Using Serial Trichotomization to Determine Fitness to Drive in Medically At-Risk Drivers.

IMPORTANCE: Clinical tests that identify fit and unfit drivers with 100% sensitivity and specificity would reduce uncertainty and improve efficiency of occupational therapists performing comprehensive driving evaluations (CDEs). OBJECTIVE: To examine whether serial trichotomization of clinical tests predicts pass-fail outcomes with 100% sensitivity and specificity in a sample of medically at-risk drivers and in drivers with and without cognitive impairment (CI) referred for a CDE. DESIGN: Retrospective data collection and analysis of scores on the Montreal Cognitive Assessment; Trail Making Test, Part A and Part B; and the Useful Field of View® Subtests 1 to 3 and outcomes on the CDE (pass-fail or indeterminate requiring lessons and retesting). Receiver operating characteristic curves of clinical tests were performed to determine 100% sensitivity and specificity cut points in predicting CDE outcomes. Clinical tests were arranged in order from most to least predictive to identify pass-fail and indeterminate outcomes. SETTING: A driving assessment clinic. PARTICIPANTS: Among 142 medically at-risk drivers (M age = 69.2 yr, SD = 14.1), 66 with CI, 46 passed and 39 failed the CDE; 57 were indeterminate. OUTCOMES AND MEASURES: On-road pass-fail outcomes. RESULTS: Together, the six clinical tests predicted 62 pass and 49 fail outcomes in the total sample; 21 pass and 34 fail outcomes in participants with CI; and 58 pass and 14 fail outcomes in participants without CI. CONCLUSIONS AND RELEVANCE: Serial trichotomization of clinical tests increases the accuracy of making informed decisions and reduces the number of drivers undergoing unnecessary on-road assessments. Plain-Language Summary: Clinical tests and their cut points that identify fit and unfit drivers vary substantially across settings and research studies. Serial trichotomization is one method that could help control for this variation by combining clinical test scores showing 100% sensitivity and specificity to identify pass (fit drivers) and fail outcomes (unfit drivers) and to reduce the number of drivers undergoing unnecessary on-road assessments.

Análise de Perícias Psicológicas de Trânsito: Um Olhar sobre os Construtos Cognitivos / Analysis of Traffic Psychological Expertise: A Look at Cognitive Constructs / Análisis de la Experiencia Psicológica del Tráfico: Una Mirada a los Constructos Cognitivos

O objetivo da pesquisa foi analisar perícias psicológicas realizadas em cidades do Paraná do ano de 2019 no que tange aos aspectos cognitivos. Para tanto, foram consultados 1009 processos arquivados em clínicas credenciadas ao Departamento de Trânsito do Paraná (DETRAN-Pr). Os resultados, inerentes à caracterização das perícias, apontaram que os participantes com idade média de 27 anos, 44,4% possuindo ensino médio completo, 72,2% para a 1ª habilitação, 61% para a categoria A/B. Foram encontrados 12 tipos de instrumentos de Avaliação Psicológica padronizados. Os resultados apontam desempenho médio nos instrumentos e relação de dependência entre os principais construtos investigados. Considera-se que, além de habilidades cognitivas preservadas, a formação dos condutores desde o ensino básico é importante contribuinte para o trânsito seguro.(AU)

The objective of this research was to analyze psychological tests conducted in cities in the state of Paraná in the year 2019, focusing on cognitive aspects. For this purpose, we examined 1009 records from clinics accredited to the State Traffic Department of Paraná (DETRAN-Pr). The results, inherent to the characterization of the expertise, pointed out that the participants had an average age of 27 years, 44.4% had completed secondary education, 72.2% were first-time applicants, and 61% had the A/B category. Twelve types of standardized Psychological Assessment instruments were found. The results indicated that participants exhibited an average performance in these instruments, and there was a significant correlation between the main constructs investigated. These findings suggest that, in addition to maintaining cognitive skills, providing driver education starting from elementary school could significantly contribute to enhancing road safety.(AU)

El objetivo de la investigación fue analizar las pruebas psicológicas realizadas en ciudades de Paraná en el año 2019 sobre aspectos cognitivos. Para ello se consultaron 1009 expedientes archivados en clínicas acreditadas ante el Departamento de Tránsito de Paraná (DETRAN-Pr). Los resultados, inherentes a la caracterización de la especialización, apuntaron que los participantes tenían una edad media de 27 años, 44,4% tenían estudios secundarios completos, 72,2% para el 1º título, 61% para la categoría A/B. Se encontraron doce tipos de instrumentos de Evaluación Psicológica estandarizados. Los resultados muestran un desempeño promedio en los instrumentos y una relación de dependencia entre los principales constructos investigados. Se considera que, además de preservar las habilidades cognitivas, la formación de los conductores desde la escuela primaria en adelante es un importante contribuyente a la seguridad del tráfico.(AU)

Fatores sociodemográficos e clínicos associados à força de preensão manual de idosos condutores de veículos / Sociodemographic and clinical factors associated with handgrip strength in elderly automobile drivers / Factores sociodemográficos y clínicos asociados a la fuerza de prensión de la mano en conductores de vehículos de ancianos

Objetivo: investigar a associação entre força de preensão manual e características sociodemográficas e clínicas de idosos condutores de veículos automotores. Método: estudo transversal, realizado em clínicas de medicina de tráfego na cidade de Curitiba/Paraná, com 421 idosos (≥ 60 anos). Realizou-se análise estatística pelo modelo de Regressão Logística e Teste de Wald, considerando intervalo de confiança de 95% e valores de p <0,05 como significativos. Resultados: oitenta e quatro (20%) idosos apresentaram força de preensão manual reduzida. A força de preensão manual reduzida foi associada à faixa etária (p=0,001) e à hospitalização no último ano (p=0,002). Conclusão: houve associação significativa entre a força de preensão manual de idosos motoristas e as variáveis idade e hospitalização no último ano. Dessa forma, torna-se essencial a inclusão de avaliações específicas, centradas nas variáveis sociodemográficas e clínicas próprias da pessoa idosa, durante o exame de aptidão para dirigir veículos automotores.(AU)

Objective: to investigate the association between handgrip strength and sociodemographic and clinical characteristics of elderly automobile drivers. Method: cross-sectional study, carried out in traffic medicine clinics in the city of Curitiba/Paraná, with 421 elderly people (≥ 60 years old). Statistical analysis was performed using the Logistic Regression model and the Wald Test, considering a 95% confidence interval and p values <0.05 as significant. Results: eighty-four (20%) seniors had reduced handgrip strength. Reduced handgrip strength was associated with age group (p=0.001) and hospitalization in the last year (p=0.002). Conclusion: there was a significant association between the handgrip strength of elderly drivers and the variables age and hospitalization in the last year. Thus, it is essential to include specific assessments, centered on sociodemographic and clinical variables specific to the elderly person, during the aptitude test to drive automobiles.(AU)

Objetivo: investigar la asociación entre la fuerza de prensión de la mano y las características sociodemográficas y clínicas de los ancianos conductores de vehículos automotores. Método: estudio transversal, realizado en clínicas de medicina de tránsito de la ciudad de Curitiba/Paraná, con 421 ancianos (≥ 60 años). El análisis estadístico fue realizado por el modelo de Regresión Logística y Test de Wald, considerando intervalo de confianza de 95% y valores de p <0,05 como significativos. Resultados: 84 (20%) sujetos ancianos presentaron reducción de la fuerza de prensión de la mano. La reducción de la fuerza de prensión de la mano se asoció al grupo de edad (p=0,001) y a la hospitalización en el último año (p=0,002). Conclusión: hubo una asociación significativa entre la fuerza de prensión de la mano de los conductores ancianos y las variables edad y hospitalización en el último año. Así pues, es esencial incluir evaluaciones específicas, centradas en las variables sociodemográficas y clínicas de los ancianos, durante el examen de aptitud para conducir vehículos automotores.(AU)

Driving Errors Predicting Pass/Fail On-Road Assessment Outcomes Among Cognitively Impaired Older Drivers.

Older drivers with cognitive impairment (CI)/dementia make significantly more driving errors than healthy controls; however, whether driving errors are predictive of pass/fail outcomes in older drivers with CI/dementia are unclear. This study determined the driving errors that predicted failing an on-road assessment in drivers with CI. We retrospectively collected comprehensive driving evaluation data of 80 participants (76.1 ± 9.3 years) from an Ontario driving assessment center. Adjustment to stimuli (area under the curve [AUC] = 0.88), lane maintenance (AUC = 0.84), and speed regulation errors (AUC = 0.85) strongly predicted pass/fail outcomes. Worse performance on the Trails B (time) and Useful Field of View® (Subtest 2, Subtest 3, and risk index) were significantly correlated with adjustment to stimuli (p < .05), lane maintenance (p < .05), and speed regulation errors (p < .05). Adjustment to stimuli, lane maintenance, and speed regulation errors may be critical indicators of failing an on-road assessment in older drivers with CI. Prioritizing these errors may help identify at-risk drivers.

Return-to-driving following acquired brain injury: A neuropsychological perspective.

BACKGROUND: Return to driving after an acquired brain injury (ABI) has been positively associated with return to employment, maintenance of social relationships, and engagement in recreational and other community activities. Safe driving involves multiple cognitive abilities in a dynamic environment, and cognitive dysfunction resulting from ABI can negatively impact driving performance. OBJECTIVE: This manuscript examines the post-injury return-to-driving process, including performances on the in-office and on-road assessments, and the role of a rehabilitation neuropsychologist in helping patients resume driving. METHOD: In this study, 39 of 200 individuals (approximately 20%) treated at an outpatient neurorehabilitation facility, who performed satisfactorily on a pre-driving cognitive screening, completed a behind-the-wheel driving test. RESULTS: Of the 200 individuals, 34 (87%) passed the road test. Among the remaining five individuals who did not pass the road test, primary reasons for their failure included inability to follow or retain examiner directions primarily about lane position, speed, and vehicle control. The errors were attributable to cognitive difficulties with information processing, memory, attention regulation, and dual tasking.CONCLUSIONThe rehabilitation neuropsychologist contributed to the process by assessing cognition, facilitating self-awareness and error minimization, providing education about driving regulations and safety standards, and preparing for the road test and its outcomes.

Driving specialist's ratings of on-road performance and naturalistic driving crashes and near-crashes.

BACKGROUND: This study aimed to evaluate the association between a Certified Driving Rehabilitation Specialist's (CDRS) ratings of on-road driving performance by older drivers and at-fault crash and near-crash involvement using naturalistic driving techniques where crashes and near-crashes are recorded in everyday driving through in-vehicle instrumentation. METHODS: This is a cohort study of 144 drivers aged 70 years and over who were recruited due to a recent ophthalmology clinic visit at the University of Alabama at Birmingham. Baseline measurements consisted of demographics, visual status, and other health variables. At-fault crashes and near-crashes over 6 months were identified through instrumentation placed in their personal vehicle that recorded vehicle kinematics and video. After 6 months, a CDRS completed an on-road assessment and provided a composite rating on specific driving behaviors and a global score. RESULTS: Rate ratios examining the association between older drivers with worse CDRS composite scores and rates of at-fault crashes, at-fault near-crashes, and combined at-fault crashes and near-crashes were significantly higher compared to drivers with better scores. Results were similar for the CDRS global score. CONCLUSIONS: Motor vehicle administrations use CDRS ratings to make decisions about licensure, and in clinical programs such as those based at rehabilitation clinics use them to make recommendations about fitness to drive and rehabilitation. This study suggests that these decisions and recommendations are valid from a safety standpoint.

On-road driving test performance in veterans: Effects of age, clinical diagnosis and cognitive measures.

INTRODUCTION: Veterans are at heightened risk of being in a motor-vehicle crash and many fail on-road driving evaluations, particularly as they age. This may be due in part to the high prevalence of age-associated conditions impacting cognition in this population, including neurodegenerative diseases (e.g., Alzheimer's Disease) and acquired neurological conditions (e.g., cerebrovascular accident). However, understanding of the impact of referral diagnosis, age and cognition on Veterans' on-road driving performance is limited. METHODS: 109 Veterans were referred for a driving evaluation (mean age = 72.0, SD = 11.5) at a driving assessment clinic at the Minneapolis Veterans Affairs Healthcare System. Of the 109 Veterans enrolled, 44 were referred due to a neurodegenerative disease, 37 due to an acquired neurological condition, and 28 due to a non-neurological condition (e.g., vision loss). Veterans completed collection of health history information and administration of cognitive tests assessing visual attention, processing speed, and executive functioning, as well as a standardized, on-road driving evaluation. RESULTS: A total of 17.9% of Veterans failed the on-road evaluation. Clinical diagnostic group was not associated with failure rate. Age was not associated with failure rates in the full sample or within diagnostic groups. After controlling for age, poorer processing speed and selective/divided attention were associated with higher failure rates in the full sample. No cognitive tests were associated with failure rates within diagnostic groups. CONCLUSION: Referral diagnosis and age alone are not reliable predictors of Veterans' driving performance. Cognitive performance, specifically speed of processing and attention, may be helpful in screening Veterans' driving safety. Practical Applications: Clinicians tasked with assessing Veterans' driving safety should take into account cognitive performance, particularly processing speed and attention, when making decisions regarding driving safety. Age and referral diagnosis, while helpful information, are insufficient to predict outcomes on driving evaluations.

A safety score for the assessment of driving style.

OBJECTIVE: Road traffic laws explicitly refer to a safe and cautious driving style as a means of ensuring safety. For automated vehicles to adhere to these laws, objective measurements of safe and cautious behavior in normal driving conditions are required. This paper describes the conception, implementation and initial testing of an objective scoring system that assigns safety indexes to observed driving style, and aggregates them to provide an overall safety score for a given driving session. METHODS: The safety score was developed by matching safety indexes with maneuver-based parameter ranges processed from an existing highway traffic data set with a newly developed algorithm. The concept stands on the idea that safety, rather than suddenly changing from a safe to an unsafe condition at a certain parameter value, can be better modeled as a continuum of values that consider the safety margins available for interactions among multiple vehicles and that depend on present traffic conditions. A sensitivity test of the developed safety score was conducted by comparing the results of applying the algorithm to two drivers in a simulator who were instructed to drive normally and risky, respectively. RESULTS: The evaluation of normal driving statistics provided suitable ranges for safety parameters like vehicle distances, time headways, and time to collision based on real traffic data. The sensitivity test provided preliminary evidence that the scoring method can discriminate between safe and risky drivers based on their driving style. In contrast to previous approaches, collision situations are not needed for this assessment. CONCLUSIONS: The developed safety score shows potential for assessing the level of safety of automated vehicle (AV) behavior in traffic, including AV ability to avoid exposure to collision-prone situations. Occasional bad scores may occur even for good drivers or autonomously driving vehicles. However, if the safety index becomes low during a significant part of a driving session, due to frequent or harsh safety margin violations, the corresponding driving style should not be accepted for driving in real traffic.

Evaluation of braking performances of patients with osteoarthritis of the knee or hip: Are there alternatives to a brake simulator?

OBJECTIVE: This study aims to develop and evaluate a simple tool for daily practice that might allow a rough estimate of individual braking performance (brake response time, BRT) of patients with osteoarthritis or those with arthroplasty of the knee or hip. METHODS: In this cross-sectional study, we examined 162 patients (72 men, 90 women; mean age = 64±12.8 years) who suffered from osteoarthritis of the knee (n=45) or hip (n=64) or who underwent a total hip (n=37) or knee (n=16) arthroplasty. BRT of each patient was measured in a brake simulator. The results were compared to demographic data, various clinical tests, and pain surveys. From these data, a multiple linear regression model was developed. RESULTS: From the observed correlations, the regression model consisted of age (correlation with BRT τ=0.176, p=0.001), sex (τ=0.361, p<0.001), Hau's step test (τ=-0.345, p<0.001), and the pain dimension of the Hip disability/Knee injury and Osteoarthritis Outcome Score (τ=-0.265, p<0.001). We, therefore, suggested the following formula: BRTest = 634.8 - (8.8 x Hau) + 119.2 (for women) + (3.0 x age) - (1.3 x H/KOOS Pain). The above-mentioned variables contributed significantly to the prediction of BRT and could achieve a multiple R² adj of 0.31. The model leaves a residual standard error (i.e., SD of the residuals) of 158.4 ms, which is superior to a model without predictors; F (4.140)=16.8, p<0.001. CONCLUSION: Our evaluated regression model offers an uncertainty which is comparable to the one based on a fixed time period after surgery or a defined pathologic condition. The high variability even within a single patient over several brake simulator measurements makes it unlikely for a model to be generated solely based on clinical testing. Taking the available data in literature into account, we advise caution when formulating a real-time- or condition-based recommendation. We rather suggest being aware of risk factors that might lead to impaired BRT to sensitize patients to their impaired ability to drive. We identify such risk factors, namely old age, female sex, impaired musculoskeletal function, as tested in Hau's step test, and high levels of pain. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

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.

Life is a highway: Driver's license acquisition and social determinants for youth in foster care and their non-foster care peers.

BACKGROUND: Data regarding the connection between driver licensure and social determinants for youth could provide insight into the impact of driver license acquisition. These relationships are important for youth overall and particularly for foster youth given that adolescents in foster care obtain driver's licenses less often than their non-foster care peers. This integrative review explores the association between driver licensure and social determinants. METHODS: Whittemore and Knafl guidelines were used to conduct the integrative review. The articles were identified in collaboration with an expert in library science and public health. Results were organized by the Healthy People 2030 (HP 2030) Social Determinants of Health (SDOH) model. RESULTS: Six studies were included. Social and community context included social support structures helping youth get driver's licenses. Economics, including income and education, influenced license acquisition. Driver license acquisition was associated with improved well-being, security, and mental health. CONCLUSION: While fewer of those living in urban, walkable neighborhoods with access to public transportation were licensed, results from other studies suggest that car access is associated with psychological well-being. Further, licensure is disproportionately lower for populations historically marginalized from equal housing, education, and employment opportunities. Licensure plays a role in well-being.

Return to Driving After Foot and Ankle Surgery: A Novel Survey to Predict Passing Brake Reaction Time.

Introduction. Brake reaction time (BRT) is an accepted method for establishing recommendations for safe return to driving by the National Highway Traffic Safety Administration. Other than performing a BRT test in clinic, there is no established clinical tool to help physicians differentiate safe from unsafe drivers once patients reach general recovery milestones. The purpose is to present individual recommendations to the patient through a novel, validated survey evaluating safe return to driving after orthopaedic surgery of the right foot and ankle. Methods. A total of 171 patients undergoing 1 of 3 specific foot and ankle procedures were prospectively enrolled. A 4-question survey and BRT were completed 6 weeks postoperatively. The following questions were asked: (1) "I think my brake reaction time is slower than most drivers my age," (2) "I think my brake reaction time is faster than most drivers my age," (3) "I think my brake reaction time is about the same as most drivers my age," (4) "Based on what I think my brake reaction time is, I think I am ready to drive." Internal consistency was determined with Cronbach's α and item total correlation. External validity was determined by Spearman's correlation coefficient. A BRT less than 0.850 s was considered as a pass. Results. Of 171 patients, 162 (95%) with ages ranging from 21 to 83 years achieved a passing BRT by 7.6 weeks. After removing 1 question because of internal inconsistency, the optimal threshold for predicting passing BRT was 10/15 points or higher, which had 99% probability of success that a patient would pass the BRT (95% CI = 96%, 100%). Conclusion. This novel, 3-question driving readiness survey can accurately predict a passing BRT Achilles rupture repair, total ankle arthroplasty, and hallux valgus correction performed in the right foot and ankle as early as 6 weeks postoperatively.Level of Evidence: Level II: Comparative study.

Associação entre cognição, velocidade da marcha e habilitação veicular em idosos / Relación entre cognición, velocidad de la marcha y licencia de conducir en adultos mayores / Association between cognition, gait speed and vehicle habilitation in elderly people

Resumo Objetivo: Investigar a associação entre cognição, velocidade da marcha e resultado final da habilitação veicular de idosos candidatos à Carteira Nacional de Habilitação. Métodos: Estudo quantitativo de corte transversal desenvolvido em 12 clínicas de trânsito de Curitiba/Paraná/Brasil. A amostra do tipo probabilística foi constituída por 421 idosos (≥ 60 anos). Para a coleta de dados foram aplicados o Mini-Exame do Estado Mental (MEEM), teste de velocidade da marcha e realizadas consultas ao formulário Registro Nacional de Condutores Habilitados. A relação entre as variáveis foi identificada por meio do teste de regressão linear múltipla, método stepwise, utilizando-se o programa estatístico R versão 3.4.0. Resultados: Observou-se que, ao aumentar o escore no MEEM em uma unidade a chance do idoso ser considerado inapto temporariamente para dirigir diminui em 54,96% (95%; IC 28,47% - 92,69%; p<0,0001), e ao aumentar uma unidade no escore do MEEM houve um aumento na velocidade da marcha (VM) de 0,0091 (95%; IC 0,0005 - 0,0174; p=0,0366). Conclusão: O elevado escore no MEEM diminuiu a probabilidade do idoso ser considerado inapto temporariamente para dirigir veículos automotores e houve uma tendência de aumento da VM com o aumento dos escores do MEEM. A VM é um importante indicador a ser avaliado em idosos motoristas, logo, é um tópico a ser incluído nas avaliações das clínicas de trânsito, assim como o rastreamento cognitivo, fundamental para avaliar um conjunto de atividades mentais necessárias à direção veicular segura.

Resumen Objetivo: Investigar la relación entre cognición, velocidad de la marcha y obtención del permiso de conducir en adultos mayores que tramitan la licencia de conducir. Métodos: Estudio cuantitativo de corte transversal llevado a cabo en 12 centros médicos de evaluación de tránsito de Curitiba, estado de Paraná, Brasil. La muestra probabilística fue formada por 421 adultos mayores (≥ 60 años). Para la recolección de datos se aplicó el Mini Examen del Estado Mental (MEEM), la prueba de velocidad de la marcha y se realizaron consultas al formulario del Registro Nacional de Conductores Habilitados. La relación entre las variables fue identificada mediante la prueba de regresión lineal múltiple, método stepwise, con el programa de estadística R versión 3.4.0. Resultados: Se observó que, al aumentar la puntuación del MEEM una unidad, la probabilidad de que el adulto mayor sea considerado no apto temporalmente para conducir se redujo un 54,96 % (95 %; IC 28,47 % - 92,69 %; p<0,0001), y al aumentar una unidad la puntuación del MEEM, hubo un aumento en la velocidad de la marcha (VM) de 0,0091 (95 %; IC 0,0005 - 0,0174; p=0,0366). Conclusión: La puntuación del MEEM elevada redujo la probabilidad de que el adulto mayor sea considerado no apto temporalmente para conducir automóviles y hubo una tendencia de aumento de la VM con un aumento de la puntuación del MEEM. La VM es un indicador importante que debe ser evaluado en adultos mayores conductores. Por lo tanto, es un tema que deberá ser incluido en las evaluaciones de los centros médicos de evaluación de tránsito, así como también el rastreo cognitivo, fundamental para analizar un conjunto de actividades mentales necesarias para una conducción vehicular segura.

Abstract Objective: To investigate the association between cognition, gait speed and the result of vehicle habilitation of elderly candidates for the National Driver's License. Methods: Quantitative cross-sectional study developed in 12 traffic agencies in Curitiba, state of Paraná, Brazil. The probabilistic sample consisted of 421 elderly people (≥ 60 years). The Mini-Mental State Examination (MMSE), gait speed testing and consultations to forms of the National Qualified Drivers Registration were used for data collection. The relationship between variables was identified through the multiple linear regression test, stepwise method, using the statistical program R, version 3.4.0. Results: When increasing a unit in the MMSE score, the chance of the elderly person being considered as temporarily unfit to drive decreased by 54.96% (95% CI; 28.47% - 92.69%I; p<0.0001). When increasing a unit in the MMSE score, there was an increase in gait speed (GS) of 0.0091 (95% CI: 0.0005 - 0.0174; p=0.0366). Conclusion: The high MMSE score decreased the probability of the elderly participant being considered temporarily unfit to drive motor vehicles. There was a trend of higher GS with the increase in MMSE scores. As GS is an important indicator to be assessed in elderly drivers, this topic should be included in evaluations of traffic agencies, as well as cognitive screening, which is essential to assess a set of mental activities necessary for safe driving.

Effect of Cannabidiol and Δ9-Tetrahydrocannabinol on Driving Performance: A Randomized Clinical Trial.

Importance: Cannabis use has been associated with increased crash risk, but the effect of cannabidiol (CBD) on driving is unclear. Objective: To determine the driving impairment caused by vaporized cannabis containing Δ9-tetrahydrocannabinol (THC) and CBD. Design, Setting, and Participants: A double-blind, within-participants, randomized clinical trial was conducted at the Faculty of Psychology and Neuroscience at Maastricht University in the Netherlands between May 20, 2019, and March 27, 2020. Participants (N = 26) were healthy occasional users of cannabis. Interventions: Participants vaporized THC-dominant, CBD-dominant, THC/CBD-equivalent, and placebo cannabis. THC and CBD doses were 13.75 mg. Order of conditions was randomized and balanced. Main Outcomes and Measures: The primary end point was standard deviation of lateral position (SDLP; a measure of lane weaving) during 100 km, on-road driving tests that commenced at 40 minutes and 240 minutes after cannabis consumption. At a calibrated blood alcohol concentration (BAC) of 0.02%, SDLP was increased relative to placebo by 1.12 cm, and at a calibrated BAC of 0.05%, SDLP was increased relative to placebo by 2.4 cm. Results: Among 26 randomized participants (mean [SD] age, 23.2 [2.6] years; 16 women), 22 (85%) completed all 8 driving tests. At 40 to 100 minutes following consumption, the SDLP was 18.21 cm with CBD-dominant cannabis, 20.59 cm with THC-dominant cannabis, 21.09 cm with THC/CBD-equivalent cannabis, and 18.28 cm with placebo cannabis. SDLP was significantly increased by THC-dominant cannabis (+2.33 cm [95% CI, 0.80 to 3.86]; P < .001) and THC/CBD-equivalent cannabis (+2.83 cm [95% CI, 1.28 to 4.39]; P < .001) but not CBD-dominant cannabis (-0.05 cm [95% CI, -1.49 to 1.39]; P > .99), relative to placebo. At 240 to 300 minutes following consumption, the SDLP was 19.03 cm with CBD-dominant cannabis, 19.88 cm with THC-dominant cannabis, 20.59 cm with THC/CBD-equivalent cannabis, and 19.37 cm with placebo cannabis. The SDLP did not differ significantly in the CBD (-0.34 cm [95% CI, -1.77 to 1.10]; P > .99), THC (0.51 cm [95% CI, -1.01 to 2.02]; P > .99) or THC/CBD (1.22 cm [95% CI, -0.29 to 2.72]; P = .20) conditions, relative to placebo. Out of 188 test drives, 16 (8.5%) were terminated due to safety concerns. Conclusions and Relevance: In a crossover clinical trial that assessed driving performance during on-road driving tests, the SDLP following vaporized THC-dominant and THC/CBD-equivalent cannabis compared with placebo was significantly greater at 40 to 100 minutes but not 240 to 300 minutes after vaporization; there were no significant differences between CBD-dominant cannabis and placebo. However, the effect size for CBD-dominant cannabis may not have excluded clinically important impairment, and the doses tested may not represent common usage. Trial Registration: EU Clinical Trials Register: 2018-003945-40.

Exploring the Predictive Ability of the Motor-Free Visual Perception Test (MVPT) and Trail Making Test (TMT) for On-Road Driving Performance.

IMPORTANCE: Resuming driving after a change in functional ability is challenging for patients with a neurological condition. Although a combination of assessment tools has been suggested for use in driving evaluation, resources and availability of tools have been a problem. OBJECTIVE: To examine the predictive ability of two commonly used tools, the Motor-Free Visual Perception Test (MVPT) and the Trail Making Test, Parts A and B (TMTA and TMTB), on on-road driving performance. DESIGN: Retrospective chart review of 82 patient charts between 2015 and 2016. SETTING: Local rehabilitation hospital. PARTICIPANTS: Eighty-two patients with a primary neurological diagnosis (general neurological condition, n = 13; spinal cord injury, n = 11; stroke, n = 58). OUTCOMES AND MEASURES: MVPT, TMTA, and TMTB. RESULTS: Among the patients, 36 passed and 46 failed the on-road evaluation. The TMTA and TMTB scores were significantly different between those who passed or failed the on-road evaluation. Logistic regression analyses revealed that the TMTB completion time was the only significant predictor of on-road driving performance (for the all-patient model, 66% prediction accuracy, -2 log-likelihood [LL] = 93.47, exp ß = 0.98; for the stroke-only model, 76% prediction accuracy, -2LL = 59.61, exp ß = 0.97). CONCLUSIONS AND RELEVANCE: Our findings suggest that the TMTB is a better predictor of on-road driving performance for patients with a neurological condition than the MVPT. The findings shed light on the importance of selecting proper tools when assessing driving performance. Future prospective studies with a wider array of predictive variables are recommended to support the present findings. WHAT THIS ARTICLE ADDS: Occupational therapists should revisit the use of the MVPT in driving assessment and consider multiple assessment tools when evaluating and predicting driving performance.

Maze test score time adjustments when using nondominant hand in fitness-to-drive assessments.

Drivers with medical conditions may need to demonstrate their fitness by participating in clinical and on-road assessments. Scores from the clinic-based occupational therapy-drive home maze test (OT-DHMT) can contribute to fitness-to-drive recommendations. The OT-DHMT is a short, timed test that has previously been shown to be valid and reliable, and norms are available for completion with a driver's dominant hand. Following stroke or trauma, many drivers need to complete assessments and resume driving using their nondominant hand. The validity of a person's OT-DHMT score when completed with a nondominant hand is unknown. This study investigated if a person's OT-DHMT score time requires adjustment when completed with a nondominant hand. The OT-DHMT was administered with a convenience sample of 148 community-dwelling participants, aged 21-81 years (M = 48.6, SD = 19.38) using both their dominant and nondominant hands, in a random order. OT-DHMT score times were significantly faster when using dominant (M = 15.73) compared with nondominant (M = 17.64) hand, d = 1.91 [confidence interval (CI) 1.13, 2.69], t = 4.84, P < 0.01. Employing a generalized weighted least squares regression model indicated that multiplying a driver's nondominant hand time by 0.833 s for drivers aged ≤60, and by 0.929 s for drivers aged 61+ can approximate dominant hand completion times. The OT-DHMT has been validated for use with people using their nondominant hand. Time adjustments are required for people using their nondominant hand when completing the OT-DHMT, and a larger adjustment is required for people aged ≤60 reinforcing previous findings that younger people have faster OT-DHMT completion times.