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1.
Am J Occup Ther ; 74(5): 7405205070p1-7405205070p8, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32804625

RESUMO

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.


Assuntos
Condução de Veículo , Acidente Vascular Cerebral , Exame para Habilitação de Motoristas , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Teste de Sequência Alfanumérica , Percepção Visual
2.
PLoS One ; 15(5): e0233125, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32421733

RESUMO

OBJECTIVE: The on-road assessment is the gold standard because of its ecological validity. Yet existing instruments are heterogeneous and little is known about their psychometric properties. This study identified existing on-road assessment instruments and extracted data on psychometric properties and usability in clinical settings. METHOD: A systematic review identified studies evaluating standardized on-road evaluation instruments adapted for people with cognitive impairment. Published articles were searched on PubMed, CINHAL, PsycINFO, Web of Science, and ScienceDirect. Study quality and the level of evidence were assessed using the COSMIN checklist. The collected data were synthetized using a narrative approach. Usability was subjectively assessed for each instrument by extracting information on acceptability, access, cost, and training. RESULTS: The review identified 18 published studies between 1994 and 2016 that investigated 12 different on-road evaluation instruments: the Performance-Based Driving Evaluation, the Washington University Road Test, the New Haven, the Test Ride for Practical Fitness to Drive, the Rhode Island Road Test, the Sum of Manoeuvres Score, the Performance Analysis of Driving Ability, the Composite Driving Assessment Scale, the Nottingham Neurological Driving Assessment, the Driving Observation Schedule, the Record of Driving Errors, and the Western University's On-road Assessment. Participants were mainly male (64%), between 48 and 80 years old, and had a broad variety of cognitive disorders. Most instruments showed reasonable psychometric values for internal consistency, criterion validity, and reliability. However, the level of evidence was poor to support any of the instruments given the low number of studies for each. CONCLUSION: Despite the social and health consequences of decisions taken using these instruments, little is known about the value of a single evaluation and the ability of instruments to identify expected changes. None of the identified on-road evaluation instruments seem currently adapted for clinical settings targeting rehabilitation and occupational priorities rather than road security alone. STUDY REGISTRATION: PROSPERO registration number CRD42018103276.


Assuntos
Exame para Habilitação de Motoristas , Disfunção Cognitiva , Psicometria/métodos , Condução de Veículo , Humanos
3.
Handb Clin Neurol ; 167: 563-573, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31753155

RESUMO

Driving is a complex, multifaceted instrumental activity of daily living that has an independent influence on multiple health and well-being outcomes among older adults. Therefore, the benefits of driving to the individual must be balanced, through careful assessment and diagnosis, with the potential risk to self and others posed by a medically impaired driver. The influence of dementia changes substantially during the disease progression from very mild to mild, and driving is not advised for those who have progressed to the moderate stage of Alzheimer disease. Fortunately, validated high-quality screening instruments, including modern simulators and other technology aids, can help clinicians trichotomize risk (i.e., high, moderate, or low) and determine which patients need further evaluation by a driving specialist (e.g., those in the moderate range). Moreover, a body of evidence is building regarding the efficacy of certain intervention pathways to maintain current levels of driving performance among individuals with dementia, or at least slow its decline. Even with the progression of advanced driving technologies, understanding driving ability of patients with dementia will remain a critical challenge to clinicians for the foreseeable future.


Assuntos
Doença de Alzheimer , Exame para Habilitação de Motoristas , Condução de Veículo , Disfunção Cognitiva , Demência , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino
4.
Appl Ergon ; 81: 102886, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31422251

RESUMO

Distraction constitute one of the 'five fatal' behaviours that contribute to road trauma, and some people may be more susceptible to it than others. It is also known that a greater ability to predict danger is related to a lower probability of suffering accidents. It could be hypothesised that drivers with a higher tendency to distraction are worse at predicting traffic hazards, but to what extent might driving experience serve to mitigate this tendency to distraction? The current study collected self-reported attentional errors from drivers by using the Attention-Related Driving Errors Scale (ARDES-Spain) in order to examine whether novice drivers suffered from inattention more than experienced drivers. The results demonstrated that novice drivers scored more highly on ARDES than experienced drivers. ARDES scores were then related to performance in a Hazard Prediction test, where participants had to report what hazard was about to happen in a series of video clips that occlude just as the hazard begins to develop. While experienced drivers were better at the Hazard Prediction test than novice drivers, those participants who reported fewer attention errors were also better able to detect the upcoming hazard following occlusion. In addition, our results demonstrate a relationship between self-reported attentional errors and the ability to predict upcoming hazards on the road, with driving experience having a moderating role. In the case of novice drivers, as their scores in the Manoeuvring Errors ARDES factor increase, their ability in Hazard Prediction diminishes, while for experienced drivers the increase is not significant. Guidance on how to improve training for drivers in order to mitigate the effects of inattention on driving safety can be addressed.


Assuntos
Acidentes de Trânsito/psicologia , Atenção , Condução de Veículo/psicologia , Direção Distraída/psicologia , Fatores de Tempo , Acidentes de Trânsito/prevenção & controle , Adulto , Exame para Habilitação de Motoristas , Conscientização , Aprendizagem por Discriminação , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Percepção , Psicometria , Tempo de Reação , Reprodutibilidade dos Testes , Assunção de Riscos
5.
Int J Rehabil Res ; 42(4): 289-299, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31469673

RESUMO

The on-road driving test is considered a 'gold standard' evaluation; however, its validity and reliability have not been sufficiently reviewed. This systematic review aimed to map out and synthesize literature regarding on-road driving tests using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. Cochrane Library, PubMed, CINAHL, and Web of Science databases were searched from initiation through February 2018. All articles addressing reliability or validity of on-road driving tests involving adult rehabilitation patients were included. The search output identified 513 studies and 36 articles, which were included in the review. The Washington University Road Test/Rhode Island Road Test, performance analysis of driving ability, test ride for investigating practical fitness-to-drive, and K-score demonstrated high reliability and validity in regard to the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. The Washington University Road Test/Rhode Island Road Test and test ride for investigating practical fitness-to-drive were analyzed based on Classical Test Theory techniques, and performance analysis of driving ability and K-score were analyzed based on Item Response Theory techniques. The frequency of studies were Washington University Road Test/Rhode Island Road Test (n=9), Test Ride for Investigating Practical fitness-to-drive (n=8), performance analysis of driving ability (n=4), and K-score (n=1). From the viewpoint of accuracy and generalization, the Washington University Road Test/Rhode Island Road Test, test ride for investigating practical fitness-to-drive, and performance analysis of driving ability were identified as highly qualified concerning on-road driving tests. However, the ability to assess real-world driving depends on various environmental conditions.


Assuntos
Exame para Habilitação de Motoristas/estatística & dados numéricos , Doença Crônica/reabilitação , Populações Vulneráveis/estatística & dados numéricos , Adulto , Idoso , Exame para Habilitação de Motoristas/psicologia , Cognição , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Projetos de Pesquisa , Tóquio , Populações Vulneráveis/psicologia
6.
J Safety Res ; 69: 109-114, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31235221

RESUMO

INTRODUCTION: In mid-2007 the State of New South Wales (NSW) in Australia introduced modifications to the existing graduated driver licensing system, lengthening the mandatory number of supervised hours for learner drivers aged under 25 years from 50 to 120 and extending the minimum learner period from 6 to 12 months. Additional driving restrictions were also introduced for young drivers in the two provisional licensed periods, P1, P2. This paper aims to evaluate this change by comparing the crash and offense experiences of young learner drivers before and after it occurred. METHOD: From driver licensing files supplied by the NSW transport authority two cohorts of persons obtaining their initial learner's permits in the year prior to the changes and in the subsequent year were constructed with demographic data, dates of transition to the driving phases, dates of crashes, and dates and types of traffic offenses. Both cohorts comprised around 100,000 individuals. Crash rates per 100 years of person-time under observation post P1 with their standard errors were calculated. Using a survival-analytic approach the proportion of crashes of all types were graphed in three month periods post P1. Sexes were treated separately as were initial learner ages of 16, 17, 18-21, and 22-24 years. The distribution of traffic offense types during P1 and P2 phases were also compared. With such large numbers formal statistical testing was avoided. RESULTS: No meaningful differences in the crash or offense experiences of the two cohorts in either sex or at any age were observed. Delaying progress to unsupervised driving has road safety benefits. CONCLUSIONS: At least in conditions similar to those in NSW, requiring more than 50 h of supervised driving seems to have few road safety benefits. Practical applications: Licensing authorities should be cautious in extending the mandated number of supervised driving hours beyond 50.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Condução de Veículo/educação , Criminosos/educação , Licenciamento/estatística & dados numéricos , Gestão da Segurança/legislação & jurisprudência , Acidentes de Trânsito/prevenção & controle , Adolescente , Adulto , Exame para Habilitação de Motoristas/legislação & jurisprudência , Condução de Veículo/legislação & jurisprudência , Condução de Veículo/psicologia , Criminosos/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , New South Wales , Adulto Jovem
7.
Epilepsia ; 60(7): 1445-1452, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31111469

RESUMO

OBJECTIVE: Certification by treating physicians of fitness to drive in people with epilepsy creates a conflict of interest that may result in unsafe decisions, damage the doctor-patient relationship, expose the physician to legal liability and prevent optimal treatment. Ideally, the treating physician should provide objective clinical information to the driver licensing authority (DLA), which then determines fitness or otherwise. However, DLAs in Australia do not employ medical staff and the national standards are complex. Fitness is determined by the treating physician, according to published national standards. The purpose of this study was to determine the feasibility of using a decision tree to determine fitness, according to the Australian standards. METHODS: A decision tree was constructed to use clinical data to determine whether a patient met the national standard to drive a private motorcar, failed to meet it or required further assessment. A form was designed to collect the necessary clinical data from the treating physician. A computerized version of the decision tree was then used in a pilot in two Australian states in parallel with the existing certification system. Four hundred thirty-nine drivers with declared epilepsy and their treating physicians were invited to participate when their annual driver licence review was due. RESULTS: Two hundred fifty-three (58%) forms were returned. All patients were considered fit to drive by their physician. Seventy-six percent had not had a seizure for over two years. In 88.1%, there was agreement between the decision tree and treating physician, with 3.6% identified by the decision tree as requiring review. Although considered fit by their physician, 6.3% did not meet the national standard to drive. SIGNIFICANCE: The decision tree model is a practical alternative to fitness certification by treating physicians. This Australian pilot can serve as a model for applying objective standards to driving assessments in other jurisdictions, using local driving standards. It has the potential to improve road safety by avoiding the negative effects of certification by treating physicians and can cope with complex standards. It is now in use in two states of Australia.


Assuntos
Exame para Habilitação de Motoristas , Condução de Veículo/normas , Epilepsia/diagnóstico , Condução de Veículo/psicologia , Árvores de Decisões , Epilepsia/psicologia , Humanos , New South Wales , Projetos Piloto , Vitória
8.
Rev Lat Am Enfermagem ; 27: e3138, 2019 Apr 29.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31038632

RESUMO

OBJECTIVE: to analyze the factors associated with gait speed in elderly subjects undergoing physical and mental fitness tests to obtain a driver's license. METHOD: a cross-sectional quantitative study conducted in transit agencies. The probabilistic sample included 421 elderly (≥ 60 years old). The study was developed through application of questionnaires and tests that assess the frailty phenotype. For evaluating gait speed, the time spent by each participant to walk a 4.6 meter distance at normal pace on a flat surface was timed. Data were analyzed by using multiple linear regression and the stepwise method. The R statistical program version 3.4.0 was adopted. RESULTS: there was a significant association between gait speed and paid work (<0.0000), body mass index (<0.0000), Mini-Mental State Examination (=0.0366), physical frailty (pre-frail =0.0063 and non-frail <0.0000), age (<0.0000), sex (=0.0255), and manual grip strength (<0.0000). CONCLUSION: elderly drivers who do not work, women of advanced age, high body mass index, low score in the Mini-Mental State Examination, low hand grip strength, and frail tend to decrease gait speed and should be a priority of interventions.


Assuntos
Exame para Habilitação de Motoristas , Idoso Fragilizado , Avaliação Geriátrica , Velocidade de Caminhada/fisiologia , Idoso , Idoso de 80 Anos ou mais , Exame para Habilitação de Motoristas/psicologia , Estudos Transversais , Feminino , Força da Mão/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade
9.
Atten Defic Hyperact Disord ; 11(4): 403-411, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30980256

RESUMO

This study aimed to evaluate the utility of a novel, more cost-effective driving simulator, Assetto Corsa (AC), in detecting differences in driving performance between individuals with and without ADHD. Driving simulators are a useful means of assessing driving performance in those with attention-deficit hyperactivity disorder (ADHD); however, they are frequently expensive and thus unavailable to many researchers. A total of 87 participants (16 with ADHD, 71 without) completed an AC driving simulator task. They also completed computerized measures of attention and executive functioning and a questionnaire assessing self-reported driving behaviors and anger, ADHD and related symptoms, and mind wandering. Relative to those without ADHD, participants with ADHD reached higher average ground speeds and more greatly utilized the throttle. They also applied higher maximum pressure to the throttle and brake pedals. Within the full sample, greater mind wandering was associated with average and maximum throttle pressure and maximum ground speed. Findings confirm prior works indicative of a deleterious effect of ADHD diagnosis on simulator performance and may be attributed to a combination of impulsivity and mind wandering.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Exame para Habilitação de Motoristas , Condução de Veículo , Condução de Veículo/psicologia , Estudos de Casos e Controles , Simulação por Computador , Feminino , Humanos , Masculino , Adulto Jovem
10.
Orv Hetil ; 160(10): 370-377, 2019 Mar.
Artigo em Húngaro | MEDLINE | ID: mdl-30829061

RESUMO

The European Union (EU) law harmonization expects from each EU country to apply the same principles and same standards of the medical evaluation of driving licenses. All EU member states have to apply common evaluations of the driving licenses - based on the EU Regulation 2016/1006 - at the latest from January of this year. Hungary launched this new regulation on the 12th of January 2018. The most important source document of the current national regulation is the expert consensus document "New Standards for Driving and Cardiovascular Diseases" published in 2013. This is the professional evaulation of the cardiovascular diseases which can influence driving, and its importance is highlighted because even the Hungarian law listed this document as a resource. In this summary, in accordance with the current law, we provide a practical guide for the day-to-day work of assessing the permission of driving licence in connection with the different kinds of cardiovascular diseases. Orv Hetil. 2019; 160(10): 370-377.


Assuntos
Exame para Habilitação de Motoristas/legislação & jurisprudência , Condução de Veículo/legislação & jurisprudência , Doenças Cardiovasculares/diagnóstico , União Europeia , Insuficiência Cardíaca , Humanos , Hungria , Licenciamento , Síncope
11.
OTJR (Thorofare N J) ; 39(4): 257-265, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30907280

RESUMO

This study determined whether the Useful Field of View™ Risk Index (UFOV RI) adds value as a predictor of on-road outcomes in drivers with Parkinson's disease (PD) when considered with age, gender, and disease severity and compared with community-dwelling older drivers (Controls). A total of 101 PD drivers and 138 Controls underwent a comprehensive driving evaluation, including an on-road assessment. Logistic regression analyses determined the associations of age, gender, visual attention, and disease severity to on-road outcomes. Receiver operating characteristic curve analyses determined the optimal UFOV RI cut points to predict on-road outcomes. Above adding age and gender, the UFOV RI alone predicted on-road outcomes in PD, while the UFOV RI and age predicted on-road outcomes in Controls. Regardless of disease severity, visual attention was more impaired in PD than in Controls. The UFOV RI cut point of 3 provided the fewest misclassifications (n = 25) in PD. The UFOV RI is a valid screening predictor of on-road outcomes across PD drivers of different disease severity, but has moderate sensitivity and specificity.


Assuntos
Exame para Habilitação de Motoristas , Condução de Veículo , Doença de Parkinson , Acuidade Visual , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Florida , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Desempenho Psicomotor , Análise de Regressão , Inquéritos e Questionários
13.
Arch Phys Med Rehabil ; 100(8): 1534-1555, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30690007

RESUMO

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.


Assuntos
Exame para Habilitação de Motoristas , Esclerose Múltipla/fisiopatologia , Adulto , Humanos
15.
Indian J Ophthalmol ; 67(2): 240-246, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30672478

RESUMO

Purpose: Glaucoma affects different aspects of vision including visual field. This prospective observational study aims to collect details of driving license (DL) renewal procedure (in an urban metro in India) among patients with diagnosed glaucoma and the method of reporting of vision-related requirements during renewal. Methods: One-hundred patients with diagnosed glaucoma above 40 years, having valid DL (with at least one renewal cycle), were included. Patients with other ocular comorbidities were excluded. Driving Habits Questionnaire and a questionnaire about license renewal were administered. Driving eligibility was compared to international guidelines. Results: Study population included patients with 69% early, 29% moderate, and 2% advanced glaucoma. Sixteen percent of patients had stopped driving. Legal license renewal procedure was bypassed by 45%. Form-1 was not submitted by 43% and 49% did not submit Form-1A at the time of renewal. Only 7.01% mentioned about glaucoma in the self-declaration form. None were asked about their visual field during renewal. Among 61 patients who submitted a medical certificate, the undersigning doctor was an ophthalmologist in only six patients. Thirty percent patients with valid Indian DL would not have satisfied International College of Ophthalmologists guidelines. Driving difficulties were experienced by 44%, more so in advanced glaucoma (F (1, 82) = 22.12, P < 0.001). Conclusion: Vision-related testing at the time of renewal of DL is inadequate in India. Chronic eye diseases such as glaucoma are commonly not self-declared or detected at pre-renewal testing. Clear-cut guidelines about visual requirements and implementation are required to prevent road traffic events because of vision-related errors.


Assuntos
Acidentes de Trânsito/prevenção & controle , Exame para Habilitação de Motoristas/legislação & jurisprudência , Condução de Veículo/legislação & jurisprudência , Glaucoma/epidemiologia , Seleção Visual/métodos , Campos Visuais/fisiologia , Acidentes de Trânsito/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Condução de Veículo/estatística & dados numéricos , Feminino , Glaucoma/fisiopatologia , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Inquéritos e Questionários , Testes Visuais
16.
Optom Vis Sci ; 96(2): 130-132, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30601361

RESUMO

This work challenges the standard of the past 40 years, which required the use of a bioptic telescope by individuals with vision loss wanting to be licensed to drive in most states in the United States.Driving continues to be the key to independence for many individuals, particularly older drivers who live in an area where public transportation is limited or nonexistent. For the past 40 years, the most frequently option to allow drivers who are visually impaired to maintain driving privileges was to require them to use a bioptic telescope. Bioptic telescopes were felt to be necessary for wayfinding when driving. In addition, it was thought that a person could look through a bioptic telescope and still be aware of the driving environment around him/her. Human factor research has shown that the assertion that an individual can attend to two tasks simultaneously is not possible. Taking one's eyes off the road for as little as 2 seconds can lead to lane position breakdown. In 2018, wayfinding can now be more easily accomplished with the use of ubiquitous technologies like Global Positioning System systems on our telephones and in our cars. Driver distraction principles support safer alternatives to bioptic telescopes because these audio options allow the drivers to maintain their eyes and their attention on the road and the traffic around them. The switching of view within the bioptic spectacles is attentionally demanding, and the visual field restriction of such devices reduces overall situation awareness by narrowing the driver's attention.


Assuntos
Condução de Veículo , Conscientização , Sistemas de Informação Geográfica/instrumentação , Processamento Espacial , Baixa Visão/reabilitação , Pessoas com Deficiência Visual/reabilitação , Acidentes de Trânsito , Adulto , Exame para Habilitação de Motoristas , Feminino , Humanos , Masculino , Acuidade Visual
17.
REME rev. min. enferm ; 23: e-1176, jan.2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1005456

RESUMO

Objetivo: trata-se de estudo transversal cujo objetivo foi analisar a associação entre a condição de fragilidade física e as características clínicas dos idosos submetidos aos exames de aptidão física e mental para conduzir veículos automotores. Método: o estudo foi realizado em 11 clínicas de trânsito no período de agosto de 2015 a março de 2017. A amostra foi constituída por 347 idosos (≥ 60 anos). Destes, 1,5% foi considerado frágil, 46,8% pré-frágeis e 51,7% não frágeis. Quanto às características clínicas 67,4% possuem alguma doença, 66,6% utilizam medicamento(s), 4,9% usam cinco ou mais medicamentos, 21,6% ingerem bebidas alcoólicas, 9,8% fazem uso de tabaco, 9,2% sofreram queda(s) e 9,8% foram hospitalizados. Resultados: não houve associação significativa entre as características clínicas e a condição de fragilidade física dos idosos. A condição de pré-fragilidade apresentou alto percentual, o que reforça a necessidade do rastreamento da fragilidade física em idosos nas clínicas de trânsito. Conclusão: o estudo é inédito na área da Enfermagem e os resultados fornecem subsídios para outros estudos que objetivam um trânsito mais seguro.(AU)


Objective: this is a cross-sectional study whose objective was to analyze the association between the condition of physical frailty and clinical characteristics of elderly people undergoing physical and mental fitness examination for driving licensing of motor vehicles. Method: the study was carried out in 11 clinics specialized in traffic, from August 2015 to March 2017. The sample consisted of 347 elderly (≥ 60 years old). Of these, 1.5% elderly were considered frail, 46.8% pre-frail, and 51.7% non-frail. Regarding clinical characteristics, 67.4% had a disease, 66.6% used medication(s), 4.9% made use of five or more medicines, 21.6% drank alcohol, 9.8% used tobacco, 9.2% had suffered falls, and 9.8% had been hospitalized. Results: there was no significant association between the clinical characteristics and the condition of physical frailty in the elderly. Pre-frailty presented a high percentage, which reinforces the need to track physical frailty in elderly people in clinics specialized in traffic. Conclusion: the study is unprecedented in the area of Nursing and the results provide subsidies for further studies aimed at a safer traffic.(AU)


Objetivo: estudio transversal con el objetivo de analizar la asociación entre la condición de fragilidad física y las características clínicas de las personas mayores obligadas a realizar las pruebas de aptitud física y mental para conducir vehículos automotores. Método: el estudio fue realizado en 11 clínicas de tránsito entre agosto de 2015 y marzo de 2017. Resultados y discusión: la muestra estaba compuesta de 347 adultos mayores (≥ 60 anos). El 1,5% era considerado frágil, 46,8% pre-frágil y un 51,7% no frágil. Sobre...(AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Exame para Habilitação de Motoristas , Condução de Veículo , Características da População , Idoso Fragilizado , Saúde do Idoso
18.
Disabil Rehabil ; 41(11): 1313-1320, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-29334804

RESUMO

OBJECTIVE: To characterise on-road driving performance in individuals with traumatic brain injury who fail on-road driving assessment, compared with both those who pass assessment and healthy controls, and the injury and cognitive factors associated with driving performance. STUDY DESIGN: Cross-sectional. METHODS: Forty eight participants with traumatic brain injury (Age M = 40.50 SD = 14.62, 77% male, post-traumatic amnesia days M = 28.74 SD =27.68) and 48 healthy matched controls completed a standardised on-road driving assessment in addition to cognitive measures. RESULTS: Individuals with traumatic brain injury who passed on-road driving assessment performed no differently from controls while individuals with traumatic brain injury who failed the assessment demonstrated significantly worse driving performance relative to controls across a range of driving manoeuvres and error types including observation of on-road environment, speed control, gap selection, lane position, following distance and basic car control. Longer time post-injury and reduced visual perception were both significantly correlated with reduced driving skills. CONCLUSIONS: This exploratory study indicated that drivers with traumatic brain injury who failed on-road assessment demonstrated a heterogeneous pattern of impaired driving manoeuvres, characterised by skill deficits across both operational (e.g., basic car control and lane position) and tactical domains (e.g., following distance, gap selection, and observation) of driving. These preliminary findings can be used for implementation of future driving assessments and rehabilitation programs. Implications for rehabilitation Clinicians should be aware that the majority of individuals with traumatic brain injury were deemed fit to resume driving following formal on-road assessment, despite having moderate to very severe traumatic brain injuries. Drivers with traumatic brain injury who failed an on-road assessment demonstrated a heterogeneous pattern of impaired skills including errors with observation, speed regulation, gap selection, and vehicle control and accordingly had difficulty executing a diverse range of common driving manoeuvres. Comprehensive, formal on-road assessments, incorporating a range of skills, and manoeuvres, are needed to evaluate readiness to return to driving following traumatic brain injury. Individually tailored driver rehabilitation programs need to address these heterogeneous skill deficits to best support individuals to make a successful return to driving post-traumatic brain injury.


Assuntos
Exame para Habilitação de Motoristas , Condução de Veículo , Lesões Encefálicas Traumáticas , Adulto , Condução de Veículo/psicologia , Condução de Veículo/normas , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/reabilitação , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde
19.
Disabil Rehabil ; 41(15): 1797-1802, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-29488407

RESUMO

Introduction: It is difficult to determine if, or when, individuals with stroke are ready to undergo on-road fitness-to-drive assessment. The Occupational Therapy - Driver Off Road Assessment Battery was developed to determine client suitability to resume driving. The predictive validity of the Battery needs to be verified for people with stroke. Aim: Examine the predictive validity of the Occupational Therapy - Driver Off Road Assessment Battery for on-road performance among people with stroke. Method: Off-road data were collected from 148 people post stroke on the Battery and the outcome of their on-road assessment was recorded as: fit-to-drive or not fit-to-drive. Results: The majority of participants (76%) were able to resume driving. A classification and regression tree (CART) analysis using four subtests (three cognitive and one physical) from the Battery demonstrated an area under the curve (AUC) of 0.8311. Using a threshold of 0.5, the model correctly predicted 98/112 fit-to-drive (87.5%) and 26/36 people not fit-to-drive (72.2%). Conclusion: The three cognitive subtests from the Occupational Therapy - Driver Off Road Assessment Battery and potentially one of the physical tests have good predictive validity for client fitness-to-drive. These tests can be used to screen client suitability for proceeding to an on-road test following stroke. Implications for Rehabilitation: Following stroke, drivers should be counseled (including consideration of local legislation) concerning return to driving. The Occupational Therapy - Driver Off Road Assessment Battery can be used in the clinic to screen people for suitability to undertake on road assessment. Scores on four of the Occupational Therapy - Driver Off Road Assessment Battery subtests are predictive of resumption of driving following stroke.


Assuntos
Exame para Habilitação de Motoristas , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Ocupacional , Adulto Jovem
20.
Rev. latinoam. enferm. (Online) ; 27: e3138, 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-1004253

RESUMO

Objetivo analisar os fatores associados à velocidade da marcha em idosos submetidos aos exames de aptidão física e mental para habilitação veicular. Método estudo quantitativo de corte transversal realizado nas clínicas de trânsito, no qual fizeram parte da amostra do tipo probabilística 421 idosos (≥ 60 anos). O estudo foi desenvolvido mediante aplicações de questionários e testes que constituem o fenótipo da fragilidade. Para avaliar a velocidade da marcha, cronometrou-se o tempo gasto pelo participante para percorrer uma distância de 4,6 metros, de maneira habitual e em superfície plana. Os dados foram analisados utilizando a regressão linear múltipla por meio do método stepwise. Adotou-se o programa estatístico R versão 3.4.0. Resultados houve associação significativa entre velocidade da marcha e trabalho remunerado (<0,0000), índice de massa corporal (<0,0000), escore do Mini-Exame de Estado Mental (=0,0366), fragilidade física (pré-frágeis =0,0063 e não frágeis <0,0000), idade (<0,0000), sexo (=0,0255) e força de preensão manual (<0,0000). Conclusão idosos motoristas que não trabalham, mulheres, com idade avançada, elevado índice de massa corporal, baixo escore no Mini-Exame de Estado Mental, baixa força de preensão manual e frágeis possuem tendência de diminuição da velocidade da marcha e devem ser prioridade das intervenções.


Objective to analyze the factors associated with gait speed in elderly subjects undergoing physical and mental fitness tests to obtain a driver's license. Method a cross-sectional quantitative study conducted in transit agencies. The probabilistic sample included 421 elderly (≥ 60 years old). The study was developed through application of questionnaires and tests that assess the frailty phenotype. For evaluating gait speed, the time spent by each participant to walk a 4.6 meter distance at normal pace on a flat surface was timed. Data were analyzed by using multiple linear regression and the stepwise method. The R statistical program version 3.4.0 was adopted. Results there was a significant association between gait speed and paid work (<0.0000), body mass index (<0.0000), Mini-Mental State Examination (=0.0366), physical frailty (pre-frail =0.0063 and non-frail <0.0000), age (<0.0000), sex (=0.0255), and manual grip strength (<0.0000). Conclusion elderly drivers who do not work, women of advanced age, high body mass index, low score in the Mini-Mental State Examination, low hand grip strength, and frail tend to decrease gait speed and should be a priority of interventions.


Objetivo analizar los factores asociados a la velocidad de la marcha en adultos mayores sometidos a los exámenes de aptitud física y mental para habilitación vehicular. Método estudio cuantitativo de corte transversal realizado en las clínicas de tránsito, en el cual hicieron parte de la muestra del tipo probabilística 421 adultos mayores (≥ 60 años). El estudio fue desarrollado mediante aplicaciones de cuestionarios y pruebas que constituyen el fenotipo de fragilidad. Para evaluar la velocidad de la marcha fue cronometrado el tiempo gasto por el participante para andar una distancia de 4,6 metros, de manera habitual y en una superficie plana. Los datos fueron analizados utilizándose la regresión linear múltiple por medio del método stepwise. Fue adoptado el programa estadístico R versión 3.4.0. Resultados hubo una asociación significativa entre velocidad de la marcha y trabajo remunerado (<0,0000), índice de masa corporal (<0,0000), puntaje del Mini-Examen de Estado Mental (=0,0366), fragilidad física (pre-frágiles =0,0063 y no frágiles <0,0000), edad (<0,0000), sexo (=0,0255) y fuerza de prensión manual (<0,0000). Conclusión adultos mayores conductores que no trabajan, mujeres, con edad avanzada, elevado índice de masa corporal, bajo puntaje en el Mini-Examen de Estado Mental, baja fuerza de prensión manual y frágil poseen tendencia de disminución de la velocidad de la marcha y deben ser prioridad de las intervenciones.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Exame para Habilitação de Motoristas/psicologia , Força da Mão/fisiologia , Velocidade de Caminhada/fisiologia , Avaliação Geriátrica , Estudos Transversais , Idoso Fragilizado
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