Revision of the Competency Standards for Occupational Therapy Driver Assessors: An overview of the evidence for the inclusion of cognitive and perceptual assessments within fitness-to-drive evaluations

Background/aimDetermination of fitness-to-drive after illness or injury is a complex process typically requiring a comprehensive driving assessment, including off-road and on-road assessment components. The competency standards for occupational therapy driver assessors (Victoria, Australia) define the requirements for performance of a comprehensive driving assessment, and we are currently revising these. Assessment of cognitive and perceptual skills forms an important part of the off-road assessment. The aim of this systematic review of systematic reviews (known as an overview) is to identify what evidence exists for including assessment of cognitive and perceptual skills within fitness-to-drive evaluations to inform revision of the competency standards. MethodsFive electronic databases (MEDLINE, CINAHL, PsycINFO, The Cochrane Library, OT Seeker) were systematically searched. Systematic review articles were appraised by two authors for eligibility. Methodological quality was independently assessed using the AMSTAR tool. Narrative analysis was conducted to summarise the content of eligible reviews. ResultsA total of 1228 results were retrieved. Fourteen reviews met the inclusion criteria. Reviews indicated that the components of cognition and perception most frequently identified as being predictive of fitness-to-drive were executive function (n=13), processing speed (n=12), visuospatial skills, attention, memory and mental flexibility (n=11). Components less indicative were perception, concentration (n=10), praxis (n=9), language (n=7) and neglect (n=6). ConclusionThis overview of systematic reviews supports the inclusion of assessment of a range of cognitive and perceptual skills as key elements in a comprehensive driver assessment and therefore should be included in the revised competency standards for occupational therapy driver assessors.