Contribution of off-road tests to predicting on-road performance: a critical review of tests

Driving is an essential activity of daily living. Because it is easily disrupted by illness or injury, it is a common subject of occupational therapy assessment. Assessments of driving are critically important and carry legal implications for therapists. A full occupational therapy assessment comprising both off- and on-road testing is time and labour intensive and therefore expensive. Off-road tests are used to inform on-road assessments, and, if they have sufficient sensitivity and specificity they may replace an on-road assessment for some clients. The twofold purpose of this article is to compare and critique off-road tests to predict driving performance and to determine if any is sufficiently accurate to identify drivers who do not require an on-road assessment.

We reviewed tests commonly used by researchers to predict driving capacity (i) that have been used in research since 2000 and (ii) for which sensitivity and specificity had been (or could be) calculated. We compared the tests on five characteristics: diagnostic makeup of samples, sample sizes, outcome measures, sensitivity and specificity and potential for use as a supplement to on-road assessment or to identify drivers for whom an on-road assessment is not necessary.

No gold standard off-road test exists for predicting on road performance. DriveSafe/DriveAware and SMC Tests had the highest reported sensitivity and specificity. Thus, with further research, one or both may be found to predict on-road performance accurately and to minimise the need for on road assessment. Several other tests are a useful supplement to on-road testing.