Scholarly Agenda Presentation: Occupational Therapy & Driver Rehab

Created By: Luke Thompson, OTS

PIO Question

• Are certified driver rehabilitation specialists (P) using consistent assessments (I) on clients interested in regaining function in their occupation of driving (O)?

Why Driver Rehabilitation?• Driving is a valued occupation of society.

• In 2011, there were an estimated 35 million drivers in the United States (NHTSA, 2013).

• As the baby-boomers continue to age, there will be more older adults driving on the roads.

• An individual’s functional ability to drive can be compromised due to a variety of diagnoses or injuries.

• It is important that Driver Rehabilitation Specialists (DRS) are using efficient assessments that have strong reliability & validity.

• By providing driver rehabilitation to clients, DRSs are doing their part in making the roads a safer place for society.

Search Strategy• Keywords: Driver Rehabilitation, Driver Rehabilitation

Specialist, Driver Rehabilitation Program, On The Road Assessments

• Databases: CINAHL, Science Direct, Medline & EBSCOhost

• Criteria:

• Inclusion: articles in the English language, articles in full text, peer reviewed articles

• Exclusion: articles that only related to one specific diagnosis

Evidence• Number of Total Studies: 9

• Level 1: (2) Systematic Reviews

• Level 2: (0)

• Level 3: (3) Quantitative, non-randomized, controlled or cross-sectional studies

• Level 4: (2) Expert opinion

• Level 5: (2) Opinion of the author(s)

Review of the Best Evidence: Article #1

• Title: Driver rehabilitation: A systematic review of the types and effectiveness of interventions used by occupational therapists to improve on-road fitness-to-drive

• Objective: The purpose was to identify what interventions are being incorporated into driver rehabilitation programs and their level of effectiveness.

Article #1• Method: The researchers inspected a variety of databases

for interventions that focused on driver rehabilitation and can be administrated by an occupational therapy driver assessor (OTDA).

• Inclusion Criteria: published in English, peer reviewed, full text

• Exclusion Criteria: opinion pieces, narrative reviews, conference proceedings, non full-text studies, other systematic reviews that contained studies that didn’t meet the inclusion criteria

Article #1• Outcomes:

• 16/821 studies met the inclusion criteria and were included into this systematic review

• 8/16 used a bottom-up/remedial approach = computer based driver simulation followed by off road skill specific training and off road educational programs

• Inconsistencies with the type of software utilized, frequency, duration, & number of sessions

• Clinical Relevance:

• These inconsistencies make it difficult for practitioners to determine the most effective intervention for this specialty area of OT.

• Future research needs to focus on specific diagnoses and conditions in order to begin formulating a standardized approach for different populations.

Review of the Best Evidence: Article #2

• Title: On-road Evaluation: Its Use for the Identification of Impairment and Remediation of Older Drivers

• Objective: The purpose of this systematic review was to examine on-the-road driving assessments for unsafe older adults and older adults needing retraining.

Article #2• Method: A variety of databases were utilized to search for

research that focused on on-the-road assessment, regardless of closed-course or open road methods.

• Inclusion Criteria: Research that detailed on-the-road assessments, research published between 1990-2007

• Exclusion Criteria: Any research published before or after the years of 1990-2007

Article #2• Outcomes:

• All three literature perspectives (identification of impairment, retraining programs & expert opinion) agree that lane control and lane positioning are the most useful skills that an intervention should test a client.

• Other driving skills such as speed, turning, intersections, merging, braking, parking, scanning, following traffic lights and signal use are prioritized according to the reasoning for the driver rehabilitation.

• Clinical Relevance:

• The specific focus of the on-the-road assessments may vary according to a variety of factors such as facility preference, therapist’s preference, or client’s diagnosis.

• The lack of consistency among the on-the-road assessments being used makes it difficult to compare the level of effectiveness between facilities or evaluators.

• In order to remain holistic, it is important for the practitioner to consider all of the client factors needed for an individual to operate a vehicle while maintaining safety for themselves and others. After compiling all of these factors, the assessor can choose appropriate assessments for their clientele.

Review of the Best Evidence Article #3• Title: Driving Rehabilitation Programs for Older Drivers in

the United States

• Objective: The purpose was to describe the practice of the services, referrals and reports of older adults in driver rehabilitation programs. In addition, researchers attempted to identify any barriers that exist to older adults utilizing driver rehabilitation services.

Article #3• Method:

• A cross sectional survey was distributed among eligible (DRP)s that evaluate older drivers (65 years and older). These (DRP)s were selected from the databases of AOTA and Association for Driver Rehabilitation Specialists (ADRS).

• The survey consisted of three primary areas: program characteristics, referral / reporting practices & perceptions of DRPs.

• Participation was at the program level as opposed to an individual level.

Article #3• Outcomes:

• 204/331 of the eligible programs participated in the study

• 9.4 Driver Rehabilitation Programs (DRP) per 100,000 older adults = median of 64,151 older adults per DRP

• Of the participating programs…

• (96.6%) offered clinical evaluations

• (82.4%) offered in-vehicle evaluations

• Median of 8 evaluations in the past 30 days

• Median of 1 full time driving evaluator

• Median cost for a complete evaluation = $399.50

• 50% of DRPs reported 2-3 hours to complete

Article #3

• Outcomes (continued..):

• 66% of programs said that cost could be covered in part by insurance, yet 83.1% were covered by workers compensation

• Most common referral were from a physician or self referral

• Commonly identified barriers included fear of revocation of license, cost of evaluation, lack of knowledge concerning program availability and benefits among clients and healthcare providers.

• Arknasas, Oklahoma, Delaware & Wyoming had no (DRP)s recognized by AOTA

• AOTA & the National Highway Traffic Safety Administration made a partnership to motivate general OTs to take on a role in driving assessments which is called the Gaps & Pathways Project.

Article #3

• Clinical Relevance:

• The availability of DRPs vary across the United States.

• Healthcare providers must gain more knowledge and awareness about these programs in order to make the roads safer as well as encourage the sustainability of these services.

• Current and future practitioners need to promote these services in both rural and urban areas

• Insurance companies and employers should encourage older adults to seek out these services through reimbursement policies

References

• Betz, M. E., Dickerson, A. E., Coolman, T., Davis E.S., Jones, J. & Schwartz R. (2014). Driving rehabilitation programs for older drivers in the United States.

Occupational Therapy in Health Care , 28(3), 306-317. doi: 10.3109/07380577.2014.908336.

• Dickerson, A.E. (2014). Screening and assessment tools for determining fitness to drive: A review of the literature for the pathways project. Occupational Therapy in Health Care 28(2), 82-121. doi: 10.3109/07380577.2014.904535.

• Dickerson, A.E. (2013). Driving assessment tools used by driver rehabilitation specialists: Survey of use and implications for practice. American Journal

of Occupational Therapy, 67(5), 564-573.

• Dickerson, A.E. and Bedard, M. (2014). Decision tool for clients with medical issues: A framework for identifying driving risk and potential to return to driving. Occupational Therapy in Health Care, 28(2), 194-202. doi:

10.3109/07380577.2014.903357.

References

• Dickerson, A.E. and Davis, E.S. (2014). Driving experts address expanding access through pathways to older driver rehabilitation services: Expert meeting results and implications. Occupational Therapy in Health Care 28(2), 122-126.

• Kowalski, K., Tuokko, H., & Tallman, K. (2010). On-road evaluation: Its use for the identification of impairment and remediation of older drivers. Physical and Occupational Therapy in Geriatrics, 28(1), 75-85. doi: 10.3109/ 02703180903237861.

• Unsworth, C. A. (2007). Development and current status of occupational therapy driver assessment and rehabilitation in Victoria, Australia. Australian Occupational Therapy Journal 54, 153-156. doi: 10.1111/j.1440-1630.2006.00617.

References

• Unsowrth C.A. and Baker A. (2014). Driver rehabilitation: A systematic review of the types and effectiveness of interventions used by occupational therapists to improve on-road fitness-to-drive. Accident Analysis and Prevention, 71, 106-114.

• Yeun H.K., Brooks J.O., Azuero A. & Burik J.K. (2012). Certified driver rehabilitation specialists’ preferred situations

for driving simulator scenarios. American Journal of Occupational Therapy, 66(1), 110- 114.