Embed Size (px)
Citation preview
8/10/2015
1
The University of Sydney Page 1
DriveSafe DriveAware
A valid cognitive fitness to drive screening test for medical practice?
Presented by
Beth ChealFaculty of Health Sciences, School of Occupational Therapy, USyd / Pearson
The University of Sydney Page 2
Assessing Fitness to Drive
8/10/2015
2
The University of Sydney Page 3
• Physical Screening -impact of deficits on operation of car controls
• Vision Screening -Legal for driving? Need further assessment?
•Cognitive Screening - potential impact on safety / insight?
Assessing Fitness to Drive
The University of Sydney Page 4
DriveSafe DriveAware (DSDA) Project
3 Phase Prospective Study
– Phase 1:Conversion of computer DSDA iPad® Application
• Testing with seniors / healthy adults• Feasibility testing with doctors
– Phase 2:– Examine psychometric properties / predictive validity
– Phase 3: Implementation into 2 x medical practices (Sydney / Melbourne)
8/10/2015
3
The University of Sydney Page 5
National Survey of GPs
Representative Sample 250 GPs nationally:
– What are GPs doing now?– Are they satisfied with their current methods?– Do they perceive a need for a fitness to drive assessment tool?– What should it look like?
The University of Sydney Page 6
• Av. 87 assessments p.a• Rely on own judgments /
observations• Low use formal tests
(MMSE)• Referral to OT rare• 40% - felt do not have
tools to assess fitness to drive.
• Concerned about doctor-patient relationship / liability
6
What you told us…
8/10/2015
4
The University of Sydney Page 70% 20% 40% 60% 80% 100%
Other
Referral for an occupational therapydriving assessment
Formal assessments (eg. Mini- MentalState Examination)
Question family about their concerns
Refer to Assessing Fitness to Drivemedical guidelines (Austroads)
Observe factors such as patientsmobility, grooming and behaviour
Your professional judgement
How frequently do you use each of the following to assess fitness to drive?
Always
Often
Sometimes
Rarely
Never
NA
What you told us…
The University of Sydney Page 8
“I’m not sure that the tools I use are really measuring my patient's ability to drive”
“As the patient’s trusted doctor it can be difficult to broach the possibility of not driving. Patients are often extremely offended and resent you for ‘breaking their trust’”
“It's very difficult to judge when someone falls below the safe level for driving within a doctor’s office”
What you told us…
8/10/2015
5
The University of Sydney Page 9
The University of Sydney Page 10
OT Driving Assessment:
–Considered the gold standard as actual driving performance observed at a particular place at a particular time
–Limitations: Waiting time, cost, access, standardisation
Assessing Fitness to Drive
8/10/2015
6
The University of Sydney Page 11
Not practical to test every driver with a medical conditionon-road:
• Around 51,000 people had a stroke in 2014
• Each week, more than 1,800 new cases of dementia
• Around 700,000 Australians have a brain injury
Assessing Fitness to Drive
The University of Sydney Page 12
• Clear pass/fail use financial & emotional resources more appropriately
• Scarce clinical resources for those who would benefit from rehabilitation
• Reduced waiting times for on road testing
Assessing Fitness to Drive
8/10/2015
7
The University of Sydney Page 13
The University of Sydney Page 14
How can you testcognitive capacity for driving?
o Mini Mental or MoCA?
o Clock Drawing?
o Maze Tests?
o Computer Tests?
o Combined Tests?
• Face Validity - does it look like it is testing driving?
• Where is the cut off?
• Is the test sensitive enough without over diagnosing?
• How much room for error are you willing to accept?
• How do you measure insight?
Assessing Fitness to Drive
8/10/2015
8
The University of Sydney Page 15
• 20+ years of research
• Break down driving into
component skills
• Assess component skills(e.g., visual perception, concentration, memory)
• Most tests do not have face validity
• Difficult to find a single test that accurately predicts driving ability
Clinical test that will predict actual driving performance
The University of Sydney Page 16
A good test is:
– Sensitive - detects a problem if one exists
– Specific - does not over diagnose
Cognitive Assessment
8/10/2015
9
The University of Sydney Page 17
– Used for 20+ years by driver trained OTs
Pre-cursor Test – VRST/DSDA
The University of Sydney Page 18
A cognitive screening tool that measures:
Awareness of the driving environment• Real driving situations represented• Driver must recall everyday hazards that can impact driving
safety
Awareness of own abilities related to driving • A person unaware of decline in their driving performance is
unable to use compensatory strategies
Test Purpose
8/10/2015
10
The University of Sydney Page 19
Test Purpose
The University of Sydney Page 2020
DSDA Research
8/10/2015
11
The University of Sydney Page 21
DSDA Research
• 2007 large retrospective study (N=838). VRST – sound psychometric properties / promising test / cutoff scores. Sensitivity 81% / Specificity 89%.
• Updated / shortened = DSDA computer version. Awareness component added / 2009 DriveAware study (N=91).
• 2009 study examined combined tests with cognitively impaired drivers (N=115). Trichotomised drivers. Upper cutoff - identified safe drivers with a sensitivity 93% / lower cutoff - unsafe drivers - specificity 97%.
• 2015 Touch Screen DSDA (N=134)
21
The University of Sydney Page 22
• Partly self administered• Tablet / touch screen • 10-15 minutes• Busy medical practice / portable• International
DriveSafe DriveAware Challenge
• Trained administrator• Interpreting verbal responses• Computer, data projector, screen• 30 mins• Australian context
8/10/2015
12
The University of Sydney Page 23
• 10 driving clinics across Australia and New Zealand
• Criterion Measure: Standardised on road assessment
• OTs blind to DSDA results
• Compare DSDA results with outcome of on road assessment
Touch Screen DSDA Research
The University of Sydney Page 2424
Touch Screen DSDA Research
Gender No.
Female 40
Male 94 (70%)
Total 134
Country No.
Australia 80 (60%)
New Zealand 54
Age No.
18-59 34
60-91 100
Total 134
(Age 75+ = 60)
8/10/2015
13
The University of Sydney Page 25
Participant Diagnosis (N=134)
The University of Sydney Page 26
Accuracy of Classification
8/10/2015
14
The University of Sydney Page 27
• Sound psychometric properties
• Sensitivity of lower cutoff score in identifying unsafe driversDS - 91%DA - 89%
• Specificity of upper cutoff score in identifying safe driversDA – 94%DS – 91%
• Combined Tests: Specificity - 86% / Sensitivity - 91%
• Overall accuracy of classification 88%
Touch Screen DSDA Results
The University of Sydney Page 28
Who Can Administer?
• General practitioners & other medical
specialists
• Practice nurses under the supervision of a GP
• Other health professionals
8/10/2015
15
The University of Sydney Page 29
Presentation Title runs here l 00/00/0029
For patients where ability to manage the cognitive
aspects of driving may be impaired by:
• Age related changes
• A medical condition (e.g., stroke, dementia, Parkinson’s)
• Injury (e.g., traumatic brain injury)
Who Can Be Tested?
The University of Sydney Page 30
On Road Assessment still required for:
• All patients with physical disabilities• Beginning / learner drivers • Non-English speaking background• Aphasias and other communication difficulties• Caution for patients with mental health disorders
Who Can Be Tested?
8/10/2015
16
The University of Sydney Page 31
• Office Setting
• Self-administered + interview
• Approx. 10 minutes
• iPad® (iOS 7 or later)
• Desk / office chair
• Stand (20°)
• Stylus / headphones optional
Testing Setting
The University of Sydney Page 32
Testing Format
3 Subtests:
DriveSafe - Self administered
DriveAware - Partly self administered
Intersection Rules - Self administered(Optional)
32
8/10/2015
17
The University of Sydney Page 33
1. Set up the patient
The University of Sydney Page 34
8/10/2015
18
The University of Sydney Page 35
The University of Sydney Page 36
3. Conduct the interview
8/10/2015
19
The University of Sydney Page 37
4. Provide Results
The University of Sydney Page 38
Subtest 1: DriveSafe
Presentation Title runs here l 00/00/0038
8/10/2015
20
The University of Sydney Page 39
The University of Sydney Page 40
8/10/2015
21
The University of Sydney Page 41
The University of Sydney Page 42
8/10/2015
22
The University of Sydney Page 43
Demo Item
The University of Sydney Page 44
Demo Item
8/10/2015
23
The University of Sydney Page 45
Demo Item
The University of Sydney Page 46
Practice Items (3)
8/10/2015
24
The University of Sydney Page 47
Presentation Title runs here l 00/00/0047
Practice Items
The University of Sydney Page 48
Practice Items
8/10/2015
25
The University of Sydney Page 49
Practice Items
The University of Sydney Page 50
Administrator Assisted Model
Presentation Title runs here l 00/00/0050
8/10/2015
26
The University of Sydney Page 51
The University of Sydney Page 52
8/10/2015
27
The University of Sydney Page 53
Presentation Title runs here l 00/00/0053
The University of Sydney Page 54
Scoring& Reporting
8/10/2015
28
The University of Sydney Page 5555
DriveSafe DriveAware - Extended Report
Name
John HepplesMRN
654
1. DriveSafe (Objects & Directions)DriveSafe determines awareness of the driving environment.
Table 1: Missed information
Information No. Missed / Incorrect
Objects 1/28
Details (Location / Direction) 6/56
Total score 77 / 84
Additional objects 1Time taken to complete test 0.0 minutes
Research indicates the median time taken to complete DriveSafe for people who pass an occupational therapy on-r oad
assessment is 4 minutes and 46 seconds , and who fail the assessment, 6 minutes and 49 seconds .
Copyright. Pearson Australia Gr oup 1 of 2
2. Intersection RulesRight of way is determined for 8 intersections.
Table 2: Performance based on intersection complexity
Intersection No.
1, 3, 4, 7
2, 5, 6, 8 With road signs
Without road signs
Road Signs No. of Vehicles in Image
2
3-4 3/4
3/4
Score
6 / 8
minutes0.6Time taken to complete test
Total score
Research indicates the median time taken to complete Intersection Rules for people who pass an occupational therapy on-
road assessment is 2 minutes and 38 seconds , and for people who fail on-r oad, 3 minutes and 49 seconds .
DriveSafe DriveAware - Patient Letter
Name
John HepplesMRN
654
The purpose of this test is to determined a driver's awar eness of the driving environment and their own abilities r elated to
driving. Results are used to indicate if further assessment of ability to manage the cognitive aspects of driving (thinking
skills) is required.
DriveSafe
DriveAware
Intersection Test
Your results were:
12/ 84 Missed 1 object and 6 details (location/dir ection).
A score of 13 and above indicates awar ness of abilities related to driving./ 17
77
/ 8
These results place you in the category:
Likely to pass an on-road assessment
Your results indicate you are likely to pass an occupational therapy on �road assessment (provided you
do not have any physical impairment that may a ffect your driving ability).
84
72
57
0 10DriveAware
13 17
Dri
veS
afe
Note: If you have a medical condition that can a ffect physical capacity to drive, you may be r equired to undergo an
occupational therapy driving assessment even if you fall into the ‘gr een’ section on this graph.
If you would like more information about DriveSafe DriveAware please visit the following website:
www.pearsonclinical.com.au/drivesafedriveawar e
Copyright. Pearson Australia Gr oup
Disclaimer
The recommendations above were based on information provided by you, clinical information, performance on the day of the assessment, and
results of research. As in the case of any driver, no assurance can be given or implied that you will be collision �free given this assessment report.
6
The University of Sydney Page 56
8/10/2015
29
The University of Sydney Page 57
• Use in the context of your clinical judgment / other indicators
• Be cautious about the language you use when giving advice about driving
Touch Screen DSDA
The University of Sydney Page 58
Questions?
[email protected]–M: +61 (0)422 265 330
