3-Domains screening toolkit for older driver medical assessment in general practice

The 3-Domains screening toolkit has been developed for use in general practice during annual driver licence medical assessment in older drivers (>75 years). The toolkit assesses across the three functional domains essential for driving (sensory, motor, and cognitive) and generates a combined predictive score of likelihood the older driver would pass on-road driving assessment (%). The three toolkit tests are visual acuity (Sensory), functional reach (Motor), and road signs recognition (Cognitive). The combined predictive score can be used to inform GP clinical judgement and to support conversations between GPs and older drivers about the need to plan for eventual driving cessation or for further in-depth testing.

Feasibility study in general practice: The feasibility study in general practices in south-east Queensland is using the toolkit during routine annual driver medical assessment in older drivers and exploring acceptability and utility through interviews with older drivers, practice nurses and GPs.

Validation study in specialist driving assessment clinic: The validation study in the Occupational Therapy Driving Assessment & Rehabilitation Service, Princess Alexandra Hospital, Brisbane is evaluating the three toolkit tests and specialist on-road driving assessment outcome to determine and improve accuracy of the 3-Domains toolkit prediction equation for older (>75 years) Australian drivers.

Funded by: The Royal Australian College of General Practice (RACGP) Foundation and Motor Accident Insurance Commission (MAIC) Grant.

The 3-Domains screening toolkit consists of the following assessment tools to use in older driver medical assessments:

Visual Acuity

Use Snellen chart (with five letters on the 6/12 line). Read from 3 meters, each eye separately and then together as per Austroads. Score 0.1 for every correctly read line. More than two errors on any line is regarded as a failure to read that line. Score range 0 to 1.2. Enter score (e.g. “0.5”) into online calculator. https://medicine-program.uq.edu.au/3-domains-toolkit

A score of at least 6/12 (0.5) is the minimal requirement for driving in Australia (<0.5 = fail).

Snellen Chart

Functional Reach Test

Older driver stands with one arm extended forward and makes a fist (START). They reach forward as far as possible (FINISH). No contact with wall is allowed. If they touch the wall or take a step, repeat the test. Best of 3 attempts.

Measure between START and FINISH positions of the third metacarpal (cm). Enter score (cm) into online calculator.

^{*Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: A new clinical measure of balance. J Gerontol Med Sci. 1990;45(6):M192-97:10.1093/geronj/45.6.M192}

Road Signs Recognition Test

Place the road situation cards (pages 1 and 2) in front of older driver, spread the 12 road sign cards in any order below the pages with road situations. Explain the test as follows:

“I would like you to put each road sign on the picture of the road situation that it matches best. For example, this card shows a broken traffic light (point to the ‘example’ road situation card). The sign that best matches this situation is the one indicating a traffic light out of action (pick out the ‘broken traffic light’ road sign). So this road sign (broken traffic light) goes with this picture (place the ‘broken traffic light’ road sign on the ‘example’ card). Now you do the rest.”

Begin timing 3 minutes. If the older driver forgets the instructions or requests a repetition, the instructions can be repeated once using the same wording. After that no further explanation should be given. No feedback about performance is given. People are encouraged to persevere by giving non–specific feedback such as ‘that’s fine’. Score 1 point for each correct match within 3 minutes. If the older driver puts several cards in a pile, score only the top card. Maximum score 12 points in 3 minutes. Enter score into online calculator.

Lincoln NB, Radford KA, Nouri FM. 2016. Stroke Drivers’ Screening Assessment Australian Version, Manual Revised 2016. University of Nottingham. https://www.nottingham.ac.uk/medicine/documents/published-assessments/sdsa-manual-2016-australia.pdf

^{**Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: A new clinical measure of balance. J Gerontol Med Sci. 1990;45(6):M192-97:10.1093/geronj/45.6.M192}

^{**Radford KA, Lincoln NB, Murray-Leslie C. Validation of the stroke drivers screening assessment for people with traumatic brain injury. Brain Inj. 2004;18(8):775-}

Road Signs Recognition Test Printable

3-Domains screening toolkit calculator

Generate and discuss combined predictive score. Enter the 3 test scores into the online calculator.

The online calculator combines the three test scores to generate a combined predictive score which is the probability (%) the older driver would pass an on-road driving test.

The combined predictive score can be used to inform clinical judgement and support conversations with older drivers about the need to plan for eventual driving cessation or for further testing.

3 Domains Toolkit Online Calculator