Unsworth Carolyn A, Baker Anne
Faculty of Health Sciences, La Trobe University, Melbourne 3086, VIC, Australia; Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden.
Faculty of Health Sciences, La Trobe University, Melbourne 3086, VIC, Australia.
Accid Anal Prev. 2014 Oct;71:106-14. doi: 10.1016/j.aap.2014.04.017. Epub 2014 Jun 2.
Driver rehabilitation has the potential to improve on-road safety and is commonly recommended to clients. The aim of this systematic review was to identify what intervention approaches are used by occupational therapists as part of driver rehabilitation programmes, and to determine the effectiveness of these interventions.
Six electronic databases (MEDLINE, CINAHL, PsycInfo, Embase, The Cochrane Library, and OTDBase) were searched. Two authors independently reviewed studies reporting all types of research designs and for all patient populations, provided the interventions could be administered by occupational therapists. The methodological quality of studies was assessed using the 'Downs and Black Instrument', and the level of evidence for each intervention approach was established using 'Centre for Evidence Based Medicine' criteria.
Sixteen studies were included in the review. The most common type of intervention approach used was computer-based driving simulator training (n=8), followed by off-road skill-specific training (n=4), and off-road education programmes (n=3). Car adaptations/modifications were used in one of the included studies. There was significant variability between studies with regards to frequency, duration, and total number of intervention sessions, and the diagnoses of the participants. Of the four intervention approaches, there is evidence to support the effectiveness of off-road skill-specific training (with older clients), and computer-based driving simulator training (with both older clients and participants with acquired brain injury).
Three types of intervention approaches are commonly reported, however, there is limited evidence to determine to effectiveness of these in improving fitness-to-drive. Further research is required, with clients from a range of diagnostic groups to establish evidence-based interventions and determine their effectiveness in improving these clients' on-road fitness-to-drive.
驾驶员康复有改善道路安全的潜力，并且通常被推荐给客户。本系统评价的目的是确定职业治疗师在驾驶员康复计划中使用的干预方法，并确定这些干预措施的有效性。
检索了六个电子数据库（MEDLINE、CINAHL、PsycInfo、Embase、Cochrane图书馆和OTDBase）。两位作者独立审查了报告所有类型研究设计以及针对所有患者群体的研究，前提是这些干预措施可由职业治疗师实施。使用“唐斯和布莱克工具”评估研究的方法学质量，并使用“循证医学中心”标准确定每种干预方法的证据水平。
该评价纳入了16项研究。最常用的干预方法类型是基于计算机的驾驶模拟器训练（n = 8），其次是越野技能特定训练（n = 4）和越野教育计划（n = 3）。在所纳入的一项研究中使用了汽车改装。在研究之间，干预课程的频率、持续时间和总数以及参与者的诊断存在显著差异。在这四种干预方法中，有证据支持越野技能特定训练（针对老年客户）和基于计算机的驾驶模拟器训练（针对老年客户和获得性脑损伤参与者）的有效性。
通常报告了三种类型的干预方法，然而，确定这些方法在提高驾驶适宜性方面的有效性的证据有限。需要进一步开展研究，纳入来自一系列诊断组的客户，以建立循证干预措施并确定其在提高这些客户的道路驾驶适宜性方面的有效性。
