Assessing Fitness to Drive. DriveSafe DriveAware. A valid cognitive fitness to drive screening test for medical practice? 8/10/2015.

Transcription

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 1 Assessing Fitness to Drive The University of Sydney Page 2 1

2 Assessing Fitness to Drive 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? The University of Sydney Page 3 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 2: Examine psychometric properties / predictive validity Phase 3: Implementation into 2 x medical practices (Sydney / Melbourne) The University of Sydney Page 4 2

3 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? The University of Sydney Page 5 What you told us 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 doctorpatient relationship / liability The University of Sydney Page 6 6 3

4 What you told us How frequently do you use each of the following to assess fitness to drive? Your professional judgement Observe factors such as patients mobility, grooming and behaviour Refer to Assessing Fitness to Drive medical guidelines (Austroads) Question family about their concerns Formal assessments (eg. Mini- Mental State Examination) Referral for an occupational therapy driving assessment Always Often Sometimes Rarely Never NA Other 0% 20% 40% 60% 80% 100% The University of Sydney Page 7 I m not sure that the tools I use are really measuring my patient's ability to drive What you told us 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 The University of Sydney Page 8 4

5 The University of Sydney Page 9 Assessing Fitness to Drive 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 The University of Sydney Page 10 5

6 Assessing Fitness to Drive Not practical to test every driver with a medical condition on-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 The University of Sydney Page 11 Assessing Fitness to Drive 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 The University of Sydney Page 12 6

7 The University of Sydney Page 13 Assessing Fitness to Drive How can you test cognitive 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? How do you measure insight? The University of Sydney Page 14 7

8 Clinical test that will predict actual driving performance 20+ years of research Break down driving into component skills Assess component skills (e.g., visual perception, concentration, memory) Most tests do not have face validity Difficult to find a single test that accurately predicts driving ability The University of Sydney Page 15 Cognitive Assessment A good test is: Sensitive - detects a problem if one exists Specific - does not over diagnose The University of Sydney Page 16 8

9 Pre-cursor Test VRST/DSDA Used for 20+ years by driver trained OTs The University of Sydney Page 17 Test Purpose A cognitive screening tool that measures: Awareness of the driving environment Real driving situations represented Driver must recall everyday hazards that can impact driving safety Awareness of own abilities related to driving A person unaware of decline in their driving performance is unable to use compensatory strategies The University of Sydney Page 18 9

10 Test Purpose The University of Sydney Page 19 DSDA Research The University of Sydney Page

11 DSDA Research 2007 large retrospective study (N=838). VRST sound psychometric properties / promising test / cutoff scores. Sensitivity 81% / Specificity 89%. Updated / shortened = DSDA computer version. Awareness component added / 2009 DriveAware study (N=91) study examined combined tests with cognitively impaired drivers (N=115). Trichotomised drivers. Upper cutoff - identified safe drivers with a sensitivity 93% / lower cutoff - unsafe drivers - specificity 97% Touch Screen DSDA (N=134) The University of Sydney Page DriveSafe DriveAware Challenge Trained administrator Interpreting verbal responses Computer, data projector, screen 30 mins Australian context Partly self administered Tablet / touch screen minutes Busy medical practice / portable International The University of Sydney Page 22 11

12 Touch Screen DSDA Research 10 driving clinics across Australia and New Zealand Criterion Measure: Standardised on road assessment OTs blind to DSDA results Compare DSDA results with outcome of on road assessment The University of Sydney Page 23 Touch Screen DSDA Research Gender No. Female 40 Male 94 (70%) Total 134 Country No. Australia 80 (60%) New Zealand 54 Age No Total 134 (Age 75+ = 60) The University of Sydney Page

13 Participant Diagnosis (N=134) The University of Sydney Page 25 Accuracy of Classification The University of Sydney Page 26 13

14 Touch Screen DSDA Results Sound psychometric properties Sensitivity of lower cutoff score in identifying unsafe drivers DS - 91% DA - 89% Specificity of upper cutoff score in identifying safe drivers DA 94% DS 91% Combined Tests: Specificity - 86% / Sensitivity - 91% Overall accuracy of classification 88% The University of Sydney Page 27 Who Can Administer? General practitioners & other medical specialists Practice nurses under the supervision of a GP Other health professionals The University of Sydney Page 28 14

15 Who Can Be Tested? 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) The University of Sydney Page Presentation Title runs here l 00/00/00 Who Can Be Tested? 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 The University of Sydney Page 30 15

16 Testing Setting Office Setting Self-administered + interview Approx. 10 minutes ipad (ios 7 or later) Desk / office chair Stand (20 ) Stylus / headphones optional The University of Sydney Page 31 Testing Format 3 Subtests: DriveSafe DriveAware Intersection Rules (Optional) - Self administered - Partly self administered - Self administered The University of Sydney Page

17 1. Set up the patient The University of Sydney Page 33 The University of Sydney Page 34 17

18 The University of Sydney Page Conduct the interview The University of Sydney Page 36 18

19 4. Provide Results The University of Sydney Page 37 Subtest 1: DriveSafe The University of Sydney Page Presentation Title runs here l 00/00/00 19

20 The University of Sydney Page 39 The University of Sydney Page 40 20

21 The University of Sydney Page 41 The University of Sydney Page 42 21

22 Demo Item The University of Sydney Page 43 Demo Item The University of Sydney Page 44 22

23 Demo Item The University of Sydney Page 45 Practice Items (3) The University of Sydney Page 46 23

24 Practice Items The University of Sydney Page Presentation Title runs here l 00/00/00 Practice Items The University of Sydney Page 48 24

25 Practice Items The University of Sydney Page 49 Administrator Assisted Model The University of Sydney Page Presentation Title runs here l 00/00/00 25

26 The University of Sydney Page 51 The University of Sydney Page 52 26

27 The University of Sydney Page Presentation Title runs here l 00/00/00 Scoring & Reporting The University of Sydney Page 54 27

28 Copyright. Pearson Australia Gr oup 1 of 2 Copyright. Pearson Australia Gr oup 8/10/2015 DriveSafe DriveAware - Extended Report DriveSafe DriveAware - Patient Letter Name John Hepples MRN 654 Name John Hepples MRN 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 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. Your results were: DriveSafe 77 / 84 Missed 1 object and 6 details (location/dir ection). DriveAware 12 / 17 A score of 13 and above indicates awar ness of abilities related to driving. Intersection Test 6/ 8 Total score 77 / 84 Additional objects 1 Time 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. 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) Intersection Rules Right of way is determined for 8 intersections. Table 2: Performance based on intersection complexity DriveSafe Intersection No. Road Signs No. of Vehicles in Image Score 1, 3, 4, 7 Without road signs 2 3/4 2, 5, 6, 8 With road signs 3-4 3/ DriveAware Total score Time taken to complete test 6 / minutes 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. Research indicates the median time taken to complete Intersection Rules for people who pass an occupational therapy onroad assessment is 2 minutes and 38 seconds, and for people who fail on-r oad, 3 minutes and 49 seconds. If you would like more information about DriveSafe DriveAware please visit the following website: e 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. The University of Sydney Page The University of Sydney Page 56 28

29 Touch Screen DSDA Use in the context of your clinical judgment / other indicators Be cautious about the language you use when giving advice about driving The University of Sydney Page 57 Questions? beth.cheal@pearson.com M: +61 (0) The University of Sydney Page 58 29