Standardized on-road tests assessing fitness-to-drive in people with cognitive impairments: A systematic review
- Authors:
- Bellagamba, D., Vionnet, L., Margot-Cattin, I., and Vaucher, P.
- Abstract:
- 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. - DOI:
- 10.1371/journal.pone.0233125
- URL:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233547/pdf/pone.0233125.pdf
- Journal:
- PLoS One
- issn:
- 1932-6203
- Publication year:
- 2020
- pages:
- e0233125
- Functional status:
- Cognitive/mental functioning
Physical functioning
Role functioning - Age:
- Adults (18-65)
Seniors (65+) - Disease:
- Mental and behavioural disorders and related symptoms
- PRO / non-PRO:
- Non-patient Reported Outcome
- Type of measurement instrument:
- 4 - Performance-based tests
6 - Clinical rating scales
7 - Observations - Instrument:
- CDAS - Composite Driving Assessment Scale
DOS - Driving Observation Schedule
NHS - New Haven Score
NNDA - Nottingham Neurological Driving Assessment
PBDE - Performance-Based Driving Evaluation
P-drive - Performance Analysis of Driving Ability
RIRT - Rhode Island Road Test
RODE - Record of Driving Errors
SMS - Sum of Maneuvers Score
TRIP - Test Ride for Investigation Practical fitness-to-drive
UWO - University of Western Ontario’s on-road assessment
WURT - Washington University Road Test.