Central Queensland University, Australia.
Title: A RANDOMISED CONTROLLED TRIAL TO DETERMINE THE EFFECT OF ASSESSMENT LOCATION AND NUMBER OF ASSESSMENTS ON DRIVING PERFORMANCE OF PEOPLE WITH DEMENTIA
Professor Carolyn Unsworth received her BAppSci(OccTher) (Bachelor of Occupational Therapy) (1989) and PhD (1994) from La Trobe University Australia, and is a registered occupational therapist in the USA (OTR) since (1994). Dr Unsworth is an internationally respected researcher and educator, having provided undergraduate and post-graduate seminars, lectures and courses in Australia, USA, UK, Sweden and Singaopre in her specialty areas of community transport mobility and driving, cognitive and perceptual problems following acquired brain damage, and evidence-based practice. Carolyn is currently Professor of Occupational Therapy at Central Queensland University and holds Adjunct Professorial appointments at La Trobe University, Melbourne, Jönköping University, Sweden, and Curtin University in Perth, Australia. She also held the position of Visiting Professor at London South Bank University for the term 2010- 2011.
Background: An occupational therapy fitness-to-drive assessment may be required to determine if drivers in the early stages of dementia can continue to drive. Such assessments could be better tailored for clients with dementia if we had research evidence to support the
Location of assessment (open or local area), method (self-directed or directed) and whether repeat testing is required (opportunity to undertake a second test), or which combination of these factors is best for drivers with, and without navigational difficulties.
Objectives: To determine the effect of location of assessment (open or local area) and practice (undertaking more than one assessment) on pass or fail outcome for drivers both with, and without navigational problems.
Methods: 43 clients (mean age 77 SD 6.69) participated in a stratified randomised controlled trial in which the ordering and location of on-road driving tests were also randomised. Client driving assessment outcomes were recorded as pass, condition, or fail. Data were analysed using a generalized linear mixed effects model.
Results: Overall 9 (21%) of drivers failed and 34 (79%) passed. The 43 participants undertook a total of 93 on-road assessments and for clients with no navigational problems 20% failed the local and 33% failed the open route tests, as opposed to 58% (local) and 55% (open) for clients with navigational problems. Overall, participants with navigational problems were 6 times more likely to fail the on-road test: B = -1.793 (95%CI -3.265 to- 0.321), p<0.01. The OT-Drive Home Maze Test was a significant predictor of outcome on the on-road test, with slower times predictive of fail: B = -1.14, z = -2.219, p = 0.012.
Conclusions: Therapists can be confident that driver performance when undertaking a test is not influenced by practice or location. However, drivers with navigational problems are more likely to fail their on-road test.