Abstract
Primary Author and Speaker: Lori Breeden
Additional Authors and Speakers: Brittany Finigan, Hannah Elliott, Brooke Householder, Hannah Klemp, Lesly Solares
Driving is an example of an instrumental activity of daily living (IADL) that we depend on daily to support our endeavors at home and in the community. Driving plays a significant role in people’s lives as it supports engagement in occupations such as going to work, attending social gatherings, and ‘running errands’ such as grocery shopping (Dickerson, 2014; Chihuri et al., 2016; Stav, 2012). Due to the low number of specialist in driving rehab, there is concern that driving rehabilitation programs will not sufficiently meet the driving demands of the baby boomers (Dickerson, Reistetter, Davis, & Monahan, 2011) as well as those with illness or disability. Research has implied that skilled observation during IADL performance can assist with identifying an at-risk driver (Dickerson et al., 2011). Rehabilitation programs consist of both clinical screening and behind-the-wheel assessments can prove expensive (Dickerson et al., 2011).
OTs use clinical skills and science based knowledge of various health conditions to determine the impact on occupational performance (Dickerson, 2014). Organizations that endeavor to address driver training are often challenged to maintain costly programs. Stav, 2012 identified barriers of driving programs. These were funding and equipment, institution support, interdisciplinary conflict, role expectations, professional development, and staffing. A balance of standardized testing and clinical expertise can support economic efficiency of driver training programs. The purpose of this study was to identify factors that contributed to a stroke survivor’s success or failure in driving rehabilitation. The research questions were what client factors contribute to the successful return to driving following a stroke? and what combination of standardized tests and client factors influence a successful return to driving following a stroke?
This retrospective mixed method review examined 42 post stroke client charts from a driver program. No human subjects were included in this research, the team accessed de-identified charts of individuals who completed, successfully or unsuccessfully, the therapist recommended plan of care. Charts of individuals who had a stroke, and were previous drivers were included. Charts were not excluded based on severity or type of stroke.
The university Human Research Protections Program (HRPP) deemed the study exempt. The driving records were completed by a registered occupational therapist, certified driving rehabilitation specialist and deidentified data was extracted by members of the research team at the site, using Microsoft Excel. Quantitative data from assessments will be analyzed using a logistic regression. Qualitative analysis (preliminary) on narrative portions of the client charts used a thematic analysis within the categories of successful or unsuccessful return to driving. Qualitative analysis is preliminary, and quantitative analysis has not begun.
Findings indicate that individuals who were successful in a return to driving exhibited similar characteristics. Among these were adequate motor capability to quickly adapt to adaptive equipment within the vehicle, family support to ensure session attendance as well as on the road practice between sessions, and mental flexibility to adapt to multiple challenges and choices while driving. Those who were unsuccessful in driving demonstrated low frustration tolerance, poor mental flexibility and documentation did not indicate family support.
These findings are important to occupational therapy practice, providing insight into less measurable client factors. These factors, combined with standardized assessments can better predict the duration and intensity of treatment in a driver training program, supporting efficient use of resources.
Chihuri, S., Mielenz, T. J., DiMaggio, C. J., Betz, M. E., DiGuiseppi, C., Jone, V. C., & Li, G. (2016). Driving cessation and health outcomes in older adults. Journal of the American Geriatric Society, 64, 332-341.
Dickerson, A. E., Reistetter, T., Schold Davis, E., & Monahan, M. (2011). Evaluating driving as a valued instrumental activity of daily living. American Journal of Occupational Therapy, 65, 64–75. DOI:10.5014/ajot.2011.09052
Dickerson, A. E. (2014). Driving with dementia: Evaluation, referral, and resources. Occupational Therapy in Health Care, 28(1), 62-67. DOI: 10.3109/07380577.2013.867091
Stav, W. B. (2012). Developing and implementing driving rehabilitation programs: A phenomenological approach. American Journal of Occupational Therapy, 66, e11-e19. DOI:10.5014/ajot.2012.000950