Predicting fitness to drive for medically at-risk drivers using touchscreen DriveSafe DriveAware

Importance: Occupational therapists require valid cognitive fitness-to-drive tools to advise drivers in this highstakes area. Objective: To examine the psychometric properties and predictive validity of data gathered with the touchscreen DriveSafe DriveAware (DSDA). Design: Prospective study that compared a screening tool with a criterion standard. Setting: Ten community-and hospital-based driver assessment clinics in Australia and New Zealand. Participants: Older and cognitively impaired drivers (N 5=134) ages 18 to 91 years (M^age= 68) who were referred for an assessment to determine the impact of a medical condition on driving. The inclusion criteria were a valid driver's license, vision within license authority guidelines, completion of at least 1 year of high school, and English as a first language. Outcomes and Measures: The results of the touchscreen DSDA, a standardized assessment of awareness of the driving environment and one's own driving abilities, were compared with those of a standardized occupational therapist-administered on-road assessment. Results: Rasch analysis provided evidence for the construct validity and internal reliability of data gathered with the touchscreen DSDA. Optimal upper and lower cutoff scores were set to trichotomize drivers into three categories: likely to pass an on-road assessment, likely to fail an on-road assessment, and further testing required. Specificity of the touchscreen DSDA was 86%, and sensitivity was 91%; positive predictive value was 83%, negative predictive value was 92%, and overall accuracy of classification was 88%. Conclusions and Relevance: Evidence supports the utility of the touchscreen DSDA for accurately predicting which participants require on-road assessment.