Insufficient sleep and fitness to drive in shift workers: A systematic literature review.

BACKGROUND: Insufficient sleep, <6.5 h per night, majorly affects shift workers, placing them at higher risk for motor vehicle crash related injury or fatality. While systematic reviews (SLRs) examine the effects of insufficient sleep and driving, to date, no SLR focuses on driver fitness or performance in shift workers. OBJECTIVES: Determine the class of evidence (Class I-highest to Class IV-lowest), and level of confidence (Level A-high, to Level U-insufficient) in the determinants of driver fitness and performance in shift workers. Next, consider evidence-based recommendations for clinical practice, research, and policy. METHODS: A protocol was registered on PROSPERO (#CRD42018052905) using an established SLR methodology: a comprehensive electronic database search, study selection, data extraction, critical appraisal, analysis, and interpretation using published guidelines. RESULTS: Searches identified 1226 unique records with 11(2 on-road, 9 simulator) meeting final inclusion criteria. Class III to IV evidence identified that exposure to overnight shift work possibly predicts (Level C confidence) drivers at risk for adverse on-road outcomes and likely predicts (Level B) drivers at risk for adverse driving simulator outcomes. Higher ratings of subjective sleepiness and extended time driving possibly predict (Level C) drivers at risk for adverse driving simulator outcomes. CONCLUSIONS: This study demonstrates a low to moderate level of confidence in the determinants of driving in shift workers. A critical need exists for gold-standard on-road assessments integrating complex driving environments representative of real-world demands, targeting tactical and strategic outcomes in a broad spectrum of shift workers.

Clinical Determinants of Fitness to Drive in Persons With Multiple Sclerosis: Systematic Review.

OBJECTIVE: To critically appraise the evidence for the clinical determinants of fitness to drive in adults with multiple sclerosis (MS). DATA SOURCES: The research librarian and lead author searched 7 databases for driving simulator and on-road studies for adults with MS published in the English language from 1991 to 2018. STUDY SELECTION: Three reviewers independently screened titles, abstracts, and full-texts for studies with: cohort, case-control, or cross-sectional designs; participants, 18 years or older, with relapsing or progressive MS; visual, cognitive, or motor clinical assessments as predictors; and driving performance through simulator or fitness to drive through on-road assessment as outcomes. DATA EXTRACTION: Using the 2017 American Academy of Neurology guidelines, reviewers independently classified each study from class I to class IV, or highest to lowest amount of rigor. For each clinical assessment, reviewers independently rated the level of confidence for predicting driving performance or fitness to drive from level A, highly probable; B, probable; C, possible; to level U, insufficient conclusions. DATA SYNTHESIS: Through qualitative synthesis, 2 class III and 4 class IV driving simulator studies employed 24 clinical assessments with level C (n=4) or level U (n=20) confidence for predicting driving performance. Six class II and 3 class IV on-road studies employed 35 clinical assessments with level B (n=9), level C (n=22), or level U (n=4) confidence for predicting fitness to drive. CONCLUSIONS: This systematic review identified mostly insufficient conclusions for predicting driving performance in driving simulator studies, and possible conclusions for predicting fitness to drive in on-road studies. The best available evidence suggests that the Stroke Driver Screening Assessment and Useful Field of View test probably predict fitness to drive in adults with MS (level B). Class I studies that compare predictors of fitness to drive with large prospective samples of adults with and without MS are necessary for highly probable conclusions.

Insufficient sleep and fitness to drive in shift workers: a systematic literature review protocol.

BACKGROUND: The majority of shift workers experience insufficient sleep as a result of their employment. Insufficient sleep is associated with impaired neurocognitive functioning, affecting key skills required for driving, resulting in shift workers experiencing a disproportionate burden of RTC injuries and fatalities. Yet, to our knowledge, no systematic literature review (SLR) exists to critically appraise and synthesise evidence on the determinants of fitness to drive (assessed on-road) and driving performance (assessed in a driving simulator) in shift workers with insufficient sleep. OBJECTIVES: A SLR protocol is established to conduct analysis and synthesis of the level of evidence and confidence in the determinants of fitness to drive and driving performance, among shift workers with insufficient sleep. METHODS: This study follows Cooper and Hedges' established SLR methodology: formulate the problem, locate and select studies, collect data, appraise critically, analyse and present data, interpret results and disseminate information. Critical appraisal and analysis follows the 2017 American Academy of Neurology guidelines determining the level of evidence and the level of confidence for each determinant identified in the literature. Protocol and results reporting adhere to the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocols guidelines. CONCLUSIONS: This SLR contributes to research evidence examining the impact of insufficient sleep and driver sleepiness on fitness to drive and driving performance. Analysis of the level of evidence and level of confidence in the existing literature will advance evidence-informed prevention strategies and critical decision-making, to mitigate adverse effects of insufficient sleep for improving road safety.

Feasibility of DriveFocus™ and Driving Simulation Interventions in Young Drivers.

Motor vehicle collisions are the leading cause of death among North American youth, with a high prevalence of distraction-related fatalities. Youth-focused interventions must address detecting (visual scanning) and responding (adjustment to stimuli) to critical roadway information. In this repeated measures study, we investigated the feasibility (i.e., recruitment and sample characteristics; data collection procedures; acceptability of the intervention; resources; and preliminary effects) of a DriveFocus™ app intervention on youth's driving performance. Thirty-four youth participated in a 9-week protocol (retention rate = 89.7%; adherence rate = 100%). No participants experienced simulator sickness. A preliminary nonparametric evaluation of the results ( n = 34) indicated a statistically significant decrease in the number of visual scanning, F(2, 68) = 3.769, p = .028, and adjustment to stimuli, F(2, 68) = 6.759, p = .002, errors between baseline, midpoint, and posttest. This study lays the foundation to support a targeted intervention trial to improve youth's attention to critical road information, building on their mobile technology preferences.

Pilot Efficacy of a DriveFocus™ Intervention on the Driving Performance of Young Drivers.

Road traffic injuries are the leading cause of death for youth between the ages of 15 and 29 around the world. A need remains for evidence-based interventions that can improve the underlying skills of young drivers, including hazard perception and anticipation. This pilot study investigated the preliminary impact of a six session DriveFocus™ intervention on the ability of young novice drivers (mean age = 18.6, SD = 2.12) to detect (visual scanning), and respond (adjustment to stimuli) to critical roadway information. Using a CDS-200 DriveSafety™ simulator, drives were recorded and sent to a blinded evaluator (occupational therapist), who scored the recorded drives for number and type (visual scanning and adjustment to stimuli) of errors. We observed a statistically significant decline in the number of visual scanning [t(34) = 2.853, p = 0.007], adjustment to stimuli [t(34) = 3.481, p = 0.001], and total driving errors [t(34) = 3.481, p = 0.002], among baseline and post-test 2.

Interrater reliability of Western University's on-road assessment.

BACKGROUND: Little empirical support exists for interrater reliability between evaluators from different backgrounds when assessing on-road outcomes of drivers. PURPOSE: We quantified interrater reliability of on-road outcomes between a certified driving school instructor (DI) and an occupational therapist and certified driver rehabilitation specialist (CDRS). METHOD: Both raters used the Global Rating Score (GRS) with two levels (pass, fail), the GRS with four levels (pass, pass with recommendations, fail remediable, fail), and the priority error rating score (PERS; most frequently occurring on-road errors in priority order) to assess 35 drivers (age, M = 48.31 years, SD = 9.76 years; 40% male; 86% with multiple sclerosis). FINDINGS: The DI and occupational therapist CDRS had excellent agreement on the GRS with two levels (κ = .892, p < .0001), GRS with four levels (κ = .952, p < .0001), and the PERS (κ = .847-.902, p < .0001), indicating interrater reliability. IMPLICATIONS: This research contributes to empirical support for the on-road assessment.

Work capacity assessment and return to work: a scoping review.

OBJECTIVE: This review sought to synthesize existing evidence on work capacity assessments and to identify the knowledge supporting their use in return to work practice and future research. METHODS: A scoping review was conducted identifying studies examining assessments used in return to work. Studies published before 1986 and studies not written in English were excluded. A five point relevancy criteria was used to establish the fit of articles with the research question. Articles were thematically analyzed into components of the PEO Model, proposed future research, and areas of vested interest. RESULTS: Forty four articles met the criteria for inclusion. For over twenty five years, work capacity assessment literature has remained focused on the individual's physical work performance capacities. Gaps were identified in the lack of qualitative research and incorporation of person, occupation, and environmental dimensions in evaluation of work capacity. Future research recommendations emphasize the need for knowledge generation on work modification and investigation of psychosocial factors that impact work capacity and return to work yet only minimal progression is evident in these areas in the literature reviewed. CONCLUSION: The limited consideration of the occupation and environmental dimensions in returning to work and the global interest in work capacity assessment highlight the need for the development of contextually based assessment tools. Assessment needs to move toward the incorporation of environmental and occupational aspects in addition to the person dimension in a culturally transcendent manner.

Knowledge brokering with injured workers: Perspectives of injured worker groups and health care professionals.

OBJECTIVE: The aim of this study is to understand the barriers and facilitators in brokering knowledge brokering knowledge to help injured workers make informed decisions about recovery and to support their transitions to return to work (RTW). PARTICIPANTS: Perceptions of 63 Injured Worker Groups (IWGs) and 43 Health Care Professionals (HCPs) in facilitating and brokering knowledge were examined. METHODS: Critical theory and participatory action research approaches informed the development of a multi-stakeholder research team and the study design to support an exploration into knowledge exchange and transfer. Data was analyzed using a critical occupational perspective to reveal the source of barriers and to identify the facilitators of the knowledge exchange and transfer process. RESULTS: Barriers in transferring knowledge included system barriers, a lack of information accessibility, and problems with variations in injured worker capacity and experience using information. IWG and HCP participants lacked expertise in knowledge transfer. Findings also revealed the interactive knowledge transfer processes that IWGs and HCPs use to help injured workers understand and use information. CONCLUSIONS: Change is required to improve knowledge exchange and transfer of information for and to persons with injuries and disabilities. Suggested changes include the development of a sustainable knowledge transfer community of practice, a best practice guide for knowledge brokers such as IWGs and HCPs, and a process for ongoing assessment and evaluation of injured worker information needs and preferences.