Assessment tools for evaluating fitness to drive: A critical appraisal of evidence

Background. Many office-based assessment tools are used by occupational therapists to predict fitness to drive. Purpose. To appraise psychometric properties of such tools, specifically predictive validity for on-road performance. Methods. A literature search was conducted to identify assessment tools and studies involving on-road outcomes (behind-the-wheel evaluation, crashes, traffic violations). Using a standardized appraisal process, reviewers rated each tool's psychometric properties, including its predictive validity with on-road performance. Findings. Seventeen measures met the inclusion criteria. Evidence suggests many tools do not have cutoff scores linked with on-road outcomes, although some had stronger evidence than others. Implications. When making a determination regarding driver fitness, clinicians should consider the psychometric properties of the tool as well as existing evidence concerning its utility in predicting on-road performance. Caution is warranted in using any one office-based tool to predict driving fitness; rather, a multifactorial-based assessment approach that includes physical, cognitive, and visual-perceptual components, is recommended.