Establishing the Predictive Validity of the ScanCourse for Assessing On-Road Driving Performance.

IMPORTANCE: Scanning the environment is critical for driving safety. The ScanCourse is a functional assessment that assesses a person's ability to scan the environment for visual information while in motion. Measurement properties for the ScanCourse have been reported; however, its predictive validity is unknown. OBJECTIVE: To determine the predictive validity of the ScanCourse for on-road driving performance and establish clinical cutoff scores. DESIGN: Retrospective chart reviews were conducted over a 6-mo period. SETTING: Four Canadian driver rehabilitation programs. PARTICIPANTS: Charts from patients with neurological or vision conditions were eligible if they contained ScanCourse and on-road driving evaluation results between September 1, 2008, and August 30, 2018. Three hundred twenty-five charts were included for analysis. OUTCOMES AND MEASURES: Area under the curve (AUC) analysis was used to determine the predictive validity of ScanCourse scores for on-road outcomes; cutoff scores were established by optimizing sensitivity and specificity. RESULTS: The ScanCourse had an AUC of .702. The optimal cutoff score was 18/20 with a sensitivity of 76.7% and a specificity of 47.1%. CONCLUSIONS AND RELEVANCE: Assessing the scanning abilities of at-risk drivers who intend to return to driving after sustaining an injury can help identify safety risks and inform interventions. The ScanCourse was found to have acceptable discriminatory ability for on-road driving performance. This study provides evidence supporting its continued use as a screening tool to assess driver fitness with an identified optimal cutoff score for clinical use. WHAT THIS ARTICLE ADDS: Measuring the predictive ability of the ScanCourse assessment in relation to on-road driving performance provides occupational therapists with an evidence-based clinical tool to assist with screening fitness to drive among at-risk people.

Evaluating the Measurement Properties of the ScanCourse, a Dual-Task Assessment of Visual Scanning.

IMPORTANCE: The ScanCourse is used by occupational therapists to evaluate visual scanning ability during locomotion. Its measurement properties have not been examined. OBJECTIVE: To assess the interrater reliability, test-retest reliability, and construct validity of the ScanCourse. DESIGN: This study involved data collection at two time points. To assess test-retest reliability, the ScanCourse was administered twice within a 2-week period. To assess interrater reliability, a second rater was present for one session. To assess level of agreement, a Bland-Altman plot was created. To assess absolute reliability, the standard error of measurement was calculated. To evaluate construct validity, the results of the ScanCourse were compared with results of the Bells Test and Trail Making Test A and B. SETTING: Rehabilitation hospital. PARTICIPANTS: Forty-one patients with neurological impairments. OUTCOMES AND MEASURES: The ScanCourse (participants identify numbered cards placed on both sides of a hallway at various heights during locomotion). RESULTS: The ScanCourse was found to have excellent interrater reliability (intraclass correlation coefficient [ICC] [1,1] = .998; 95% confidence interval [CI] [.996-.999]), test-retest reliability (ICC [1,1] = .912; 95% CI [.811-.959]), a high level of agreement, and a low standard error of measurement (.503), and it was found to be significantly correlated with Trails A (rs = -.436, p = .009) and B (rs = -.364, p = .029). CONCLUSIONS AND RELEVANCE: The assessment was found to have strong measurement properties, and it is therefore an appropriate tool for assessing dual-task visual scanning among those with neurological impairments. WHAT THIS ARTICLE ADDS: This research demonstrates that the ScanCourse is reliable between raters and over time and that scores on the measure vary as anticipated with scores on a related measure, which provides evidence of its validity. These findings support its use in practice.

Visual Field Impairment and Driver Fitness: A 1-Year Review of Crashes and Traffic Violations.

IMPORTANCE: Occupational therapists frequently assess the fitness to drive of people with visual field impairment, but the relationship between these assessments and driving performance over time is not well understood. OBJECTIVE: To determine traffic violation and crash incidence over a 1-yr period for drivers with visual field impairment. DESIGN: Retrospective review of medical and driving records. SETTING: British Columbia, Canada. PARTICIPANTS: Participants (N = 445) were ages 26-74 yr with binocular, corrected visual acuity of ≥20/50. Goldmann visual field tests were reviewed to stratify participants on the basis of visual field impairment and whether impairments exceeded licensing standards. OUTCOME AND MEASURES: Traffic records were reviewed to determine group-specific traffic violations and crash incidence during the year after the visual field test. RESULTS: Of 445 participants, 292 held a valid driver's license during the designated period. Participants not meeting the licensing standards were less likely to become licensed than participants who met the standards. The results indicate that drivers with visual field impairment did not have a higher probability of crashes or violations than drivers without visual field impairment. CONCLUSION: Drivers with visual field impairment who retained a driver's license did not have an increased probability of crashes in the following year. A larger, prospective, mixed methods study of long-term driving behaviors among people with visual field impairment is recommended. WHAT THIS ARTICLE ADDS: This study provides preliminary data on the 1-yr incidence of traffic violations and crashes among people with visual field impairment.

Evaluating the Measurement Properties of the ScanCourse, a Dual-Task Assessment of Visual Scanning.

IMPORTANCE: The ScanCourse is used by occupational therapists to evaluate visual scanning ability during locomotion. Its measurement properties have not been examined. OBJECTIVE: To assess the interrater reliability, test-retest reliability, and construct validity of the ScanCourse. DESIGN: This study involved data collection at two time points. To assess test-retest reliability, the ScanCourse was administered twice within a 2-week period. To assess interrater reliability, a second rater was present for one session. To assess level of agreement, a Bland-Altman plot was created. To assess absolute reliability, the standard error of measurement was calculated. To evaluate construct validity, the results of the ScanCourse were compared with results of the Bells Test and Trail Making Test A and B. SETTING: Rehabilitation hospital. PARTICIPANTS: Forty-one patients with neurological impairments. Outcomes and Measures: The ScanCourse (participants identify numbered cards placed on both sides of a hallway at various heights during locomotion). RESULTS: The ScanCourse was found to have excellent interrater reliability (intraclass correlation coefficient [ICC] [1,1] = .998; 95% confidence interval [CI] [.996-.999]), test-retest reliability (ICC [1,1] = .912; 95% CI [.811-.959]), a high level of agreement, and a low standard error of measurement (.503), and it was found to be significantly correlated with Trails A (rs = -.436, p = .009) and B (rs = -.364, p = .029). CONCLUSIONS AND RELEVANCE: The assessment was found to have strong measurement properties, and it is therefore an appropriate tool for assessing dual-task visual scanning among those with neurological impairments. What This Article Adds: This research demonstrates that the ScanCourse is reliable between raters and over time and that scores on the measure vary as anticipated with scores on a related measure, which provides evidence of its validity. These findings support its use in practice.