[Show abstract][Hide abstract] ABSTRACT: Background/aim:
The assessment of executive functions is an integral component in determining fitness to drive. A structured review was conducted to identify assessment tools used to measure executive function in relation to driving and to describe these tools according to: (i) specific executive function components assessed; (ii) the tool's validity in predicting safe driving; and (iii) clinical utility.
Sixty-nine articles were reviewed, identifying 53 executive function tools/assessments used in driving research. Each tool was critically appraised and the findings were compiled in a Driving Executive Function Tool Guide.
Among the 53 tools, there were 27 general assessments of cognition, 19 driving-specific and seven activities of daily living/instrumental activities of daily living assessments. No single tool measured all executive function components: working memory was the most common (n = 20/53). Several tools demonstrated strong predictive validity and clinical utility. For example, tools, such as the Trail Making Test and the Maze Task, have the shortest administration time (i.e. often less than 10 minutes) and the most easily accessible method of administration (i.e. pen and paper or verbal). Driving-specific tools range from short questionnaires, such as the 10-minute Manchester Driving Behaviour Questionnaire, to more complex tools requiring about 45 minutes to administer. CONCLUSIONS AND SIGNIFICANCE OF THE STUDY: The appropriateness of a tool depends on the individual being assessed and on practical constraints of the clinical context. The Driving Executive Function Tool Guide provides useful information that should facilitate decision-making and selection of appropriate executive function tools in relation to driving.
No preview · Article · Dec 2012 · Australian Occupational Therapy Journal
[Show abstract][Hide abstract] ABSTRACT: The objective of the authors in this study was to qualitatively explore occupational therapists’ role in providing driving-related services to people with mental illnesses. Two focus groups composed of 20 occupational therapists were conducted. The data regarding current and ideal role, barriers, and facilitators for implementing those services were analyzed using inductive analysis. A strong message was that occupational therapists have a central role in providing driving-related services including screening, assessment, and interventions for people with mental illnesses. But, comfort in fulfilling this role is limited because of the lack of evidence-based research and validated evaluation tools. More education and research is recommended.
No preview · Article · Jan 2012 · Occupational Therapy in Mental Health
[Show abstract][Hide abstract] ABSTRACT: Few studies have explored driving issues in adult mental health. In this pilot study, 48 drivers were compared to 24 participants who had ceased driving, on their clinical and driving characteristics. Driving-related services offered to them were also documented. Participants who had stopped driving were more likely to be in-patients on antipsychotic or several medications. A third of the participants reported negative effects of their illness and/or medications on driving. Psychiatrists and occupational therapists offered assessments and recommendations related to fitness to drive to 30% of their clients using complementary approaches. This survey indicates that few drivers with mental health disorders receive driving-related services. More evidence-based practice guidelines are needed.
No preview · Article · Feb 2010 · Occupational Therapy in Mental Health
[Show abstract][Hide abstract] ABSTRACT: Background: There is concern that mental illnesses, and/or medications associated with their treatment, can affect fitness-to-drive. Internationally, occupational therapists are the professional group that most commonly assesses fitness-to-drive.Objective: A systematic review of the literature was done to identify and appraise the scientific evidence on fitness-to-drive amongst people with mental illness and those using psychotropic medications.Results: Fourteen studies were retrieved. In eight, mental illness was linked to higher traffic accident rates. Some psychotropic medications have the potential to negatively affect fitness-to-drive, especially in the starting phase of treatment, or when adjusting medications. Newer anti-depressants have been shown to improve specific pre-requisite skills for driving. Although newer antipsychotic medications improve cognitive skills, these improvements do not translate into driving-related tasks.Conclusion: Accident rates are higher among sub-groups of individuals including those having the most severe degree of mental illness and those using specific psychotropic medications such as benzodiazepines. These findings are sufficient to argue the need for attention on standardized screening and assessment of fitness-to-drive in psychiatric patients.
No preview · Article · Mar 2008 · Occupational Therapy in Mental Health
[Show abstract][Hide abstract] ABSTRACT: To assess current attitudes, practices, and knowledge of Canadian psychiatrists regarding fitness to drive in individuals with mental illness and to explore variations according to provincial legislation.
We carried out a national cross-sectional survey, using a random sample of psychiatrists. We used a mail survey to collect data.
In total, 248 psychiatrists participated; the response rate was 54.2% on traced subjects. The majority (64.1%) reported that they strongly agreed or agreed that addressing patients' fitness to drive is an important issue. However, only 18.0% of respondents were always aware of whether their patients were active drivers. One-fourth strongly agreed or agreed that they were confident in their ability to evaluate fitness to drive. In discretionary provinces, 29.3% of psychiatrists reported not knowing their provincial legislation, as did 14.6% of psychiatrists in mandatory provinces; of those responding, 54.0% from discretionary provinces and 2.8% from mandatory provinces gave incorrect answers.
Psychiatrists' responses demonstrate a broad range of attitudes, practices, and knowledge. There appears to be a large gap between what is expected of psychiatrists and their readiness and self-perceived ability to make informed clinical decisions related to driving safety.
There is a clear need for education and guidelines to assist psychiatrists in decision making about driving fitness.
No preview · Article · Dec 2006 · Canadian journal of psychiatry. Revue canadienne de psychiatrie