Identifying Current Driver Rehabilitation Practices for Clients With Physical Impairments

BACKGROUND: Driving is an important occupation that influences a person's ability to access community resources and participate in social activities that are meaningful to them. Clinicians, such as occupational therapists, who are trained as driver rehabilitation specialists (DRS) work with individuals experiencing physical limitations and provide interventions to improve function and independence in driving. Currently, this area of practice has limited standardized guidelines and protocols (Di Stefano et al., 2019) and there is anecdotal evidence of inconsistent clinical practice for both new and experienced DRS.

OBJECTIVE: To identify common intervention practices and factors that influence driver rehabilitation recommendations that DRS use when working with clients needing adaptive driving equipment.

DESIGN: Cross-sectional on-line survey.

METHODS: DRS from the US and Canada were surveyed using a survey that was created by the research team and distributed online. The survey consisted of close-ended and open-ended questions eliciting information on demographics, practice processes/protocols and factors influencing recommendations for driver retraining and adaptive equipment prescription. To elicit more specific and concrete responses, two case studies and corresponding questions were also included in the survey. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using conventional content analysis (Hsieh & Shannon, 2005). Findings: Thirty-six respondents completed the survey; half were from the United States. The majority of respondents were trained occupational therapists practicing in the area of driver rehabilitation (97.2%). Completion of in-clinic and on-road evaluation were consistent among the majority of respondents, yet the specific evaluation components varied. Inconsistencies emerged in prescription recommendations of secondary controls, where < 75% of respondents recommended this specific adaptive driving equipment. The results also identified differences in requirements for clients to pass provincial/state licensing examinations which affected practice. Responses to open-ended questions emphasized the importance of clinical reasoning skills in light of the person-centered and jurisdictionally specific nature of this practice area. There was variability in the type of training, and experience of clinicians.

CONCLUSION: The results of this study add further evidence of consistencies in practice of in-clinic and on-road evaluation. When determining equipment prescription and driver rehabilitation recommendations, a person-centered approach and the presence of external variables influence recommendations. Further exploration into why formal education is not more prevalent and if this influences practice may be an area of future research. Further research should focus on explore novel approaches to ensure effective service delivery to all clients. Implications for practice: Clinicians working in driver rehabilitation must rely on research evidence, and clinical reasoning skills to deliver person-centred care when prescribing adaptive driving equipment and implementing driver rehabilitation. There is need for the development of better practice guidelines in this area.

References

Di Stefano, M., Stuckey, R., Kinsman, N., & Lavender, K. (2019). Vehicle modification prescription: Australian occupational therapy consensus-based guidelines. American Journal of Occupational Therapy, 73(2), 7302205140.

Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277-1288. https://doi.org/10.1177/1049732305276687