision training were able to change their recommendations whereas those who did not receive training did not. Those receiving training became more able to identify drivers who were not fit-to-drive, as measured against experts’ decisions on the same cases.This research demonstrated that novice occupational therapists can be trained to make decisions more aligned to those of expert OTDAs. The decision training and cases have been launched as a free training resource at www.fitnesstodrive.com. This can be used by novice driver assessors to increase their skill to identify drivers who are, and are not fit-to-drive, potentially increasing international workforce capacity in this growing field of practice.

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.

Determination of fitness-to-drive after illness or injury is a complex process typically requiring a comprehensive driving assessment, including off-road and on-road assessment components. The competency standards for occupational therapy driver assessors (Victoria, Australia) define the requirements for performance of a comprehensive driving assessment, and we are currently revising these. Assessment of cognitive and perceptual skills forms an important part of the off-road assessment. The aim of this systematic review of systematic reviews (known as an overview) is to identify what evidence exists for including assessment of cognitive and perceptual skills within fitness-to-drive evaluations to inform revision of the competency standards. Five electronic databases (MEDLINE, CINAHL, PsycINFO, The Cochrane Library, OT Seeker) were systematically searched. Systematic review articles were appraised by two authors for eligibility. Methodological quality was independently assessed using the AMSTAR tool. Narrative analysis was conducted to summarise the content of eligible reviews. A total of 1228 results were retrieved. Fourteen reviews met the inclusion criteria. Reviews indicated that the components of cognition and perception most frequently identified as being predictive of fitness-to-drive were executive function (n=13), processing speed (n=12), visuospatial skills, attention, memory and mental flexibility (n=11). Components less indicative were perception, concentration (n=10), praxis (n=9), language (n=7) and neglect (n=6). This overview of systematic reviews supports the inclusion of assessment of a range of cognitive and perceptual skills as key elements in a comprehensive driver assessment and therefore should be included in the revised competency standards for occupational therapy driver assessors.

Using Social Judgment Theory method to examine how experienced occupational therapy driver assessors use information to make fitness-to-drive recommendations.

IntroductionAs people with a range of disabilities strive to increase their community mobility, occupational therapy driver assessors are increasingly required to make complex recommendations regarding fitness-to-drive. However, very little is known about how therapists use information to make decisions. The aim of this study was to model how experienced occupational therapy driver assessors weight and combine information when making fitness-to-drive recommendations and establish their level of decision agreement.MethodUsing Social Judgment Theory method, this study examined how 45 experienced occupational therapy driver assessors from the UK, Australia and New Zealand made fitness-to-drive recommendations for a series of 64 case scenarios. Participants completed the task on a dedicated website, and data were analysed using discriminant function analysis and an intraclass correlation coefficient.ResultsAccounting for 87% of the variance, the cues central to the fitness-to-drive recommendations made by assessors are the client’s physical skills, cognitive and perceptual skills, road law craft skills, vehicle handling skills and the number of driving instructor interventions. Agreement (consensus) between fitness-to-drive recommendations was very high: intraclass correlation coefficient = .97, 95% confidence interval .96–.98).ConclusionFindings can be used by both experienced and novice driver assessors to reflect on and strengthen the fitness-to-drive recommendations made to clients.

A Systematic Review of the Effectiveness of Behavioural Interventions for Improving Driving Outcomes in Novice Drivers with Attention Deficit Hyperactivity Disorder (ADHD)

Introduction:The efficacy of non-pharmacological interventions for improving driving outcomes in young drivers with attention deficit hyperactivity disorder has not been established. Such interventions are of interest to occupational therapists who work with this population to attain driving independence. This research article had two aims: (1) to systematically review the effectiveness of behavioural interventions to improve driving outcomes for this population, and (2) to identify studies detailing behavioural interventions that could be used to improve driving skills.Method:Nineteen databases were searched and 13 studies were appraised using the PEDro scale (the Physiotherapy Evidence Database), where appropriate.Findings:For the first aim, while two studies reported training led to significant improvements in driver skills, methodological problems limited the validity of one study. Eleven studies were reviewed in relation to the second aim, describing nine interventions. Of these, situation awareness training, such as commentary driving, show particular promise.Conclusion:Several interventions have the potential to improve the driving skills of this population. These interventions warrant further research and in the interim could be used clinically by occupational therapy driver assessors. Further research is required to determine if non-pharmacological interventions are of benefit for young drivers with attention deficit hyperactivity disorder. Situation awareness training may be beneficial for improving driving skills.

Design of occupational therapy on‐road test routes and related validity issues

Specialist Occupational Therapy Driver Assessors and driver licensing authorities require on-road assessment procedures that are both valid and reliable. Assessment validity may be influenced by both test route characteristics and driver characteristics. To address these issues, this study aimed to evaluate the characteristics of test routes used by Occupational Therapy Driver Assessors (including associated driving manoeuvres and traffic conditions) and to explore Occupational Therapy Driver Assessor views relating to on-road assessment procedures. In-depth interviews of 22 Occupational Therapy Driver Assessors were conducted; seven of the routes examined were in rural or regional locations. Supplementary information was obtained by observation of routes and review of Occupational Therapy Driver Assessors' route documentation. All Occupational Therapy Driver Assessors reported using a standard test route for clients seeking an open (i.e. not geographically restricted) licence. Compliance with professional guidelines reassessment procedures was very high for test items designated as compulsory, but more variable for those designated only as desirable. Differences between rural/regional vs. urban routes were noted, with those in rural/regional areas being less cognitively demanding. This study highlighted variation in route complexity between urban and rural locations. Whereas compliance with current professional guidelines for compulsory route items was very high, more detailed specification of standard route requirements is needed to improve the construct and content validity of assessments.

Interrater Reliability of the Road Law and Road Craft Test as Part of the OT-DORA Battery for Off-Road Driver Assessment

Background: The Occupational Therapy Driver Off Road Assessment (OT-DORA) Battery is in development as a comprehensive off-road evaluation of fitness to drive. Although several psychometric properties of the Road Law and Road Craft Test (RLRCT) have been previously studied, interrater reliability must also be established to include this test in the battery. Aim: The aim of the study was to determine the interrater reliability of the RLRCT. Method: Three occupational therapy driver assessors independently scored 20 client responses on the 14-item RLRCT. Results: The interrater reliability for all items, except item 6, was found to be between 0.57 and 1.00. The scoring instructions for item 6 were revised and the interrater reliability rose from 0.42 to 0.77. Conclusion: The RLRCT has been found to be reliable when administered by different raters and is thus suitable for inclusion in the OT-DORA Battery. Ongoing research to confirm the psychometric properties of the RLRCT is required.

Survey on Victorian driver assessors’ experience of critical incidents

To determine the prevalence of critical incidents among driver assessors, identify the type and frequency of critical incidents experienced and the strategies used to cope following these incidents. Mail survey of 70 Victorian occupational therapy driver assessors. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using content analysis. Almost 60% of driver assessors had experienced one or more critical incidents. Most frequently occurring incidents were near collisions and aggressive/threatening clients. Support was most often obtained from the driving instructor involved in the assessment. Older people with cognitive impairment were the client group most commonly involved. Greater acknowledgement and awareness of critical incidents and the importance of strategies to assist in the prevention and management of critical incidents are essential.

Normative data, preliminary inter-rater reliability and predictive validity of the Drive Home Maze Test

Objective: The Drive Home Maze Test has been developed as part of a clinic-based driver assessment battery. This article reports normative data and preliminary inter-rater reliability for this test together with predictive validity for a clinical sample. Subjects and setting: 223 individuals contributed to the normative data. Of these, data from 42 clients undergoing driver assessment as part of their rehabilitation or health care plan were used to ascertain the predictive validity of the Drive Home Maze Test for on-road driving performance (Pass/ Fail). Main measure: The Drive Home Maze Test was developed for occupational therapy driver assessors to use with all older and/ or functionally impaired drivers prior to on-road testing. The test assesses a person s executive function, attention and visuoconstructive skills. Results: The normative data indicated that time taken and number of errors on the maze increases with age. Performance on this test was strongly indicative of driver assessment outcome using the regression model: ln(Odds of failing on road) = 5.9451 + 2.7047 (log10 time taken to complete the maze). Excellent preliminary inter-rater reliability was also found using Ordinary Least Products linear regression analysis to test for bias between two raters for time taken and number of errors on the maze, with values ranging from r = 0.858 to 0.999. Conclusions: The Drive Home Maze Test provides useful information concerning a person's cognitive skills prior to undertaking an on-road assessment. Time taken to complete this test is indicative of the outcome of an on-road driver assessment.

Australian Occupational Therapy Driver Assessors’ Opinions on Improving On-Road Driver Assessment Procedures

We collected practitioner opinions to improve the validity and reliability of the on-road driver assessment procedures used in Australia. We used focus groups to document the views of experienced occupational therapy driver assessors using a purposive sampling method. Eight focus groups were conducted with 55 clinicians practicing in urban and rural regions. There was strong support for greater standardization of procedures for all tests. For drivers seeking unrestricted (open) licenses, use of standard routes with predetermined assessment points was important where practicable. Where use of a nonstandard route for this purpose was unavoidable, it was important to specify a minimum set of requirements related to route characteristics and assessment items. Australian occupational therapy driver assessors support greater standardization of test routes and procedures to improve reliability and validity. However, the extent to which standardization can be achieved is limited by variable road traffic environments where assessments are conducted.

Development and current status of occupational therapy driver assessment and rehabilitation in Victoria, Australia

This article reports on a study of driver assessment practices in Victoria, Australia. Based on similar work done in the United States in 1985, the study reports on work of the Driving for the Disabled Committee, formed within the Victorian Association of Occupational Therapists. The author comments on the role of driving as a valuable activity undertaken by most members of a community. Participating in driving may be challenged by congenital disabilities; accident or injury resulting in physical, cognitive/perceptual or sensory disabilities; psychiatric disorders or drug use; or factors associated with aging such as deteriorating vision. The author notes that 3,300 driver assessments are undertaken annually by occupational therapy driver assessors in Victoria, with subsequent reporting (as of 2003). The author comments on the twenty years that have passed since the occupational specialty area of driver assessment was developed in Melbourne, Victoria.

Review of tests contributing to the occupational therapy off‐road driver assessment

In order to make evidence-based decisions in clinical environments, therapists must use psychometrically sound measures of client skill and performance (Ellenberg, 1996). In the area of driver assessment and rehabilitation, suitably qualified occupational therapists in Australia currently use a variety of unstandardised assessments or parts of standardised tests in the off-road environment (Lovell & DiStefano, 2003). Therapists combine the results of these assessments with on-road test results to make licence recommendations for older and functionally impaired individuals to the state licensing authority. The aim of this paper is to document and review off-road driver assessments reported in the published literature or used by occupational therapists in Australia. No other driver test review papers could be found in the published literature. Specifically, the paper examines assessments that purport to measure client skill and performance in the areas of basic cognitive and perceptual skills, reaction time, and road law knowledge. As a resource for clinicians, a summary of each assessment is included in Appendix 1, and it includes information such as aims, scoring, cost and availability, strengths and weaknesses and the level of skills measured according to Michon’s model of driver behaviour (van Zomeren, Brouwer & Minderhound, 1987). The findings of this review can be used to guide occupational therapy driver assessors in their selection of off-road assessments, and contribute to future research to develop a standardised off-road driver assessment for occupational therapists.