Occupational Therapy In Health Care, 28(2):223–228, 2014 C 2014 by Informa Healthcare USA, Inc. Available online at http://informahealthcare.com/othc DOI: 10.3109/07380577.2014.896490
ARTICLE
Summary of an Evidence Based Review on Interventions for Medically at Risk Older Drivers Sherrilene Classen Professor and Chair: School of Occupational Therapy, Western University, Elborn College, 1201 Western Road, London, Ontario, Canada
ABSTRACT. This paper offers a summary based on the findings of an evidence-based review previously conducted to determine the effectiveness of interventions for medically at risk drivers with stroke, visual deficits, or cognitive decline. Specifically, this work offers occupational therapy practitioners clinically applicable recommendations and intervention strategies. Because driving is a key instrumental activity of daily living for continued independence, autonomy, and quality of life, the recommendations provided in this review may enable the clinical reasoning and decision-making skills of occupational therapists working with medically at risk older drivers. KEYWORDS. conditions
Aged, automobile driving, elderly, evidence-based practice, medical
BACKGROUND The Gaps and Pathways Project, funded through a cooperative agreement between the American Occupational Therapy Association (AOTA) and the National Highway Traffic Safety Administration (NHSTA), is intended to provide guidance to occupational therapy practitioners, in helping clients with the instrumental activity of daily living, specifically driving and community mobility (Schold Davis & Dickerson, 2012). A panel of expert researchers and clinicians guided project priorities, including the importance of finding evidence to identify at-risk drivers and to develop evidence guided strategies and recommendations on interventions for occupational therapy practitioners. The author of this project was charged with addressing this “gap” by conducting an evidence-based review to determine the effectiveness of driving interventions for medically at risk older drivers. Although that manuscript is published elsewhere (Classen et al., in press), this brief paper offers a summary of the main findings of the evidence-based review. Specifically, based on the evidence from that review, the authors offer practitioners clinically applicable Address correspondence to Sherrilene Classen, PhD, MPH, OTR/L, FAOTA, Professor and Chair: School of Occupational Therapy, Western University, Elborn College, 1201 Western Road, London, Ontario N6G 1H1, Canada. (E-mail: [email protected]). (Received 9 November 2013; accepted 17 February 2014)
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recommendations and intervention strategies related to studies targeting medically at risk drivers with stroke, visual deficits, or cognitive decline. SUMMARY OF THE DEVELOPMENT PROCESS LEADING TO THE FINAL PRODUCT The primary research team (Classen et al., in press) used the AOTA’s classification criteria (Level I-V, I = highest level of evidence) to search for and identify driving rehabilitation intervention literature published in the last 15 years (Stav et al., 2008). After identifying explicit inclusion and exclusion criteria, and having established rater reliability, they classified and synopsized information from 15 studies pertaining to drivers with stroke, visual deficits, or cognitive decline. Using the AOTA criteria, recommendations representing the following levels were suggested: (A) strongly recommend the intervention; (B) recommend intervention is provided routinely; (C) weak evidence that the intervention can improve outcomes; (D) recommend not to provide the intervention; (I) insufficient evidence to recommend for or against the intervention. SUMMARY OF FINAL OUTCOME Overall the final review included 15 studies, organized and discussed below, by the following categories: Studies on Drivers with Stroke The review included six studies: five Level I randomized clinical trials (RCTs) (Akinwuntan et al., 2005; Crotty & George, 2009; Devos et al., 2009; Devos et al., 2010; ¨ ¨ Mazer et al., 2003), and one Level II nonrandomized two-groups study (Soderstr om et al., 2006). The authors suggested the following: (1) Strongly recommend (A) that trained occupational therapy practitioners provide the graded simulator intervention, as validated on the STISM drive, to eligible stroke clients; (2) Recommend (B) that occupational therapy practitioners routinely provide traffic theory knowledge test and on-road training interventions to clients with stroke; (3) insufficient (I) evidence to recommend for or against routinely providing Dynavision (visual attention), Useful Field of ViewTM (UFOV) (visual attention), or general visual perceptual training (exercises) interventions for effective on-road outcomes in drivers with stroke. Studies on Drivers with Visual Impairments This review included seven studies: three Level I RCTs Owsley et al., 2003; (Owsley et al., 2004; Stalvey & Owsley, 2003), three Level II experimental studies (two with crossover designs and one with random assignment) (Szlyk et al., 1998; Szlyk et al., 2000; Szlyk et al., 2005), and one Level IV survey design (Bowers et al., 2005). Based on the findings from the educational intervention (Owsley et al., 2003; Owsley et al., 2004; Stalvey & Owsley, 2003), the authors recommend (1) with high certainty, that occupational therapy practitioners cannot expect to see a difference in crash rates based on an educational intervention, in drivers with low vision (D); and (2) with high certainty, that occupational therapy practitioners may
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routinely provide the educational intervention to drivers with low vision, as it improves self-reported regulatory behaviors and minimizes exposure to challenging situations (A). Based on the findings from the three bioptic telescope system (BTS) intervention studies (Bowers et al., 2005; Szlyk et al., 1998; Szlyk et al., 2000) the authors recommend with moderate certainty (B) that occupational therapy practitioners, with adequate training in BTS, may routinely provide the bioptic training to clients to improve their visual, simulated, and on-road driving skills. However, caution needs to be used, as not all of the studies were specific to visually impaired at-risk older drivers. As for prism lenses (Szlyk et al., 2005) insufficient evidence (I) exists to recommend for or against routinely providing the intervention. Studies on Drivers with Cognitive Impairments The review included one Level II nonrandomized three-groups study (Freund & Petrakos, 2008) and one Level I systematic literature review (Man-Son-Hing et al., 2007). Weak evidence exists (C) that driving restriction interventions improve driving outcomes. If occupational therapy practitioners use driving restrictions in clients with cognitive impairment, caution needs to be applied and consideration must be given to the multiple factors that may affect fitness to drive, such as client insight, external support, and unanticipated events in the driving environment. Insufficient (I) evidence exists, to support that compensatory strategies (as mentioned above) enhance driving capabilities in persons with dementia. INTENDED USE OF THE RECOMMENDATIONS IN CLINICAL PRACTICE FOR DRIVERS WITH STROKE From the five Level I studies on stroke and driving, multimodal interventions (i.e., graded simulator intervention, traffic theory knowledge testing, and on-road training) are effective, with moderate to high certainty, to improve on-road driving outcomes. But, insufficient evidence exist that visual attention, speed of processing, or visual perceptual training result in effective on-road outcomes. This evidence suggests that occupational therapy practitioners should focus on remediating drivingrelated tasks such as behind-the-wheel training, rather than focusing on the underlying client factors. For Drivers with Visual Impairments Personalized educational interventions may be used to improve drivers with low vision’s self-perceptions on driving exposures and to increase their knowledge on risks of driving with such conditions. However, these effects (e.g., self-perceptions and knowledge) do not carry over to reduce crashes. One reason, perhaps, is that crashes are rare events, and as such the effects may not be observable via this driving outcome. The effect of the educational intervention has not yet been established during on-road or simulated driving events, so no certainty exists whether this intervention will benefit the fitness to drive abilities of older drivers with low vision. Training in the use of BTS holds potential as an effective intervention strategy, but testing must be done in older drivers (>65 years) to ascertain improvements in this group’s fitness to drive abilities. Moreover, the use of BTS while driving is not allowable in all states as vision policies vary from state to state. Therefore,
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occupational therapy practitioners who provide driving interventions need to be knowledgeable about the laws and policies in the various states where they practice, and where their clients live and drive. For Drivers with Cognitive Impairments Insufficient evidence exists to support the use of driving restrictions or compensatory strategies to enhance the driving capabilities of drivers with dementia. Because approximately 6 to 10% of the population over the age of 65 has dementia (Chapman et al., 2006), occupational therapy practitioners must cautiously consider the use of driving restrictions or compensatory strategies. Drivers with dementia do not perform well in less than predictable or unpredictable situations. Moreover, they may not have the insight to understand the rationale for driving restrictions or to follow through with compensatory strategies. Further studies are needed to determine the effectiveness of such interventions on the fitness to drive abilities of older drivers with cognitive impairment, before recommendations can be made with certainty. CONCLUSION The Classen et al. (in press) study provides evidence-based recommendations to occupational therapy practitioners who are working with medically at risk (e.g., stroke, low vision, and cognitive decline) older drivers. Much of the evidence was derived from different fields, such as physical therapy, ophthalmology, and/or public health. Thus, further research, specifically, well-designed RCTs that provide Alevel recommendations, is needed in and across occupational therapy settings to ascertain the effectives of those interventions. However, the recommendations of this project must be interpreted in light of some of the obvious limitations documented in the Classen et al. (in press) study. Those pertain to use of heterogeneous populations or methods (e.g., use of different simulators and simulator scenarios), sample size fluctuations, gender composition biased to one gender only, age differences (e.g., not all studies included older drivers exclusively), and methods of conducting the evidence based review (e.g., only studies published in the English language, and in peer reviewed journals, vs. the gray literature, were included). That been said, driving is a key instrumental activity of daily living for continued independence, autonomy, and quality of life, and the recommendations provided in this review may enable the clinical reasoning and decision-making skills of occupational therapy practitioners working with medically at risk older drivers. Declaration of interest: The author reports no conflict of interest. The author alone is responsible for the content and writing of this paper. This evidence-based review was funded by the AOTA-NHTSA Mini grant project (PI: Sherrilene Classen) and this paper is a summary of that project. ABOUT THE AUTHOR Sherrilene Classen, PhD, MPH, OTR/L, FAOTA, Professor and Chair: School of Occupational Therapy, Western University, Elborn College, 1201 Western Road, London, Ontario, Canada N6G 1H1.
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REFERENCES Akinwuntan AE, De Weerdt W, Feys H, Pauwels J, Baten G, Arno P, & Kiekens C. (2005). Effect of simulator training on driving after stroke: A randomized controlled trial. Neurology, 65(6), 843–850. Bowers A, Peli E, Elgin J, McGwin G, Jr., & Owsley C. (2005). On-road driving with moderate visual field loss. Optometry and Vision Science, 82(8), 657–667. doi: 00006324-200508000-00007 [pii] Chapman DP, Williams SM, Strine TW, Anda RF, & Moore MJ. (2006). Dementia and its implications for public health. Preventing Chronic Disease, 3(2), 1–13. Retrieved from http://www.cdc.gov/pcd/issues/2006/apr/05 0167.htm. Classen S, Monahan M, Auten B, & Yarney KA. (2014). Evidence based review of rehabilitation interventions for medically at risk older drivers. American Journal of Occupational Therapy. In press. Crotty M, & George S. (2009). Retraining visual processing skills to improve driving ability after stroke. Archives of Physical Medicine and Rehabilitation, 90(12), 2096–2102. doi: 10.1016/j.apmr.2009.08.143. Devos H, Akinwuntan AE, Nieuwboer A, Ringoot I, Berghen K, Tant M, et al. (2010). Effect of simulator training on fitness-to-drive after stroke: a 5-year follow-up of a randomized controlled trial. Neurorehabilitation and Neural Repair, 24(9), 843–850. doi: 10.1177/1545968310368687 Devos H, Akinwuntan AE, Nieuwboer A, Tant M, Truijen S, De Wit L, et al. (2009). Comparison of the effect of two driving retraining programs on on-road performance after stroke. Neurorehabilitation and Neural Repair, 23(7), 699–705. doi: 10.1177/1545968309334208 Freund B, & Petrakos D. (2008). Continued driving and time to transition to nondriver status through error-specific driving restrictions. Gerontology & Geriatrics Education, 29(24), 326–335. doi: 10.1080/02701960802497852 Man-Son-Hing M, Marshall SC, Molnar FJ, & Wilson KG. (2007). Systematic review of driving risk and the efficacy of compensatory strategies in persons with dementia. Journal of the American Geriatrics Society, 55(6), 878–884. Mazer BL, Sofer S, Korner-Bitensky N, Gelinas I, Hanley J, & Wood-Dauphinee S. (2003). Effectiveness of a visual attention retraining program on the driving performance of clients with stroke. Archives of Physical Medicine and Rehabilitation, 84(4), 541–550. doi: http://dx.doi.org/10.1053/apmr.2003.50085 Owsley C, McGwin G, Phillips JM, McNeal SF, & Stalvey BT. (2004). Impact of an educational program on the safety of high-risk, visually impaired, older drivers. American Journal of Preventive Medicine, 26(3), 222–229. doi: 10.1016/j.amepre.2003.012.005 Owsley C, Stalvey BT, & Phillips JM. (2003). The efficacy of an educational intervention in promoting self-regulation among high-risk older drivers. Accident Analysis & Prevention, 35(3), 393–400. Schold Davis E, & Dickerson A. (2012). The gaps and pathways project. OT Practice, 17(21), 9–13, 19. ¨ ¨ ST, Pettersson RP, & Leppert J. (2006). Prediction of driving ability after stroke and Soderstr om the effect of behind-the-wheel training. Scandinavian Journal of Psychology, 47(5), 419–429. doi: 10.1111/j.1467-9450.2006.00550.x Stalvey BT, & Owsley C. (2003). The development and efficacy of a theory-based educational curriculum to promote self-regulation among high-risk older drivers. Health Promotion Practice, 4(2), 109–119. Stav WB, Arbesman M, & Lieberman D. (2008). Background and methodology of the older driver evidence-based systematic literature review. American Journal of Occupational Therapy, 62, 130–135. Szlyk JP, Seiple W, Laderman DJ, Kelsch R, Ho K, & McMahon T. (1998). Use of bioptic amorphic lenses to expand the visual field in patients with peripheral loss. Optometry and Vision Science, 75(7), 518–524.
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Szlyk JP, Seiple W, Laderman DJ, Kelsch R, Stelmack J, & McMahon T. (2000). Measuring the effectiveness of bioptic telescopes for persons with central vision loss. Journal of Rehabilitation Research and Development, 37(1), 101–108. Szlyk JP, Seiple W, Stelmack J, & McMahon T. (2005). Use of prisms for navigation and driving in hemianopic patients. Ophthalmic and Physiological Optics, 25(2), 128–135. doi: 10.1111/j.1475–1313.2004.00265.x
Copyright of Occupational Therapy in Health Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
ARTICLE
Summary of an Evidence Based Review on Interventions for Medically at Risk Older Drivers Sherrilene Classen Professor and Chair: School of Occupational Therapy, Western University, Elborn College, 1201 Western Road, London, Ontario, Canada
ABSTRACT. This paper offers a summary based on the findings of an evidence-based review previously conducted to determine the effectiveness of interventions for medically at risk drivers with stroke, visual deficits, or cognitive decline. Specifically, this work offers occupational therapy practitioners clinically applicable recommendations and intervention strategies. Because driving is a key instrumental activity of daily living for continued independence, autonomy, and quality of life, the recommendations provided in this review may enable the clinical reasoning and decision-making skills of occupational therapists working with medically at risk older drivers. KEYWORDS. conditions
Aged, automobile driving, elderly, evidence-based practice, medical
BACKGROUND The Gaps and Pathways Project, funded through a cooperative agreement between the American Occupational Therapy Association (AOTA) and the National Highway Traffic Safety Administration (NHSTA), is intended to provide guidance to occupational therapy practitioners, in helping clients with the instrumental activity of daily living, specifically driving and community mobility (Schold Davis & Dickerson, 2012). A panel of expert researchers and clinicians guided project priorities, including the importance of finding evidence to identify at-risk drivers and to develop evidence guided strategies and recommendations on interventions for occupational therapy practitioners. The author of this project was charged with addressing this “gap” by conducting an evidence-based review to determine the effectiveness of driving interventions for medically at risk older drivers. Although that manuscript is published elsewhere (Classen et al., in press), this brief paper offers a summary of the main findings of the evidence-based review. Specifically, based on the evidence from that review, the authors offer practitioners clinically applicable Address correspondence to Sherrilene Classen, PhD, MPH, OTR/L, FAOTA, Professor and Chair: School of Occupational Therapy, Western University, Elborn College, 1201 Western Road, London, Ontario N6G 1H1, Canada. (E-mail: [email protected]). (Received 9 November 2013; accepted 17 February 2014)
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recommendations and intervention strategies related to studies targeting medically at risk drivers with stroke, visual deficits, or cognitive decline. SUMMARY OF THE DEVELOPMENT PROCESS LEADING TO THE FINAL PRODUCT The primary research team (Classen et al., in press) used the AOTA’s classification criteria (Level I-V, I = highest level of evidence) to search for and identify driving rehabilitation intervention literature published in the last 15 years (Stav et al., 2008). After identifying explicit inclusion and exclusion criteria, and having established rater reliability, they classified and synopsized information from 15 studies pertaining to drivers with stroke, visual deficits, or cognitive decline. Using the AOTA criteria, recommendations representing the following levels were suggested: (A) strongly recommend the intervention; (B) recommend intervention is provided routinely; (C) weak evidence that the intervention can improve outcomes; (D) recommend not to provide the intervention; (I) insufficient evidence to recommend for or against the intervention. SUMMARY OF FINAL OUTCOME Overall the final review included 15 studies, organized and discussed below, by the following categories: Studies on Drivers with Stroke The review included six studies: five Level I randomized clinical trials (RCTs) (Akinwuntan et al., 2005; Crotty & George, 2009; Devos et al., 2009; Devos et al., 2010; ¨ ¨ Mazer et al., 2003), and one Level II nonrandomized two-groups study (Soderstr om et al., 2006). The authors suggested the following: (1) Strongly recommend (A) that trained occupational therapy practitioners provide the graded simulator intervention, as validated on the STISM drive, to eligible stroke clients; (2) Recommend (B) that occupational therapy practitioners routinely provide traffic theory knowledge test and on-road training interventions to clients with stroke; (3) insufficient (I) evidence to recommend for or against routinely providing Dynavision (visual attention), Useful Field of ViewTM (UFOV) (visual attention), or general visual perceptual training (exercises) interventions for effective on-road outcomes in drivers with stroke. Studies on Drivers with Visual Impairments This review included seven studies: three Level I RCTs Owsley et al., 2003; (Owsley et al., 2004; Stalvey & Owsley, 2003), three Level II experimental studies (two with crossover designs and one with random assignment) (Szlyk et al., 1998; Szlyk et al., 2000; Szlyk et al., 2005), and one Level IV survey design (Bowers et al., 2005). Based on the findings from the educational intervention (Owsley et al., 2003; Owsley et al., 2004; Stalvey & Owsley, 2003), the authors recommend (1) with high certainty, that occupational therapy practitioners cannot expect to see a difference in crash rates based on an educational intervention, in drivers with low vision (D); and (2) with high certainty, that occupational therapy practitioners may
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routinely provide the educational intervention to drivers with low vision, as it improves self-reported regulatory behaviors and minimizes exposure to challenging situations (A). Based on the findings from the three bioptic telescope system (BTS) intervention studies (Bowers et al., 2005; Szlyk et al., 1998; Szlyk et al., 2000) the authors recommend with moderate certainty (B) that occupational therapy practitioners, with adequate training in BTS, may routinely provide the bioptic training to clients to improve their visual, simulated, and on-road driving skills. However, caution needs to be used, as not all of the studies were specific to visually impaired at-risk older drivers. As for prism lenses (Szlyk et al., 2005) insufficient evidence (I) exists to recommend for or against routinely providing the intervention. Studies on Drivers with Cognitive Impairments The review included one Level II nonrandomized three-groups study (Freund & Petrakos, 2008) and one Level I systematic literature review (Man-Son-Hing et al., 2007). Weak evidence exists (C) that driving restriction interventions improve driving outcomes. If occupational therapy practitioners use driving restrictions in clients with cognitive impairment, caution needs to be applied and consideration must be given to the multiple factors that may affect fitness to drive, such as client insight, external support, and unanticipated events in the driving environment. Insufficient (I) evidence exists, to support that compensatory strategies (as mentioned above) enhance driving capabilities in persons with dementia. INTENDED USE OF THE RECOMMENDATIONS IN CLINICAL PRACTICE FOR DRIVERS WITH STROKE From the five Level I studies on stroke and driving, multimodal interventions (i.e., graded simulator intervention, traffic theory knowledge testing, and on-road training) are effective, with moderate to high certainty, to improve on-road driving outcomes. But, insufficient evidence exist that visual attention, speed of processing, or visual perceptual training result in effective on-road outcomes. This evidence suggests that occupational therapy practitioners should focus on remediating drivingrelated tasks such as behind-the-wheel training, rather than focusing on the underlying client factors. For Drivers with Visual Impairments Personalized educational interventions may be used to improve drivers with low vision’s self-perceptions on driving exposures and to increase their knowledge on risks of driving with such conditions. However, these effects (e.g., self-perceptions and knowledge) do not carry over to reduce crashes. One reason, perhaps, is that crashes are rare events, and as such the effects may not be observable via this driving outcome. The effect of the educational intervention has not yet been established during on-road or simulated driving events, so no certainty exists whether this intervention will benefit the fitness to drive abilities of older drivers with low vision. Training in the use of BTS holds potential as an effective intervention strategy, but testing must be done in older drivers (>65 years) to ascertain improvements in this group’s fitness to drive abilities. Moreover, the use of BTS while driving is not allowable in all states as vision policies vary from state to state. Therefore,
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occupational therapy practitioners who provide driving interventions need to be knowledgeable about the laws and policies in the various states where they practice, and where their clients live and drive. For Drivers with Cognitive Impairments Insufficient evidence exists to support the use of driving restrictions or compensatory strategies to enhance the driving capabilities of drivers with dementia. Because approximately 6 to 10% of the population over the age of 65 has dementia (Chapman et al., 2006), occupational therapy practitioners must cautiously consider the use of driving restrictions or compensatory strategies. Drivers with dementia do not perform well in less than predictable or unpredictable situations. Moreover, they may not have the insight to understand the rationale for driving restrictions or to follow through with compensatory strategies. Further studies are needed to determine the effectiveness of such interventions on the fitness to drive abilities of older drivers with cognitive impairment, before recommendations can be made with certainty. CONCLUSION The Classen et al. (in press) study provides evidence-based recommendations to occupational therapy practitioners who are working with medically at risk (e.g., stroke, low vision, and cognitive decline) older drivers. Much of the evidence was derived from different fields, such as physical therapy, ophthalmology, and/or public health. Thus, further research, specifically, well-designed RCTs that provide Alevel recommendations, is needed in and across occupational therapy settings to ascertain the effectives of those interventions. However, the recommendations of this project must be interpreted in light of some of the obvious limitations documented in the Classen et al. (in press) study. Those pertain to use of heterogeneous populations or methods (e.g., use of different simulators and simulator scenarios), sample size fluctuations, gender composition biased to one gender only, age differences (e.g., not all studies included older drivers exclusively), and methods of conducting the evidence based review (e.g., only studies published in the English language, and in peer reviewed journals, vs. the gray literature, were included). That been said, driving is a key instrumental activity of daily living for continued independence, autonomy, and quality of life, and the recommendations provided in this review may enable the clinical reasoning and decision-making skills of occupational therapy practitioners working with medically at risk older drivers. Declaration of interest: The author reports no conflict of interest. The author alone is responsible for the content and writing of this paper. This evidence-based review was funded by the AOTA-NHTSA Mini grant project (PI: Sherrilene Classen) and this paper is a summary of that project. ABOUT THE AUTHOR Sherrilene Classen, PhD, MPH, OTR/L, FAOTA, Professor and Chair: School of Occupational Therapy, Western University, Elborn College, 1201 Western Road, London, Ontario, Canada N6G 1H1.
EBR Summary on Drivers with Medical Conditions
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REFERENCES Akinwuntan AE, De Weerdt W, Feys H, Pauwels J, Baten G, Arno P, & Kiekens C. (2005). Effect of simulator training on driving after stroke: A randomized controlled trial. Neurology, 65(6), 843–850. Bowers A, Peli E, Elgin J, McGwin G, Jr., & Owsley C. (2005). On-road driving with moderate visual field loss. Optometry and Vision Science, 82(8), 657–667. doi: 00006324-200508000-00007 [pii] Chapman DP, Williams SM, Strine TW, Anda RF, & Moore MJ. (2006). Dementia and its implications for public health. Preventing Chronic Disease, 3(2), 1–13. Retrieved from http://www.cdc.gov/pcd/issues/2006/apr/05 0167.htm. Classen S, Monahan M, Auten B, & Yarney KA. (2014). Evidence based review of rehabilitation interventions for medically at risk older drivers. American Journal of Occupational Therapy. In press. Crotty M, & George S. (2009). Retraining visual processing skills to improve driving ability after stroke. Archives of Physical Medicine and Rehabilitation, 90(12), 2096–2102. doi: 10.1016/j.apmr.2009.08.143. Devos H, Akinwuntan AE, Nieuwboer A, Ringoot I, Berghen K, Tant M, et al. (2010). Effect of simulator training on fitness-to-drive after stroke: a 5-year follow-up of a randomized controlled trial. Neurorehabilitation and Neural Repair, 24(9), 843–850. doi: 10.1177/1545968310368687 Devos H, Akinwuntan AE, Nieuwboer A, Tant M, Truijen S, De Wit L, et al. (2009). Comparison of the effect of two driving retraining programs on on-road performance after stroke. Neurorehabilitation and Neural Repair, 23(7), 699–705. doi: 10.1177/1545968309334208 Freund B, & Petrakos D. (2008). Continued driving and time to transition to nondriver status through error-specific driving restrictions. Gerontology & Geriatrics Education, 29(24), 326–335. doi: 10.1080/02701960802497852 Man-Son-Hing M, Marshall SC, Molnar FJ, & Wilson KG. (2007). Systematic review of driving risk and the efficacy of compensatory strategies in persons with dementia. Journal of the American Geriatrics Society, 55(6), 878–884. Mazer BL, Sofer S, Korner-Bitensky N, Gelinas I, Hanley J, & Wood-Dauphinee S. (2003). Effectiveness of a visual attention retraining program on the driving performance of clients with stroke. Archives of Physical Medicine and Rehabilitation, 84(4), 541–550. doi: http://dx.doi.org/10.1053/apmr.2003.50085 Owsley C, McGwin G, Phillips JM, McNeal SF, & Stalvey BT. (2004). Impact of an educational program on the safety of high-risk, visually impaired, older drivers. American Journal of Preventive Medicine, 26(3), 222–229. doi: 10.1016/j.amepre.2003.012.005 Owsley C, Stalvey BT, & Phillips JM. (2003). The efficacy of an educational intervention in promoting self-regulation among high-risk older drivers. Accident Analysis & Prevention, 35(3), 393–400. Schold Davis E, & Dickerson A. (2012). The gaps and pathways project. OT Practice, 17(21), 9–13, 19. ¨ ¨ ST, Pettersson RP, & Leppert J. (2006). Prediction of driving ability after stroke and Soderstr om the effect of behind-the-wheel training. Scandinavian Journal of Psychology, 47(5), 419–429. doi: 10.1111/j.1467-9450.2006.00550.x Stalvey BT, & Owsley C. (2003). The development and efficacy of a theory-based educational curriculum to promote self-regulation among high-risk older drivers. Health Promotion Practice, 4(2), 109–119. Stav WB, Arbesman M, & Lieberman D. (2008). Background and methodology of the older driver evidence-based systematic literature review. American Journal of Occupational Therapy, 62, 130–135. Szlyk JP, Seiple W, Laderman DJ, Kelsch R, Ho K, & McMahon T. (1998). Use of bioptic amorphic lenses to expand the visual field in patients with peripheral loss. Optometry and Vision Science, 75(7), 518–524.
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Classen
Szlyk JP, Seiple W, Laderman DJ, Kelsch R, Stelmack J, & McMahon T. (2000). Measuring the effectiveness of bioptic telescopes for persons with central vision loss. Journal of Rehabilitation Research and Development, 37(1), 101–108. Szlyk JP, Seiple W, Stelmack J, & McMahon T. (2005). Use of prisms for navigation and driving in hemianopic patients. Ophthalmic and Physiological Optics, 25(2), 128–135. doi: 10.1111/j.1475–1313.2004.00265.x
Copyright of Occupational Therapy in Health Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
