8/10/2015 1 The University of Sydney Page 1 DriveSafe DriveAware A valid cognitive fitness to drive screening test for medical practice? Presented by Beth Cheal Faculty of Health Sciences, School of Occupational Therapy, USyd / Pearson The University of Sydney Page 2 Assessing Fitness to Drive
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The University of Sydney Page 1
DriveSafe DriveAware
A valid cognitive fitness to drive screening test for medical practice?
Presented by
Beth ChealFaculty of Health Sciences, School of Occupational Therapy, USyd / Pearson
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Assessing Fitness to Drive
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• Physical Screening -impact of deficits on operation of car controls
• Vision Screening -Legal for driving? Need further assessment?
•Cognitive Screening - potential impact on safety / insight?
Assessing Fitness to Drive
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DriveSafe DriveAware (DSDA) Project
3 Phase Prospective Study
– Phase 1:Conversion of computer DSDA iPad® Application
• Testing with seniors / healthy adults• Feasibility testing with doctors
– Phase 3: Implementation into 2 x medical practices (Sydney / Melbourne)
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National Survey of GPs
Representative Sample 250 GPs nationally:
– What are GPs doing now?– Are they satisfied with their current methods?– Do they perceive a need for a fitness to drive assessment tool?– What should it look like?
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• Av. 87 assessments p.a• Rely on own judgments /
observations• Low use formal tests
(MMSE)• Referral to OT rare• 40% - felt do not have
tools to assess fitness to drive.
• Concerned about doctor-patient relationship / liability
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What you told us…
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The University of Sydney Page 70% 20% 40% 60% 80% 100%
Other
Referral for an occupational therapydriving assessment
Refer to Assessing Fitness to Drivemedical guidelines (Austroads)
Observe factors such as patientsmobility, grooming and behaviour
Your professional judgement
How frequently do you use each of the following to assess fitness to drive?
Always
Often
Sometimes
Rarely
Never
NA
What you told us…
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“I’m not sure that the tools I use are really measuring my patient's ability to drive”
“As the patient’s trusted doctor it can be difficult to broach the possibility of not driving. Patients are often extremely offended and resent you for ‘breaking their trust’”
“It's very difficult to judge when someone falls below the safe level for driving within a doctor’s office”
What you told us…
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OT Driving Assessment:
–Considered the gold standard as actual driving performance observed at a particular place at a particular time
–Limitations: Waiting time, cost, access, standardisation
Assessing Fitness to Drive
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Not practical to test every driver with a medical conditionon-road:
• Around 51,000 people had a stroke in 2014
• Each week, more than 1,800 new cases of dementia
• Around 700,000 Australians have a brain injury
Assessing Fitness to Drive
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• Clear pass/fail use financial & emotional resources more appropriately
• Scarce clinical resources for those who would benefit from rehabilitation
• Reduced waiting times for on road testing
Assessing Fitness to Drive
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How can you testcognitive capacity for driving?
o Mini Mental or MoCA?
o Clock Drawing?
o Maze Tests?
o Computer Tests?
o Combined Tests?
• Face Validity - does it look like it is testing driving?
• Where is the cut off?
• Is the test sensitive enough without over diagnosing?
• How much room for error are you willing to accept?
For patients where ability to manage the cognitive
aspects of driving may be impaired by:
• Age related changes
• A medical condition (e.g., stroke, dementia, Parkinson’s)
• Injury (e.g., traumatic brain injury)
Who Can Be Tested?
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On Road Assessment still required for:
• All patients with physical disabilities• Beginning / learner drivers • Non-English speaking background• Aphasias and other communication difficulties• Caution for patients with mental health disorders
Who Can Be Tested?
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• Office Setting
• Self-administered + interview
• Approx. 10 minutes
• iPad® (iOS 7 or later)
• Desk / office chair
• Stand (20°)
• Stylus / headphones optional
Testing Setting
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Testing Format
3 Subtests:
DriveSafe - Self administered
DriveAware - Partly self administered
Intersection Rules - Self administered(Optional)
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1. Set up the patient
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3. Conduct the interview
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4. Provide Results
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Subtest 1: DriveSafe
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Demo Item
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Demo Item
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Demo Item
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Practice Items (3)
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Practice Items
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Practice Items
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Practice Items
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Administrator Assisted Model
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Scoring& Reporting
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DriveSafe DriveAware - Extended Report
Name
John HepplesMRN
654
1. DriveSafe (Objects & Directions)DriveSafe determines awareness of the driving environment.
Table 1: Missed information
Information No. Missed / Incorrect
Objects 1/28
Details (Location / Direction) 6/56
Total score 77 / 84
Additional objects 1Time taken to complete test 0.0 minutes
Research indicates the median time taken to complete DriveSafe for people who pass an occupational therapy on-r oad
assessment is 4 minutes and 46 seconds , and who fail the assessment, 6 minutes and 49 seconds .
Copyright. Pearson Australia Gr oup 1 of 2
2. Intersection RulesRight of way is determined for 8 intersections.
Table 2: Performance based on intersection complexity
Intersection No.
1, 3, 4, 7
2, 5, 6, 8 With road signs
Without road signs
Road Signs No. of Vehicles in Image
2
3-4 3/4
3/4
Score
6 / 8
minutes0.6Time taken to complete test
Total score
Research indicates the median time taken to complete Intersection Rules for people who pass an occupational therapy on-
road assessment is 2 minutes and 38 seconds , and for people who fail on-r oad, 3 minutes and 49 seconds .
DriveSafe DriveAware - Patient Letter
Name
John HepplesMRN
654
The purpose of this test is to determined a driver's awar eness of the driving environment and their own abilities r elated to
driving. Results are used to indicate if further assessment of ability to manage the cognitive aspects of driving (thinking
skills) is required.
DriveSafe
DriveAware
Intersection Test
Your results were:
12/ 84 Missed 1 object and 6 details (location/dir ection).
A score of 13 and above indicates awar ness of abilities related to driving./ 17
77
/ 8
These results place you in the category:
Likely to pass an on-road assessment
Your results indicate you are likely to pass an occupational therapy on �road assessment (provided you
do not have any physical impairment that may a ffect your driving ability).
84
72
57
0 10DriveAware
13 17
Dri
veS
afe
Note: If you have a medical condition that can a ffect physical capacity to drive, you may be r equired to undergo an
occupational therapy driving assessment even if you fall into the ‘gr een’ section on this graph.
If you would like more information about DriveSafe DriveAware please visit the following website:
www.pearsonclinical.com.au/drivesafedriveawar e
Copyright. Pearson Australia Gr oup
Disclaimer
The recommendations above were based on information provided by you, clinical information, performance on the day of the assessment, and
results of research. As in the case of any driver, no assurance can be given or implied that you will be collision �free given this assessment report.
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• Use in the context of your clinical judgment / other indicators
• Be cautious about the language you use when giving advice about driving