Research Papers

A Collaborative International Knowledge Synthesis to Update Guidelines for Determining Medical Fitness to Operate Motor Vehicles with Traumatic Brain Injury or Dementia

Version 1
Date added June 30, 2016
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Category 2016 CARSP XXVI Halifax
Tags Research and Evaluation, Session 3B
Author/Auteur Shawn Marshall
Stream/Volet Research and Evaluation

Slidedeck Presentation not available (no paper submitted)


Background/Context: The Canadian Medical Association (CMA) Driver's Guide is widely used by physicians across Canada to guide decision-making about assessing the impact of medical conditions and treatments on driving abilities, advising patients of the risks, and reporting to transportation authorities. The CMA Driver's Guide and other similar international guidelines are limited in their currency, applicability, rigour of development, and integration of knowledge-user perspectives. Those most affected by the guidelines, healthy drivers, patients and caregivers, have not provided input.

Aims/Objectives: The objective is to create up-to-date knowledge syntheses (KS) and high-quality clinical recommendations on assessing and managing risks to driving posed by two medical conditions of high priority: traumatic brain injury (TBI) and dementia. The KS will leverage skills of Canadian and international knowledge experts, and incorporate the input of clinician and transportation knowledge-users as well as drivers, patients and caregivers.

Methods/Target Group: An international team of experts followed the ADAPTE process (as outlined in the manual and resource toolkit for guideline adaptation by the ADAPTE Collaboration) to conduct two knowledge syntheses (KS) (i.e. TBI and dementia) and update existing recommendations. To-date, this has involved reviewing international and national guidelines; developing a short-list of key topics on driving and these medical conditions; selecting research questions of high-priority; performing comprehensive searches of literature databases; and systematically screening the titles of search results.

Results/Activities: A total of 166 recommendations were retrieved from twelve international-national guidelines on both conditions collectively. After prioritizing a shortlist of 11 potential topics for TBI and 8 for dementia, separate working groups consolidated the topics into 3 TBI-related and 4 dementia-related research questions for the KS. Systematic searches of seven databases (MEDLINE, Embase, CINAHL, Scopus, PsychInfo, Cochrane library, and Transportation Research Information Database) were developed by a medical librarian and subsequently produced a total of 9986 citation results for TBI and 12860 for dementia. Screening of the TBI titles revealed that only 4507 were relevant, with the screening of dementia citations currently in progress.

Discussion/Deliverables: Although reviews on the topic of fitness to drive in TBI and dementia have been conducted in the past, no recent syntheses have been done with the aim of creating quality guidelines for clinicians and transportation authorities. This study will present the first systematic evaluation of national-level guidelines for determining medical fitness to drive. The next steps in the process will involve the independent screening of all relevant abstracts for eligibility by two reviewers, followed by: extracting pertinent information from the included articles; summarizing and assessing those articles on quality and risk of bias; updating clinical guidelines with input from knowledge-users; and revising the CMA Driver's Guide accordingly.

Conclusions: A well-executed knowledge synthesis incorporating knowledge-user input will increase confidence of clinicians using the guidelines, inform transportation policy, and improve driving safety. As this study provides a model for updating syntheses as well as Canadian and other international fitness to drive guidelines, plans are being developed by our team to address other health conditions and driving (e.g. cardiovascular diseases) in the near future.

Shawn Marshall