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Acceptability and concurrent validity of measures to predict older driver involvement in motor vehicle crashes: an Emergency Department pilot case-control study.

https://arctichealth.org/en/permalink/ahliterature161383
Source
Accid Anal Prev. 2007 Sep;39(5):1056-63
Publication Type
Article
Date
Sep-2007
Author
Frank J Molnar
Shawn C Marshall
Malcolm Man-Son-Hing
Keith G Wilson
Anna M Byszewski
Ian Stiell
Author Affiliation
CanDRIVE(1): a Canadian Institutes of Health Research (CIHR) Institute of Aging funded New Emerging Team, Elisabeth-Bruyère Research Institute, 43 Bruyère Street, Ottawa, ON, Canada K1N 5C8. fmolnar@ottawahospital.on.ca
Source
Accid Anal Prev. 2007 Sep;39(5):1056-63
Date
Sep-2007
Language
English
Publication Type
Article
Keywords
Accidents, Traffic - prevention & control - statistics & numerical data
Aged
Automobile Driver Examination - statistics & numerical data
Case-Control Studies
Chronic Disease - epidemiology
Dementia - diagnosis - epidemiology
Disability Evaluation
Female
Head Movements
Humans
Male
Mass Screening - statistics & numerical data
Mental Status Schedule - statistics & numerical data
Motor Skills
Neuropsychological Tests - statistics & numerical data
Ontario
Pilot Projects
Psychomotor Performance
Questionnaires
Reaction Time
Risk
Visual Fields
Wounds and injuries - epidemiology - prevention & control
Abstract
Older drivers have one of the highest motor vehicle crash (MVC) rates per kilometer driven, largely due to the functional effects of the accumulation, and progression of age-associated medical conditions that eventually impact on fitness-to-drive. Consequently, physicians in many jurisdictions are legally mandated to report to licensing authorities patients who are judged to be medically at risk for MVCs. Unfortunately, physicians lack evidence-based tools to assess the fitness-to-drive of their older patients. This paper reports on a pilot study that examines the acceptability and association with MVC of components of a comprehensive clinical assessment battery.
To evaluate the acceptability to participants of components of a comprehensive assessment battery, and to explore potential predictors of MVC that can be employed in front-line clinical settings.
Case-control study of 10 older drivers presenting to a tertiary care hospital emergency department after involvement in an MVC and 20 age-matched controls.
The measures tested were generally found to be acceptable to participants. Positive associations (p
PubMed ID
17854579 View in PubMed
Less detail

The acceptability to older drivers of different types of licensing restriction.

https://arctichealth.org/en/permalink/ahliterature165854
Source
Accid Anal Prev. 2007 Jul;39(4):776-93
Publication Type
Article
Date
Jul-2007
Author
Shawn C Marshall
Malcolm Man-Son-Hing
Frank Molnar
Keith G Wilson
Richard Blair
Author Affiliation
Elisabeth Bruyère Research Institute, SCO Health Service, Ottawa, Ontario, Canada. smarshall@ottawahospital.on.ca
Source
Accid Anal Prev. 2007 Jul;39(4):776-93
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Automobile Driver Examination - legislation & jurisprudence
Automobile Driving - psychology - standards
Female
Humans
Interviews as Topic
Licensure - standards
Male
Ontario
Public Opinion
Rural Population
Urban Population
Abstract
The primary objective of this study was to determine the acceptability of various driving restrictions to older drivers. Licensed drivers aged 65 years or more living in the community in the Ottawa, Ontario area were recruited by means of posters and advertisements in regional and local newspapers. We recruited 86 subjects, 56 men and 30 women with a mean age of 75 years (50 urban and 36 rural residents). The subjects completed a one-hour interview with one of two trained study nurses during which their driving restriction preferences (utilities) were determined using a modified standard gamble technique. Highly endorsed restrictions included regular assessment by the Ministry of Transportation (mean utility 0.94), driving with vehicle adaptations (0.94) and daytime driving only (0.93). Less acceptable restrictions included avoidance of roads with a speed limit greater than 60 km/h (0.50), limitation of destinations (0.45), driving only within a 10-km radius of home (0.45) and requirement of another licensed driver in the vehicle (0.42). Our subjects' preferences appeared to be inversely related to the impact on autonomy and the ability to access the community. These findings may be useful to motor transport administrators in designing effective restricted licensing programs that are acceptable to older drivers.
PubMed ID
17196917 View in PubMed
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The Canadian Safe Driving Study-Phase I pilot: Examining potential logistical barriers to the full cohort study.

https://arctichealth.org/en/permalink/ahliterature113896
Source
Accid Anal Prev. 2013 Dec;61:236-44
Publication Type
Article
Date
Dec-2013
Author
Shawn C Marshall
Keith G Wilson
Malcolm Man-Son-Hing
Ian Stiell
Andrew Smith
Kelly Weegar
Yara Kadulina
Frank J Molnar
Author Affiliation
Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont., Canada. Electronic address: smarshall@ottawahospital.on.ca.
Source
Accid Anal Prev. 2013 Dec;61:236-44
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Accidents, Traffic - prevention & control - statistics & numerical data
Aged
Aged, 80 and over
Automobile Driving - statistics & numerical data
Canada
Cohort Studies
Data Collection - methods
Decision Support Techniques
Female
Humans
Longitudinal Studies
Male
Patient Dropouts
Pilot Projects
Prospective Studies
Research Design
Sample Size
Abstract
Multiple organizations and task forces have called for a reliable and valid method to identify older drivers who are medically unfit to drive. The development of a clinical decision rule for this type of screening requires data from a longitudinal prospective cohort of older drivers. The aim of this article is to identify potential design, sampling and data collection barriers to such studies based on an analysis of the Canadian Safe Driving Study-phase I pilot (Candrive I). A convenience sample of 100 active older drivers aged 70 years or more was recruited through the aid of a seniors' organization, 94 of whom completed the full study (retention rate 94%). Data were collected over the course of 1 year on various driving behaviours, as well as on cognitive, physical and mental functioning. Driving patterns were recorded using driving diaries, logs and electronic devices. Driving records from the Ministry of Transportation of Ontario (MTO) were obtained for the 3-year period preceding the study initiation and up to 1 year following study completion. An increased burden of illness was observed as the number of medical diagnoses and medication use increased over the study period. Study participants were involved in a total of five motor vehicle collisions identified through MTO records, which was comparable to the Ontario annual collision rate of 4.1% for drivers aged 75 years or older. In sum, many of the relevant logistical and practical barriers to studying a large sample of older drivers longitudinally have been shown to be addressable, supporting the feasibility of completing a large prospective cohort study of older drivers.
PubMed ID
23672943 View in PubMed
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Department of Transportation vs self-reported data on motor vehicle collisions and driving convictions for stroke survivors: do they agree?

https://arctichealth.org/en/permalink/ahliterature132374
Source
Traffic Inj Prev. 2011 Aug;12(4):327-32
Publication Type
Article
Date
Aug-2011
Author
Hillel M Finestone
Meiqi Guo
Paddi O'Hara
Linda Greene-Finestone
Shawn C Marshall
Lynn Hunt
Anita Jessup
Jennifer Biggs
Author Affiliation
Elisabeth Bruyère Hospital, Bruyère Continuing Care, Ottawa, Ontario, Canada. hfinestone@bruyere.org
Source
Traffic Inj Prev. 2011 Aug;12(4):327-32
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Accidents, Traffic - statistics & numerical data
Aged
Automobile Driving - legislation & jurisprudence - psychology - statistics & numerical data
Female
Government Agencies
Humans
Male
Middle Aged
Ontario
Prospective Studies
Records as Topic
Reproducibility of Results
Safety
Self Report
Stroke - epidemiology - psychology
Survivors - psychology - statistics & numerical data
Abstract
Research on stroke survivors' driving safety has typically used either self-reports or government records, but the extent to which the 2 may differ is not known. We compared government records and self-reports of motor vehicle collisions and driving convictions in a sample of stroke survivors.
The 56 participants were originally recruited for a prospective study on driving and community re-integration post-stroke; the study population consisted of moderately impaired stroke survivors without severe communication disorders who had been referred for a driving assessment. The driving records of the 56 participants for the 5 years before study entry and the 1-year study period were acquired with written consent from the Ministry of Transportation of Ontario (MTO), Canada. Self-reports of collisions and convictions were acquired via a semistructured interview and then compared with the MTO records.
Forty-three participants completed the study. For 7 (13.5%) the MTO records did not match the self-reports regarding collision involvement, and for 9 (17.3%) the MTO records did not match self-reports regarding driving convictions. The kappa coefficient for the correlation between MTO records and self-reports was 0.52 for collisions and 0.47 for convictions (both in the moderate range of agreement). When both sources of data were consulted, up to 56 percent more accidents and up to 46 percent more convictions were identified in the study population in the 5 years before study entry compared to when either source was used alone.
In our population of stroke survivors, self-reports of motor vehicle collisions and driving convictions differed from government records. In future studies, the use of both government and self-reported data would ensure a more accurate picture of driving safety post-stroke.
PubMed ID
21823940 View in PubMed
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Differences between poststroke drivers and nondrivers: demographic characteristics, medical status, and transportation use.

https://arctichealth.org/en/permalink/ahliterature150629
Source
Am J Phys Med Rehabil. 2009 Nov;88(11):904-23
Publication Type
Article
Date
Nov-2009
Author
Hillel M Finestone
Shawn C Marshall
Dmitry Rozenberg
Raffy C Moussa
Lynn Hunt
Linda S Greene-Finestone
Author Affiliation
Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Bruyère Continuing Care, Ontario, Canada.
Source
Am J Phys Med Rehabil. 2009 Nov;88(11):904-23
Date
Nov-2009
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Adult
Age Factors
Aged
Aged, 80 and over
Automobile Driving - statistics & numerical data
Canada - epidemiology
Cohort Studies
Demography
Female
Humans
Interviews as Topic
Male
Middle Aged
Recovery of Function
Retrospective Studies
Stroke - epidemiology - rehabilitation
Transportation
Abstract
To determine the demographic, medical, and transportation use characteristics of stroke survivors wanting to drive who resumed or did not resume driving and compare the driving habits of those who drove with those of a nonstroke control group.
One hundred and six stroke survivors who underwent a driving evaluation at a rehabilitation center in Ottawa, Canada, between 1995 and 2003, participated in a structured telephone interview 4-5 yrs after the evaluation. Information on driving history and transportation use before the driving assessment was obtained from the driving assessment client database. The nonstroke control group was derived from the literature.
After stroke, 66% of subjects had resumed driving. Prestroke driving history was similar for drivers and nondrivers. Drivers were younger than nondrivers (mean age +/- SD, 62.7 +/- 12.7 yrs vs. 69.2 +/- 13.4 yrs; P = 0.02), had less medical comorbidity (mean modified Cumulative Illness Rating Scale score, 3.7 +/- 1.97 vs. 5.0 +/- 2.89; P = 0.01), and were less likely to rely on a walker (1.4% vs. 19.4%, P
PubMed ID
19487920 View in PubMed
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Driving and reintegration into the community in patients after stroke.

https://arctichealth.org/en/permalink/ahliterature142162
Source
PM R. 2010 Jun;2(6):497-503
Publication Type
Article
Date
Jun-2010
Author
Hillel M Finestone
Meiqi Guo
Paddi O'Hara
Linda Greene-Finestone
Shawn C Marshall
Lynn Hunt
Jennifer Biggs
Anita Jessup
Author Affiliation
Candrive Research Program, Canadian Institutes of Health Research, Ottawa, ON K1N 5C8, Canada. hfinestone@bruyere.org
Source
PM R. 2010 Jun;2(6):497-503
Date
Jun-2010
Language
English
Publication Type
Article
Keywords
Aged
Automobile Driving
Factor Analysis, Statistical
Female
Health Status Indicators
Humans
Life Style
Male
Middle Aged
Ontario
Prospective Studies
Stroke - rehabilitation
Abstract
To investigate the relationship between driving versus not driving and community integration after stroke. Much research on patients who drive after experiencing a stroke has focused on driving assessment protocols; little attention has been given to the implications of assessment outcomes.
Prospective study.
Six driving evaluation centers in Ontario, Canada.
Fifty-three community-dwelling patients who were referred for a driving assessment after they experienced a stroke.
Data on demographics, living circumstances, health status, driving habits, and driving history were gathered via a semistructured interview and various questionnaires administered on 3 occasions: study entry (> or =1 month after stroke; n = 53), 3 months (n = 44), and 1 year (n = 43).
Reintegration into the community at 1 year, as evaluated with the Reintegration to Normal Living Index (RNLI).
The participants had sustained a stroke an average of 12.3 months before study entry. Two subjects were driving at study entry. At 1 year, 28 (65%) of 43 subjects had passed their driving test and had resumed/continued driving. Nondrivers had a significantly lower mean RNLI score than drivers. Subjects who were not driving at study entry but had resumed driving by 1 year had a significant increase in RNLI score (P = .011). Driving was significantly associated with community integration after adjustment for concomitant health status (P
PubMed ID
20630436 View in PubMed
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Evaluating medically at-risk drivers: a survey of assessment practices in Canada.

https://arctichealth.org/en/permalink/ahliterature104699
Source
Can J Occup Ther. 2013 Dec;80(5):295-303
Publication Type
Article
Date
Dec-2013
Author
Brenda H Vrkljan
Anita M Myers
Alexander M Crizzle
Robin A Blanchard
Shawn C Marshall
Source
Can J Occup Ther. 2013 Dec;80(5):295-303
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Ataxia
Automobile Driver Examination
Automobile Driving
Canada
Health status
Humans
Mental health
Muscle strength
Occupational Therapy - methods
Range of Motion, Articular
Referral and Consultation
Risk factors
Vision, Ocular
Abstract
Assessing medical fitness to drive (FTD) can include both off- and on-road testing, although consistency of practice is unclear.
To examine actual practices being used to assess FTD at driver assessment centres (DACs) across Canada.
Surveys e-mailed to 90 DACs were returned by 47 assessors.
The majority of respondents (89%) were occupational therapists. Assessors reported doing an average of eight FTD assessments per month (range = I to 40) at an average cost of $366 (SD = $225; range = $40 to $985). Referrals came from physicians (96%), other health professionals (70%), and licensing authorities (66%). Clients with stroke, dementia, traumatic brain injury, mild cognitive impairment, and multiple sclerosis composed 62% of estimated caseloads. Assessments took 3 hr on average (range = 1.24 to 4.5 hr); 64% reported they always took clients on road regardless of clinic results.
Evidence-based guidelines for training and assessment are clearly needed given the inconsistency in practice.
PubMed ID
24640644 View in PubMed
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In-office evaluation of medical fitness to drive: practical approaches for assessing older people.

https://arctichealth.org/en/permalink/ahliterature175546
Source
Can Fam Physician. 2005 Mar;51:372-9
Publication Type
Article
Date
Mar-2005
Author
Frank J Molnar
Anna M Byszewski
Shawn C Marshall
Malcolm Man-Son-Hing
Author Affiliation
Institute of Aging, Canadian Institute of Health Research, Elizebeth-Bruyère Research Institute, Ottawa, ON.
Source
Can Fam Physician. 2005 Mar;51:372-9
Date
Mar-2005
Language
English
Publication Type
Article
Keywords
Aged
Automobile Driving - legislation & jurisprudence
Canada
Evidence-Based Medicine
Family Practice
Geriatric Assessment
Humans
Licensure - legislation & jurisprudence
Mass Screening
Abstract
To provide background for physicians'in-office assessment of medical fitness to drive, including legal risks and responsibilities. To review opinion-based approaches and current attempts to promote evidence-based strategies for this assessment.
MEDLINE, EMBASE, CINAHL, PsyclNFO, Ageline, and Sociofile were searched from 1966 on for articles on health-related and medical aspects of fitness to drive. More than 1500 papers were reviewed to find practical approaches to, or guidelines for, assessing medical fitness to drive in primary care. Only level III evidence was found. No evidence-based approaches were found.
Three practical methods of assessment are discussed: the American Medical Association guidelines, SAFE DRIVE, and CanDRIVE.
There is no evidence-based information to help physicians make decisions regarding medical fitness to drive. Current approaches are primarily opinion-based and are of unknown predictive value. Research initiatives, such as the CanDRIVE program of the Canadian Institutes of Health Research, can provide empiric data that would allow us to move from opinion to evidence.
Notes
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PubMed ID
15794022 View in PubMed
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Measurement of driving patterns of older adults using data logging devices with and without global positioning system capability.

https://arctichealth.org/en/permalink/ahliterature161806
Source
Traffic Inj Prev. 2007 Sep;8(3):260-6
Publication Type
Article
Date
Sep-2007
Author
Shawn C Marshall
Keith G Wilson
Frank J Molnar
Malcolm Man-Son-Hing
Ian Stiell
Michelle M Porter
Author Affiliation
Elisabeth Bruyère Research Institute, Ottawa, Ontario, Canada. smarshall@ottawahospital.on.ca
Source
Traffic Inj Prev. 2007 Sep;8(3):260-6
Date
Sep-2007
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Automobile Driving
Canada
Data Collection - instrumentation
Female
Geographic Information Systems
Humans
Male
Prospective Studies
Abstract
Methods to study driving patterns and exposure of older drivers have typically relied on surveys or driving diaries. Electronic data logging devices may offer a reliable, alternative method of measuring driving exposure, and global positioning system (GPS) technology may be able to provide further information about driving patterns.
The aim of this study was to compare a driving diary with two electronic data logging devices, one of which had GPS capability, in order to identify which method best assesses the driving exposure and habits of older drivers as well as the method most acceptable to study participants.
In this prospective cohort study we recruited 20 participants aged 70 years or more (mean 78; range 70-85) (15 men and 5 women). The participants' driving patterns were recorded for one week with an electronic data logging device with GPS (FleetPulse), followed by recording for a further week with an electronic data logging device without GPS (CarChip). During both time periods the subjects also completed a standard driving diary.
More comprehensive information, including braking and acceleration patterns, duration of driving time, time of day, and maximum speeds, was collected with the electronic devices than with the driving diary. There was excellent correlation between the driving diary data and those obtained with the CarChip (r = 0.9; p
PubMed ID
17710716 View in PubMed
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A prospective study to validate an impairment questionnaire for major trauma survivors.

https://arctichealth.org/en/permalink/ahliterature165478
Source
Am J Phys Med Rehabil. 2007 Feb;86(2):114-24
Publication Type
Article
Date
Feb-2007
Author
Shawn C Marshall
Daryl Gray
Keith G Wilson
Jean-Denis Yelle
Paul Hébert
Keith O'Rourke
Maryam Jamshidi
Author Affiliation
Division of Physical Medicine and Rehabilitation, The Rehabilitation Centre, Ottawa, Ontario, Canada.
Source
Am J Phys Med Rehabil. 2007 Feb;86(2):114-24
Date
Feb-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Disabled Persons - psychology - rehabilitation
Female
Health Knowledge, Attitudes, Practice
Humans
Male
Middle Aged
Ontario
Prospective Studies
Psychometrics - instrumentation
Quality of Life
Questionnaires
Sickness Impact Profile
Survivors - psychology
Wounds and Injuries - physiopathology - psychology - rehabilitation
Abstract
To develop and validate an impairment questionnaire that will provide an estimate of whole-person impairment in patients who have suffered major trauma.
This was a multicenter prospective study involving a convenience sample of 43 volunteer participants who had sustained major trauma within 1 yr of study commencement. Patients were recruited from two trauma centers in Ontario, Canada. The impairment questionnaire was developed as a self-administered questionnaire based on the American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition.
Clinician assessments of whole-person impairment showed adequate interrater (r > or = 0.55, P or = 0.62, P or = 0.57, P 0.60, P
PubMed ID
17251693 View in PubMed
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14 records – page 1 of 2.