POSITION STATEMENTS

 

Occupational Therapy Association of South Africa (OTASA) Position Statement. Enabling community mobility through driver evaluation and rehabilitation: The role of occupational therapists

 

 

INTRODUCTION AND PURPOSE

Community mobility includes walking, cycling, negotiating all forms of public transport, and driving is defined as "planning and moving around in the community and using public or private transportation"'^1S19. Driving, a form of community mobility, is a complex activity that requires interaction between multiple human systems, including vision, cognition, motor and other sensory functions, to assert adequate vehicle control within a dynamic and changing environment ². Driving is an instrumental activity of daily life, and is integral in enabling individuals to regain and/or maintain independence in their occupational domains (e.g., work, leisure pursuits, social interaction) in the community. The ability to drive is important in all jurisdictions and contexts, including the South African context; especially in gaining access to basic amenities and/or employment, in a developing country, with limited availability of, and access to public transport. Driver evaluation and rehabilitation, an evolving field in international occupational therapy for over '5 years, has recently begun to evoke attention in South Africa.

With a rise in road traffic injuries and/or fatalities in South Africa³, there is an increased need for the medical profession, commercial sector and general public to identify at-risk drivers. Functional impairments as a result of injury, acute or chronic illnesses, neurological conditions, mental health conditions, aging, congenital disorders, and physical or mental disability may influence a driver's fitness to drive. Moreover, driver fitness may contribute to road traffic injuries and/or fatalities. To date, neither the transport sector nor the health sector has taken responsibility for identifying fitness to drive in at-risk drivers on South African roads, leaving at-risk drivers to decide for themselves whether they may commence or resume driving following illness or injury.

Occupational therapists are trained in: assessing functional impairments and the impact thereof on performing instrumental activities of daily living, understanding the person-vehicle-environment interactions, and in promoting health through optimising functional performance. As such, occupational therapists are optimally positioned to assess fitness to drive in at-risk drivers and recommend vehicle adaptations, driver rehabilitation or driving cessation.

The purpose of this position paper is to clarify the role of Occupational Therapy in driver evaluation, driver rehabilitation and driving cessation in South Africa.

Position Taken

Occupational therapists evaluate fitness to drive as it relates to functional capacity of at-risk drivers, wanting to resume or initiate driving. Occupational therapists are uniquely positioned through their scope of practice, education and role in the multi-disciplinary team to make recommendations on driver rehabilitation, vehicle adaptation and fitness to commence or resume driving. Through rendering driver evaluation and driver rehabilitation services, occupational therapists promote independent driving and contribute to reduce risk to at-risk drivers and the general public.

Significance of Position to Occupational Therapy

Internationally, Occupational Therapy is recognised as the profession to address impairment in driving and community mobility. Occupational therapists' understanding of the relationship between the environment, the person and the occupation, position them uniquely to address driving and community mobility. Furthermore, occupational therapists' training includes evaluation practices and activity analysis, which position them to perform analysis of the activity of driving, as well as clients' functional capacity, thus determining the fit between the driver and the task of driving.

Due to insufficient local research evidence and a lack of specialised training in this field, the authors of this paper recognise the need for (a) the development of formal protocols and procedures for South Africa through research and (b) specialised training based on existing international evidence-based protocols. Such protocols and training will enable occupational therapists to deliver quality driving evaluation and rehabilitation services that are in the interest of other road users and the public's health in general.

Significance of Position to Society

Occupational therapy driver evaluation and rehabilitation services impact on the lives of drivers and other road users. In at-risk drivers, these services, once established in South Africa, may enable independence and quality of life. In South Africa, the National Road Traffic Act 93 of '996⁴ leaves the responsibility with the public to disclose functional impairment that may affect their fitness to drive and recommend consulting with a medical practitioner for determining their mental and physical fitness to drive. Medical practitioners in South Africa continue to make judgement on fitness to drive based solely on diagnosis and interview of the driver. A driver's ability to accommodate and adapt to his/her specific medical condition varies with each individual, therefore an individual should have the right to be assessed individually for his/her fitness to drive. Occupational therapists recognise the medical practitioner's responsibility in providing clearance of medical fitness to drive, however, the occupational therapist's role in evaluating functional fitness to drive is essential to uphold these rights of individual's. Licensing officers have limited training and knowledge of medical conditions and sequelae likely to impact fitness to drive. Occupational therapists, with sufficient training, are able to identify at-risk drivers through functional evidence-based assessments and to recommend driver rehabilitation or driving cessation in drivers with an increased crash risk. As such, occupational therapists are positioned to make a valuable contribution to the decisions in the licensing process.

Substantiating Rationale for Position

Occupational therapists work with clients across the lifespan who experience difficulties in performing activities of daily life, such as driving. The occupation of driving is a critical instrumental activity of daily living to enable independent community mobility and employment in South Africa. Occupational therapy is concerned with promoting health and well-being through occupation⁵ and occupational therapists are positioned to inform decisions about individuals' functional ability related to the occupation of driving.

Challenges and Strategies

 

 

CONCLUSION

Occupational therapists can make a unique contribution in traffic safety by identifying at-risk drivers and determining whether drivers would benefit from rehabilitation or driving cessation. There is significant international evidence that supports occupational therapy's role in driver evaluation and rehabilitation. As such, occupational therapists in South Africa will continue to equip themselves with evidence-based knowledge and skills in community mobility, and particularly in driver evaluation and rehabilitation relevant to the South African context.

 

REFERENCES

1. American Occupational Therapy Association. Occupational Therapy Practice Framework: Domain and Process. American Journal of Occupational Therapy. 2014; (68): S1-S48.         [ Links ]

2. Hunter J, de Vries J, Brown Y Hekstra A; Eds. Handbook of Disabled Driver Assessment. 1st ed. Republic of Slovenia: Ljubljana; 2009.         [ Links ]

3. World Health Organisation. World Health Organisation Global status report on road safety 2015. Geneva: WHO Press; 2015.         [ Links ]

4. South African Legal Information Institute. The National Road Traffic Act 93 of 1996: The South African Government Gazette; 1996.         [ Links ]

5. World Federation of Occupational Therapy. World Federation of Occupational Therapy: Definitions of Occupational Therapy. October, 2013. [Online: 22 February 2017.] http://www.wfot.org/aboutus/aboutoccupationaltherapy/definitionofoccupationaltherapy.aspx.         [ Links ]

 

 

Cotributing Authors

(in alphabetical order)

Sherrilene Classen

Rozanne Groenewald

Justine Kolling

Haley Norval

Caroline Rule

Lizette Swanepoel