A randomised controlled trial to test the effectiveness of decision training on assessors' ability to determine optimal fitness-to-drive recommendations for older or disabled drivers
- Harries, Priscilla, Unsworth, Carolyn, Gokalp, Hulya, Davies, Miranda, Tomlinson, Christopher, Harries, Luke
- Authors: Harries, Priscilla , Unsworth, Carolyn , Gokalp, Hulya , Davies, Miranda , Tomlinson, Christopher , Harries, Luke
- Date: 2018
- Type: Text , Journal article
- Relation: BMC Medical Education Vol. 18, no. 1 (2018), p.
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- Description: Background: Driving 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. Methods: A 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. Results: Two 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). Conclusions: Novices 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. © 2018 The Author(s).
- Authors: Harries, Priscilla , Unsworth, Carolyn , Gokalp, Hulya , Davies, Miranda , Tomlinson, Christopher , Harries, Luke
- Date: 2018
- Type: Text , Journal article
- Relation: BMC Medical Education Vol. 18, no. 1 (2018), p.
- Full Text:
- Reviewed:
- Description: Background: Driving 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. Methods: A 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. Results: Two 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). Conclusions: Novices 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. © 2018 The Author(s).
Linking people and activities through community mobility : an international comparison of the mobility patterns of older drivers and non-drivers
- Unsworth, Carolyn, Dickerson, Anne, Gélinas, Isabelle, Harries, Priscilla, Margot-Cattin, Isabel, Mazer, Barbara, Stapleton, Tadhg, Swanepoel, Lizette, Timmer, Amanda, Niekerk, Lana, Vrkljan, Brenda
- Authors: Unsworth, Carolyn , Dickerson, Anne , Gélinas, Isabelle , Harries, Priscilla , Margot-Cattin, Isabel , Mazer, Barbara , Stapleton, Tadhg , Swanepoel, Lizette , Timmer, Amanda , Niekerk, Lana , Vrkljan, Brenda
- Date: 2022
- Type: Text , Journal article
- Relation: Ageing and Society Vol. 42, no. 8 (2022), p. 1938-1963
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- Description: Community mobility using private and public transportation is important for maintaining health, social participation and living well in later life. This international cross-sectional cohort study (N = 246) reported on the health and driving status of older adults from seven countries where the mobility patterns of drivers and non-drivers were compared in terms of city and rural areas, weather, as well as their respective differences in the number of out-of-home places accessed and quality of life. Older adults participated in a semi-structured interview and completed four standardised instruments: the EQ-5D-5L, modified PULSES health profile, modified Transportation Questionnaire, and the Transport - Participation in Activities and Places Outside the Home. Results suggested inclement weather and place of residence negatively impacted out-of-home activities but did not increase use of public transportation. Drivers accessed more out-of-home activities than non-drivers, suggesting higher community participation among this group, and quality of life was generally high among all participants, but slightly higher for drivers. Findings indicate that a complex myriad of factors can influence community mobility in older adults and further investigations are needed to understand patterns of transport in later life, particularly with regard to those factors that promote and maintain transport mobility, and relationships between transport mobility, community participation and quality of life. Copyright © The Author(s), 2021. Published by Cambridge University Press.
- Authors: Unsworth, Carolyn , Dickerson, Anne , Gélinas, Isabelle , Harries, Priscilla , Margot-Cattin, Isabel , Mazer, Barbara , Stapleton, Tadhg , Swanepoel, Lizette , Timmer, Amanda , Niekerk, Lana , Vrkljan, Brenda
- Date: 2022
- Type: Text , Journal article
- Relation: Ageing and Society Vol. 42, no. 8 (2022), p. 1938-1963
- Full Text:
- Reviewed:
- Description: Community mobility using private and public transportation is important for maintaining health, social participation and living well in later life. This international cross-sectional cohort study (N = 246) reported on the health and driving status of older adults from seven countries where the mobility patterns of drivers and non-drivers were compared in terms of city and rural areas, weather, as well as their respective differences in the number of out-of-home places accessed and quality of life. Older adults participated in a semi-structured interview and completed four standardised instruments: the EQ-5D-5L, modified PULSES health profile, modified Transportation Questionnaire, and the Transport - Participation in Activities and Places Outside the Home. Results suggested inclement weather and place of residence negatively impacted out-of-home activities but did not increase use of public transportation. Drivers accessed more out-of-home activities than non-drivers, suggesting higher community participation among this group, and quality of life was generally high among all participants, but slightly higher for drivers. Findings indicate that a complex myriad of factors can influence community mobility in older adults and further investigations are needed to understand patterns of transport in later life, particularly with regard to those factors that promote and maintain transport mobility, and relationships between transport mobility, community participation and quality of life. Copyright © The Author(s), 2021. Published by Cambridge University Press.
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
- Unsworth, Carolyn, Baker, Anne, So, Man, Harries, Priscilla, O'Neill, Desmond
- Authors: Unsworth, Carolyn , Baker, Anne , So, Man , Harries, Priscilla , O'Neill, Desmond
- Date: 2017
- Type: Text , Journal article
- Relation: BMC Psychiatry Vol. 17, no. 1 (2017), p.
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- Description: Background: Limited evidence exists regarding fitness-to-drive for people with the mental health conditions of schizophrenia, stress/anxiety disorder, depression, personality disorder and obsessive compulsive disorder (herein simply referred to as 'mental health conditions'). The aim of this paper was to systematically search and classify all published studies regarding driving for this population, and then critically appraise papers addressing assessment of fitness-to-drive where the focus was not on the impact of medication on driving. Methods: A systematic search of three databases (CINAHL, PSYCHINFO, EMBASE) was completed from inception to May 2016 to identify all articles on driving and mental health conditions. Papers meeting the eligibility criteria of including data relating to assessment of fitness-to-drive were critically appraised using the American Academy of Neurology and Centre for Evidence-Based Medicine protocols. Results: A total of 58 articles met the inclusion criteria of driving among people with mental health conditions studied, and of these, 16 contained data and an explicit focus on assessment of fitness-to-drive. Assessment of fitness-to-drive was reported in three ways: 1) factors impacting on the ability to drive safely among people with mental health conditions, 2) capability and perception of health professionals assessing fitness-to-drive of people with mental health conditions, and 3) crash rates. The level of evidence of the published studies was low due to the absence of controls, and the inability to pool data from different diagnostic groups. Evidence supporting fitness-to-drive is conflicting. Conclusions: There is a relatively small literature in the area of driving with mental health conditions, and the overall quality of studies examining fitness-to-drive is low. Large-scale longitudinal studies with age-matched controls are urgently needed in order to determine the effects of different conditions on fitness-to-drive. © 2017 The Author(s).
- Authors: Unsworth, Carolyn , Baker, Anne , So, Man , Harries, Priscilla , O'Neill, Desmond
- Date: 2017
- Type: Text , Journal article
- Relation: BMC Psychiatry Vol. 17, no. 1 (2017), p.
- Full Text:
- Reviewed:
- Description: Background: Limited evidence exists regarding fitness-to-drive for people with the mental health conditions of schizophrenia, stress/anxiety disorder, depression, personality disorder and obsessive compulsive disorder (herein simply referred to as 'mental health conditions'). The aim of this paper was to systematically search and classify all published studies regarding driving for this population, and then critically appraise papers addressing assessment of fitness-to-drive where the focus was not on the impact of medication on driving. Methods: A systematic search of three databases (CINAHL, PSYCHINFO, EMBASE) was completed from inception to May 2016 to identify all articles on driving and mental health conditions. Papers meeting the eligibility criteria of including data relating to assessment of fitness-to-drive were critically appraised using the American Academy of Neurology and Centre for Evidence-Based Medicine protocols. Results: A total of 58 articles met the inclusion criteria of driving among people with mental health conditions studied, and of these, 16 contained data and an explicit focus on assessment of fitness-to-drive. Assessment of fitness-to-drive was reported in three ways: 1) factors impacting on the ability to drive safely among people with mental health conditions, 2) capability and perception of health professionals assessing fitness-to-drive of people with mental health conditions, and 3) crash rates. The level of evidence of the published studies was low due to the absence of controls, and the inability to pool data from different diagnostic groups. Evidence supporting fitness-to-drive is conflicting. Conclusions: There is a relatively small literature in the area of driving with mental health conditions, and the overall quality of studies examining fitness-to-drive is low. Large-scale longitudinal studies with age-matched controls are urgently needed in order to determine the effects of different conditions on fitness-to-drive. © 2017 The Author(s).
A systematic review of effective interventions and strategies to support the transition of older adults from driving to driving retirement/cessation
- Dickerson, Anne, Stapleton, Tadhg, Bloss, Jamie, Géinas, Isabelle, Harries, Priscilla, Choi, Moon, Margot-Cattin, Isabel, Mazer, Barbara, Patomella, Anne-Helen, Swanepoel, Lizette, Van Niekerk, Lana, Unsworth, Carolyn, Vrkljan, Brenda
- Authors: Dickerson, Anne , Stapleton, Tadhg , Bloss, Jamie , Géinas, Isabelle , Harries, Priscilla , Choi, Moon , Margot-Cattin, Isabel , Mazer, Barbara , Patomella, Anne-Helen , Swanepoel, Lizette , Van Niekerk, Lana , Unsworth, Carolyn , Vrkljan, Brenda
- Date: 2024
- Type: Text , Journal article , Review
- Relation: Innovation in Aging Vol. 8, no. 6 (2024), p.
- Full Text:
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- Description: Background and Objectives: In most western countries, older adults depend on private cars for transportation and do not proactively plan for driving cessation. The objective of this review was to examine current research studies outlining effective interventions and strategies to assist older adults during their transition from driver to driving retirement or cessation. Research Design and Methods: A search was completed across 9 databases using key words and MeSH terms for drivers, cessation of driving, and older adult drivers. Eligibility screening of 9,807 titles and abstracts, followed by a detailed screening of 206 papers, was completed using the Covidence platform. Twelve papers were selected for full-text screen and data extraction, comprising 3 papers with evidence-based intervention programs and 9 papers with evidence-informed strategies. Results: Three papers met the research criteria of a controlled study for programs that support and facilitate driving cessation for older adults. Nine additional studies were exploratory or descriptive, which outlined strategies that could support older drivers, their families, and/or healthcare professionals during this transition. Driving retirement programs/toolkits are also presented. Discussion and Implications: The driver retirement programs had promising results, but there were methodological weaknesses within the studies. Strategies extracted contributed to 6 themes: Reluctance and avoidance of the topic, multiple stakeholder involvement is important, taking proactive approach is critical, refocus the process away from assessment to proactive planning, collaborative approach to enable “ownership” of the decision is needed, and engage in planning alternative transportation should be the end result. Meeting the transportation needs of older adults will be essential to support aging in place, out-of-home mobility, and participation, particularly in developed countries where there is such a high dependency on private motor vehicles. © The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.
- Authors: Dickerson, Anne , Stapleton, Tadhg , Bloss, Jamie , Géinas, Isabelle , Harries, Priscilla , Choi, Moon , Margot-Cattin, Isabel , Mazer, Barbara , Patomella, Anne-Helen , Swanepoel, Lizette , Van Niekerk, Lana , Unsworth, Carolyn , Vrkljan, Brenda
- Date: 2024
- Type: Text , Journal article , Review
- Relation: Innovation in Aging Vol. 8, no. 6 (2024), p.
- Full Text:
- Reviewed:
- Description: Background and Objectives: In most western countries, older adults depend on private cars for transportation and do not proactively plan for driving cessation. The objective of this review was to examine current research studies outlining effective interventions and strategies to assist older adults during their transition from driver to driving retirement or cessation. Research Design and Methods: A search was completed across 9 databases using key words and MeSH terms for drivers, cessation of driving, and older adult drivers. Eligibility screening of 9,807 titles and abstracts, followed by a detailed screening of 206 papers, was completed using the Covidence platform. Twelve papers were selected for full-text screen and data extraction, comprising 3 papers with evidence-based intervention programs and 9 papers with evidence-informed strategies. Results: Three papers met the research criteria of a controlled study for programs that support and facilitate driving cessation for older adults. Nine additional studies were exploratory or descriptive, which outlined strategies that could support older drivers, their families, and/or healthcare professionals during this transition. Driving retirement programs/toolkits are also presented. Discussion and Implications: The driver retirement programs had promising results, but there were methodological weaknesses within the studies. Strategies extracted contributed to 6 themes: Reluctance and avoidance of the topic, multiple stakeholder involvement is important, taking proactive approach is critical, refocus the process away from assessment to proactive planning, collaborative approach to enable “ownership” of the decision is needed, and engage in planning alternative transportation should be the end result. Meeting the transportation needs of older adults will be essential to support aging in place, out-of-home mobility, and participation, particularly in developed countries where there is such a high dependency on private motor vehicles. © The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.
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