Fitness-to-Drive Screening Measure : From Conceptualization to Global Implementation

Transcription

1 Fitness-to-Drive Screening Measure : From Conceptualization to Global Implementation Sherrilene Classen PhD, MPH, OTR/L, FAOTA Professor & Chair: Department of Occupational Therapy University of Florida 27 Oct 2018

2 Acknowledgement AOTA 90 th Annual Conference & Expo Academic Institutions University of Florida, USA University of Western Ontario, Canada Mentors Craig Velozo, PhD, FAOTA William C. Mann, PhD Funders U.S. Government: NIH; CDC; US DOT State: FL DOT Technical Support Jason Rogers Steve Beaulac Research Labs I-MAP, University of Florida, USA i-mobile Research Lab, Western University, ON, Canada Centre for Safe Driving, Lakehead University, Thunder bay, ON, Canada Collaborators U.S. Canada Japan Korea Students Post-Docs Doctoral MSc(OT) Research Assistants

3 Outline Context for older drivers in North America Development of the FTDS Psychometrics Web-based version Further developments Case study

4 Older Drivers in the U.S. & Canada About 36M older drivers (>65 yrs.) in U.S. increase to 76M by About 3M drivers (of 22M) in Canada > 65 2 double in the 10 years North-America 1 of 4 people will be > 65 Leading cause of accidental deaths for persons years old is motor vehicle crashes 3 Individuals > 75 yrs. have a 3.5 times higher crash rate compared to 35 to 44 year old 4 Want to continue to drive 1. NHTSA, Transport Canada 3. Canada Safety Council. Seniors behind the wheel. (2005) National Blueprint for Injury Prevention in Older Drivers

5 Older Driver Older drivers are overall safe A high risk group for crash related injuries and deaths Age related declines Chronic conditions Comorbidities Frailty Medications Living longer and driving longer Capacity 350 CDRS in USA 1: 102, CDRS Canada1:120,000 Access On-road assessment Benefits Limitations Overcome these issues

6 Fitness-to-Drive Screening Measure Developed a paper and pen version Web-based To identify at-risk older drivers

7 Overview Research PHASE 1: SLR PHASE 2.. PHASE 7 Theoretical Frameworks FARS Meta-Synthesis Mixed Methods Preparation Enrollment Data Collection Analyses Dissemination Three manuscripts 1. Determinants of Safety 2. Qualitative meta- Synthesis 3. PH Model K-01

8 FTDS Measure: Video Four sections A 1= Demographics rater A 2= Demographics driver B= Driving history and habits C= 54 Driving behaviors 54 Items Observable behaviors Progress in the level of difficulty 4-point adjectival scale Very difficult, somewhat, little, no difficulty

9 Creating the Fitness-to-Drive Screening Measure Adjust mirrors B n Check blind spot Drive rush hour Pass large vehicle Open door >.50 probability of passing Maintain lane.50 probability of passing Merge highway Drive night Drive in storm <<<.50%probability of passing D i 9

10 Overview Research PHASE 1 PHASE 2 PHASE 3 Theoretical Frameworks FARS Meta-Synthesis Mixed Methods Item generation Face validity Content validity PSYCHOMETRICS N= 400 Preparation Enrollment Data Collection Analyses Dissemination Three manuscripts 1. Determinants of Safety 2. Qualitative meta- Synthesis 3. PH Model Two manuscripts 1. Classen et al. (2010), AJOT 2. Winter et al. (2011), CJOT Four manuscripts 1. Classen et al. (2012), AJOT 2. Classen et al. (2012), AJOT 3. Classen et al. (2013), AJOT 4. Classen et al. (2015), OTJR Dec 2008-Dec 2012 K-01 NIA: R-21

11 AOTA 90 th Annual Conference & Expo Procedure Drivers (N=200) Informed consent FTDS measure Standardized clinical battery Standardized on-road test Protocol standardized across sites IRR driving evaluators = 100% Caregivers (N=200) Informed consent FTDS measure

12 Overview Research PHASE 1 PHASE 2 PHASE 3 Theoretical Frameworks FARS Meta-Synthesis Mixed Methods Item generation Face validity Content validity FINAL PSYCHOMETRICS N= 400 Factor Structure Preparation Enrollment Data Collection Analyses Dissemination Three manuscripts 1. Determinants of Safety 2. Qualitative meta- Synthesis 3. PH Model Five manuscripts 1. Classen et al. (2010), AJOT 2. Winter et al. (2011), CJOT 3. Classen et al. (2012), AJOT 4. Classen et al. (2012), AJOT 5. Classen et al. (2013), AJOT Dec Dec 2012 K-01 NIA: R-21 DOT FDOT

13 Overview Research PHASE 1 PHASE 2 PHASE 3 Theoretical Frameworks FARS Meta-Synthesis Mixed Methods Item generation Face validity Content validity FINAL PSYCHOMETRICS N= 400 Factor Structure Construct validity Preparation Enrollment Data Collection Analyses Dissemination Three manuscripts 1. Determinants of Safety 2. Qualitative meta- Synthesis 3. PH Model Five manuscripts 1. Classen et al. (2010), AJOT 2. Winter et al. (2011), CJOT 3. Classen et al. (2012), AJOT 4. Classen et al. (2012), AJOT 5. Classen et al. (2013), AJOT Dec Dec 2012 K-01 NIA: R-21 DOT FDOT

14 Overview Research PHASE 1 PHASE 2 PHASE 3 Theoretical Frameworks FARS Meta-Synthesis Mixed Methods Item generation Face validity Content validity FINAL PSYCHOMETRICS N= 400 Factor Structure Construct validity Rater Reliability Preparation Enrollment Data Collection Analyses Dissemination Three manuscripts 1. Determinants of Safety 2. Qualitative meta- Synthesis 3. PH Model Five manuscripts 1. Classen et al. (2010), AJOT 2. Winter et al. (2011), CJOT 3. Classen et al. (2012), AJOT 4. Classen et al. (2012), AJOT 5. Classen et al. (2013), AJOT Dec Dec 2012 K-01 NIA: R-21 DOT FDOT

15 Overview Research PHASE 1 PHASE 2 PHASE 3 Theoretical Frameworks FARS Meta-Synthesis Mixed Methods Item generation Face validity Content validity FINAL PSYCHOMETRICS N= 400 Factor Structure Rater Effects Construct validity Rater Reliability Preparation Enrollment Data Collection Analyses Dissemination Three manuscripts 1. Determinants of Safety 2. Qualitative meta- Synthesis 3. PH Model Five manuscripts 1. Classen et al. (2010), AJOT 2. Winter et al. (2011), CJOT 3. Classen et al. (2012), AJOT 4. Classen et al. (2012), AJOT 5. Classen et al. (2013), AJOT Dec Dec 2012 K-01 NIA: R-21 DOT FDOT

16 Overview Research PHASE 1 PHASE 2 PHASE 3 Theoretical Frameworks FARS Meta-Synthesis Mixed Methods Item generation Face validity Content validity FINAL PSYCHOMETRICS N= 400 Factor Structure Rater Effects Construct validity Criterion validity Rater Reliability Preparation Enrollment Data Collection Analyses Dissemination Three manuscripts 1. Determinants of Safety 2. Qualitative meta- Synthesis 3. PH Model Five manuscripts 1. Classen et al. (2010), AJOT 2. Winter et al. (2011), CJOT 3. Classen et al. (2012), AJOT 4. Classen et al. (2012), AJOT 5. Classen et al. (2013), AJOT Dec Dec 2012 K-01 NIA: R-21 DOT FDOT

17 Table 7. Sensitivity, Specificity, PPV, NPV and error based on F/C Ratings Cutoff 1= = = = = Sensitivity (true positive rate) Specificity (true neg. rate) PPV NPV Error False Positive False Negative Total Misclassification

18 Overview Research PHASE 4 Web-based FTDS & Keyform Focus Groups OTs CDRS Caregivers Beta test Manual Videos Scoring & Results Wed-based version Pilot testing Implementation Translation Next Steps Three Manuscripts Jan 2012 October 2012 Florida Dep of Transportation

19 Algorithm to Classify Drivers Seven Critical Items 9 Stay in Ln 27 Change Ln mod traf 30 Maintain Ln when turn 32 Turn Rt enter traf 39 Let turn into traf 41 Stay within Ln mark 42 Stay within Ln absn Cutoff 1 = Cutoff 2 = Four Main Groups (A-D) 2 subgroups (A-D: 1-2) A= Accomplished Driver B= Routine Driver C= At-risk Driver D= Misfit the Model

20 Most difficult items Example of the Web-Based Keyform and Recommendations Rating scale 1. Very Difficult 2. Somewhat Difficult 3. A Little Difficult 4. Not Difficult Items Easiest items

21 Driver A Driver B Somewhat to very difficult A little difficulty Should Driver A continue to drive? Should Driver B continue to drive? What are the next steps for each of the drivers? Who needs referral to a CDRS? If you are the family member for driver A and B what would you do? A little to somewhat difficult No difficulty

22 Overview Research PHASE 4 Web-based FTDS & Keyform Focus Groups Beta test OTs Manual CDRS Videos Caregivers Pilot PHASE 5 Implement AARP AOTA AAA You PHASE 6 Canadian Context Wed-based version Pilot testing Implementation Translation Next Steps Two Manuscripts Focus groups Manuscript Final psychometrics Three Manuscripts April 2012 FDOT October 2012 Dec 2013 Jan 2014-Dec 2015

23 More than 30,000 people has accessed the FTDS from Jan 2013-June Countries are U.S., Canada, Japan, England, Europe and elsewhere Overview Research PHASE 4 Web-based FTDS & Keyform Focus Groups Beta test OTs Manual CDRS Videos Caregivers Pilot PHASE 5 Implement AARP AOTA AAA You PHASE 6 Canadian Context Consumer Patterns Wed-based version Pilot testing Implementation Translation Next Steps Two Manuscripts Focus groups Manuscript Final psychometrics Three Manuscripts April 2012 FDOT October 2012 Dec 2013 Jan 2014-Dec 2015

24 Overview Research PHASE 4 Web-based FTDS & Keyform Focus Groups Beta test OTs Manual CDRS Videos Caregivers Pilot PHASE 5 Implement AARP AOTA AAA You PHASE 6 Canadian Context Consumer patterns Korean Version Wed-based version Pilot testing Implementation Translation Next Steps Two Manuscripts Focus groups Manuscript Final psychometrics Three Manuscripts April 2012 FDOT October 2012 Dec 2013 Jan 2014-Dec 2015

25 Overview Research PHASE 4 PHASE 5 PHASE 6 PHASE 7 Web-based FTDS & Keyform Focus Groups Beta test OTs Manual CDRS Videos Caregivers Pilot Implement AARP AOTA AAA You Canadian Context Consumer Patterns Korean Version Japanese Version 32-item FTDS 21- FTDS SF; CAT Wed-based version Pilot testing Implementation Translation Next Steps Two Manuscripts Focus groups Manuscript Final psychometrics Four Manuscripts Three Manuscripts April 2012 FDOT October 2012 Dec 2013 Jan 2014-Dec 2015 Jan AHRQ

26 FTDS References 1) Classen, S., Winter, S.M., Velozo, C., Bédard, M., Lanford, D.N., & Brumback, B., Lutz, B. (2010). Item Development and Validity Testing for a Safe Driving Behavior Measure. American Journal of Occupational Therapy, 64 (2), ) Winter, S. M., Classen, S., Bédard, M., Lutz, B., Velozo, C. A., Lanford, D. N., & Brumback, B. (2011). Focus Group Findings for a Self-report Safe Driving Behavior Measure. Canadian Journal of Occupational Therapy, 78(2), ) Classen, S., Wen, P., Velozo, C., Bédard, M., Brumback, B., Winter, S.M., & Lanford, D.N. (2012). Rater Reliability and Rater Effects of the Safe Driving Behavior Measure. American Journal of Occupational Therapy, 16, ) Classen, S., Wen, P., Velozo, C., Bédard, M., Brumback, B., Winter, S.M., & Lanford, D.N. (2012). Psychometrics of the Self-Report Safe Driving Behavior. Measure for Older Adults. American Journal of Occupational Therapy, 66(2), ) Classen, S., Wang, Y., Velozo, C., Bédard, M., Winter, S.M., & Lanford, D.N. (2013). Concurrent Criterion Validity of the Safe Driving Behavior Measure: A Predictor of On-Road Driving Outcomes. American Journal of Occupational Therapy, 67(1), ) Classen, S., Winter, S. M., Velozo, C., Hannold, E. M., & Rogers, J. (2013). Stakeholder Recommendations to Refine the Fitness-to-Drive Screening Measure. The Open Journal of Occupational Therapy Vol. 1: Iss. 4, Article ) Classen, S., Velozo, C., Winter, S.M., Wang, Y., Bedard, M. (2015). Psychometrics of the Fitness-to-Drive Screening Measure. OTJR: Occupation, Participation and Health, 35(1),

27 FTDS References 8. Classen, S., Medhizadah, S. & Alvarez, L. (2015). The Fitness-to-Drive Screening Measure : Enabling Caregivers to Detect At-risk Older Drivers. Occupational Therapy Now, 17 (5), Classen, S., Alvarez, L., Chen, C., Ferreira, P., Meyer C., Nywening, A. (2016). Enhancing the Fitness-to-Drive Screening Measure to include Canadian Stakeholders. OTJR: Occupation, Participation and Health, 36(2), Yoon-Ju Jeong, Min-Ye Jung, Eun-Young Yoo, Ji-Hyuk Park, Classen, S., & Winter S. Development and Reliability of Korean Safe Driving Behavior Measure (K-SDBM) (2014). The Journal of Korean Society of Occupational Therapy, 22(3), Classen, S., Alvarez, L., & Medhizadah, S. (2016).The Fitness-to-Drive Screening Measure : Patterns and Trends for Canadian Users. The Open Journal of Occupational Therapy, 4, 4, Article Classen, S., & Medhizadah, S. (2017). Fitness-to-Drive Screening Measure: A valid and reliable tool for occupational therapy practice. OT Practice, OT Practice. SIS Quarterly Practice Connections, 2 (1), ISSN Medhizadah, S., Classen, S., & Johnson, A. Predictive validity of the short form Fitness-to-Drive Screening Measure. Frontiers of Psychology. Under review (Aug 2018). 14. Medhizadah, S., Classen, S., & Johnson, A. (2018). Constructing and validating the Short Form Fitness-to-Drive Screening Measure. OTJR: Occupation, Participation and Health, 38(2), Classen, S., Medhizadah, S., Romero, S., Lee, M.J. Constructing and validating the short form Fitness-to-Drive Screening Measure. Manuscript submitted to Frontiers in Public Health. Submitted September 14 th, 2018.

28 Visit web-site On-line FTDS Contact Information Dr. Sherrilene Classen

29 Fitness-to-Drive Screening Measure - Recommendations 1 of 2 2/14/2014 2:36 PM Also see Keyform Results Select parameters, then click Update to view recommendations. Items: Sessions: Total Item Responses: 49 Outfit (mean-squared)): 0.48 Outfit (Z-score)): Infit (mean-squared)): 0.65 Infit (Z-score)): Person Measure: out of 100 (2.72 logits) Overall rating: Based on your rating, this driver is classified within the "Routine Driver" Group and shows early signs of needing intervention. There are driving skills that are causing concern. For example: Drive in a thunderstorm with heavy rains and wind? Drive when there is glare or the sun is in his or her eyes? Drive at night on a dark road with faded or absent lane lines? Specific Recommendations: We recommend a doctor's appointment to start a conversation about conditions that may impact driving safety. The driver will also benefit from a comprehensive driving evaluation to address safety concerns. We do recommend repeating this self-screening annually, or when the driver experience changes in health or functional status. General Recommendations: The American Geriatrics Society recommends a physical and eye exam annually, or earlier, when needed. We recommend taking

30 Fitness-to-Drive Screening Measure - Recommendations 2 of 2 2/14/2014 2:36 PM a class for mature drivers such as those offered by AAA, AARP or a local driving school. For further details on driving or community mobility, click on the links below: Resources: AAA Resources for Mature Drivers American Automobile Association (AAA) AARP Driver Safety AARP Certified Driving Rehabilitation Specialists/ Occupational Therapists providing the Comprehensive Driving Evaluations American Occupational Therapy Association The Association for Driver Rehabilitation Specialists (ADED) showtitle=1 Information and free resources to help you become more familiar with transportation resources and services available in your community. National Center on Senior Transportation /site/pageserver?pagename=ncst2_older Home Disclaimer Privacy Policy User Manual Contact Us Institute for Mobility, Activity and Participation (I-MAP) 2013 University of Florida This page uses Google Analytics (Google Privacy Policy)

31 Fitness-to-Drive Screening Measure - Keyform Results 1 of 3 2/14/2014 2:37 PM Also see Recommendations Select parameters, then click Update to build Keyform output. Items: Clustering: Sessions: Show Responses: Total Items: 49 Outfit (mean-squared)): 0.48 Outfit (Z-score)): Infit (mean-squared)): 0.65 Infit (Z-score)): Person Measure: out of 100 (2.72 logits) Rating Scale Item Description Use paper map Drive heavy rain&wind Drive glare Drive night absent lane lines Drive unfamiliar urban Drive unfamiliar area Drive at night Drive when fog Parallel park

32 Fitness-to-Drive Screening Measure - Keyform Results 2 of 3 2/14/2014 2:37 PM Pass larger vehicle no passing ln Drive when upset Turn L across lns no traf light Stay focused Alter driving health changes Drive a different car Enter traf with left turn Avoid dangerous situations Pass car no passing ln Exit an expressway Drive in dense traffic Drive with conversation Control car avoid collisions Drive with assistance Drive with tractor Check blind spots bf change Control car wet road Read road signs ad to react Back out of parking Maintain ln when turn Change lns moderate traffic Merge onto a Hwy Stay with ln without markings Keep distance Drive in construction zone

33 Fitness-to-Drive Screening Measure - Keyform Results 3 of 3 2/14/2014 2:37 PM Keep up with flow Check when back out Stop Sign Check mirror change Ln Share road Drive on highway 2+ lanes Stay in the proper Ln Keep distance when change Ln Drive cautiously Use car controls Stay within ln markings Enter flow when turn R Drive in light rain Obey forms of traf lights Look L&R bf crossing Home Disclaimer Privacy Policy User Manual Contact Us Institute for Mobility, Activity and Participation (I-MAP) 2013 University of Florida This page uses Google Analytics (Google Privacy Policy)

34 Page 1 of 3 Case Study 3: Elizabeth Key Form # SDBM 1040 Elizabeth is a 74 year old white female with a diagnosis of glaucoma right eye (10 years) and comorbidities including high blood pressure (40 years), arthritis in hips and lower back (10 years), cataracts in right eye (5 years), sciatica (45 years), clinical depression (2 years), sleep disorder (20 years). She is taking; eye drops for glaucoma, hydrochlorothiazide and lisinpril for blood pressure, multivitamin, and glucosamine chondroitin. She has a doctoral degree and is living alone. She wears spectacles. She drives 5 days a week, drives mostly alone, and she maintains her vehicle well. She is active in her community participating in garden club, doing her own shopping and volunteer work at the local hospital. She avoids driving in rain, rush hour traffic, night time driving, and interstate/ highway driving. She has had no crashes or citations in the past three years. She has taken a classroom-based driving refresher course, more than three years ago. From this information, construct a list of strengths and challenges for Elizabeth Strengths Challenges She has completed a clinical battery of tests yielding the following results: Vision: Acuity 20/30 both eyes (20/50) o Right eye 20/30 o Left eye 20/20 Contrast sensitivity intact Peripheral fields intact Depth perception = 4/9, impaired (cut-off = 5/9) Color discrimination intact Lateral/vertical phorias intact Cognition: MMSE 26/30 [Recalled one of the three items; copy design = 0] (cut-point= 26/30) Trails B = 150 seconds (cut-point= 180 seconds) Useful Field of View (UFOV) = Category 3 (moderate risk for crashes) UFOV sub-test 1: 80.1; sub-test 2: ms; sub-test 3: ms (cut-point= 500 milliseconds)

35 Page 2 of 3 Motor: Transfers and ambulation= independent Rapid pace walk= 7.02 seconds (cut-point= 7 seconds) Range of Motion = Within Functional Limits: Upper extremities and Lower extremities, Trunk, and Neck Gross Manual Muscle Test Strength = Within Functional Limits for Upper extremities and Lower extremities, Trunk, and Neck Coordination o Finger to nose: Right= 6.9 seconds; Left= 7.25 seconds (cut-off = 10 seconds) o Toe tap: R= 3.25 seconds; L= 3.99 seconds (cut-off = 10 seconds) Her friend has completed the Fitness to Drive Screening Measure (FTDS) yielding the following results Measure Score = (cut point range ) She is classified as a routine driver Identify the difficulties based on her keyform results [2s and 3s] Identify the Recommendations from her keyform? She has completed an on-road test with the following results: Stops over stop lines at intersections Make wide turns and turn into the furthest lane Not maintaining lateral lane position as she drifts to the left, but can self-correct Not using turn signal consistently CDRS Recommendation No highway driving Avoid rush hour traffic Instruction on where to stop in reference to stop line Instructions on use of the turn signals What are your driving recommendations for Elizabeth? Provide a rationale Can she continue to drive? Why/ why not? If so, with or without restrictions?

36 Page 3 of 3 What are the restrictions? If so, any follow-up sessions by the CDRS? Frequency & Intensity Time Type Use the results of the clinical tests, the on-road test, and the FTDS to develop an intervention plan for Elizabeth. Short-term goals Intermediate goals Long-term goals Articulate your discharge plan