A Scoping Review of Environmental Factors That Impact Driving with Arthritis: Considerations for Occupational Therapy

Cammarata, Michael J.; Sangrar, Ruheena; Harris, Jocelyn E.; Richardson, Julie; Vrkljan, Brenda

doi:10.1080/07380577.2020.1719451

Cited by 3 publications

(8 citation statements)

References 53 publications

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“…The characterization of specific driving difficulties domains forms a useful basis for developing practical solutions to support driving. In a recent review, Cammarata et al (8) identified a series of environmental factors that influenced driving in individuals with arthritis (including RA, ankylosing spondylitis, systemic lupus erythematosus, osteoarthritis, and gout). The driving domains identified in this study map onto a number of these environmental factors, which reflect opportunities for targeting patient‐focused treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Yet surprisingly, it has received little attention. The limited number of studies that we found predominantly focused on individuals with rheumatoid arthritis (RA) (7,8). The most common clinical manifestations of axial spondyloarthritis (SpA) affect the neck and spine, and yet, we know very little about how axial SpA impacts driving ability (9).…”

Section: Introductionmentioning

confidence: 99%

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Driving Difficulties in Patients With Axial Spondyloarthritis: Results From the Scotland Registry for Ankylosing Spondylitis

Morton

Macfarlane

Jones

et al. 2022

Arthritis Care & Research

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Objective To describe the driving difficulties experienced by individuals with axial spondyloarthritis (SpA), and to characterize associated clinical and sociodemographic features and impact on work. Methods The Scotland Registry for Ankylosing Spondylitis (SIRAS) is a cohort study of patients with a clinical diagnosis of axial SpA. Baseline information was collected on clinical and patient‐reported measures and work participation measures (using the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem [WPAI:SHP]). Patient‐rated difficulties with 9 driving tasks were used in a factor analysis, and relationships between driving difficulty and work participation were investigated. Results In total, 718 patients provided data for analysis, of which 642 (89%) had some difficulty with at least 1 driving task, and 72 (10%) had some difficulty with all 9 tasks. Three domains of driving difficulty were identified: dynamic driving scenarios, crossing traffic, and the physical act of driving. Chronic widespread pain, knee and back pain, fatigue, high disease activity, and anxiety/depression were significantly associated with reporting driving difficulties across all 3 domains, particularly the physical act of driving. After adjusting for sociodemographic, disease activity, physical and mental health, driving difficulties in each domain were associated with a 2–3 times increased likelihood of restricted work productivity and with an increased risk of sickness absence in the past 7 days. Conclusion Driving difficulties are common in individuals with axial SpA and impact on work, even after adjusting for clinical status. Improving understanding and awareness of driving disability will help direct advice and resources to enable individuals to remain independent and economically active.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Driving Difficulties in Patients With Axial Spondyloarthritis: Results From the Scotland Registry for Ankylosing Spondylitis

Morton

Macfarlane

Jones

et al. 2022

Arthritis Care & Research

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“…A recent review emphasized the need for occupational therapists and healthcare providers to make patients aware of vehicle modifications, but many professionals report a lack of confidence or awareness in the discussion of these topics [14]. Moreover, system-level issues in the clinical setting such as time restraints, competing priorities, and lack of training may impact the frequency of conversations about driving safety and comfort [15].…”

Section: Discussionmentioning

confidence: 99%

Driving Impairment and Healthcare Provider Counseling in Rheumatoid Arthritis and Osteoarthritis Patients: A Cross-Sectional Survey

Romaniello¹,

Falls²,

Ricketts³

et al. 2022

Cureus

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Background/objective: To examine rates of counseling on driving for individuals with osteoarthritis (OA) and/or rheumatoid arthritis (RA) and evaluate the Health Assessment Questionnaire Disability Index (HAQ-DI) as a screening tool for further driving evaluation.Methods: A cross-sectional survey was completed by individuals recruited via ResearchMatch (a national web-based recruitment tool) between March 5 and April 20, 2020. Individuals with a current US driver's license, ≥18 years old, with self-reported OA and/or RA diagnosis were surveyed about driving difficulty and vehicle modification and completed a HAQ-DI assessment. Respondents were dichotomized based on reporting vehicle modification(s) due to arthritis versus no modification(s) for univariate and multivariate analyses.Results: Of 4,435 recruited patients, 304 (6.9%) met inclusion/exclusion criteria and completed the surveys. Of all respondents, 259 (85.2%) reported at least some difficulty with one or more driving activities, but only 47 (15.5%) reported discussion with a physician and/or healthcare professional. A total of 184 (60.5%) respondents had HAQ-DI ≥ 1 and were more likely to report vehicle modification(s) compared to respondents with HAQ-DI score < 1 (OR = 5.00, 95% CI = 2.69-9.32, p < 0.011) after controlling for age, gender, type of arthritis, and driving behaviors.Conclusion: Few respondents report discussion of driving difficulties with healthcare providers, although many report driving-related impairments, particularly those with HAQ-DI scores ≥ 1. Our data suggest a strong association between HAQ-DI scores and vehicle modification. The HAQ-DI may serve as a screening tool to predict a patient's need for driving evaluation and vehicle modification(s).

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“…Reflecting existing knowledge gaps, determinants of driving safety and potential strategies to attenuate driving risk in the context of RA are unknown. The small number of reports that have examined the association of RA with driving performance to date have primarily relied on patient self‐report, have been purely cross‐sectional in design (prohibiting causal inference), or have yielded highly variable results (2,3). It is unknown, for instance, whether RA adversely impacts driving behaviors and, if so, to what degree RA disease activity or changes in disease activity may contribute to any observed deficits.…”

Section: Introductionmentioning

confidence: 99%

“…RA is characterized by joint pain, stiffness, increased fatigue, poor sleep quality, reduced mobility, and decreases in both muscle strength and reaction times, all factors that have been demonstrated to adversely affect driving performance (1). Despite the central importance of driving in maintaining independence and quality of life among arthritis patients, limited high-quality data exists regarding the impact of RA on real-world driving performance (2,3). The absence of robust, high-quality data represents a major knowledge gap, as more than one-half of all patients with RA report some degree of difficulty driving and express concerns about the possibility of having to cease driving due to functional impairments (4).…”

Section: Introductionmentioning

confidence: 99%

Vehicle Control as a Measure of Real‐World Driving Performance in Patients With Rheumatoid Arthritis

Mikuls

Merickel

Gwon

et al. 2022

Arthritis Care & Research

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Objective. To quantify vehicle control as a metric of automobile driving performance in patients with rheumatoid arthritis (RA).Methods. Naturalistic driving assessments were completed in patients with active RA and controls without disease. Data were collected using in-car, sensor-based instrumentation installed in the participants' own vehicles to observe typical driving habits. RA disease status, disease activity, and functional status were associated with vehicle control (lateral [steering] and longitudinal [braking/accelerating] acceleration variability) using mixed-effect linear regression models stratified by road type (defined by roadway speed limit).Results. Across 1,292 driving hours, RA drivers (n = 33) demonstrated differences in vehicle control compared to controls (n = 23), with evidence of significant statistical interaction between disease status and road type (P < 0.001). On residential roads, participants with RA demonstrated overall lower braking/accelerating variability than controls (P ≤ 0.004) and, when disease activity was low, lower steering variability (P = 0.03). On interstates/highways, RA was associated with increased steering variability among those with moderate/high Clinical Disease Activity Index scores (P = 0.04). In models limited to RA, increases in disease activity and physical disability over 12 weeks of observation were associated with a significant increase in braking/accelerating variability on interstate/highways (both P < 0.05).Conclusion. Using novel naturalistic assessments, we linked RA and worsening RA disease severity with aberrant vehicle control. These findings support the need for further research to map these observed patterns in vehicle control to metrics of driver risk and, in turn, to link patterns of real-world driving behavior to diagnosis and disease activity.

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A Scoping Review of Environmental Factors That Impact Driving with Arthritis: Considerations for Occupational Therapy

Cited by 3 publications

References 53 publications

Driving Difficulties in Patients With Axial Spondyloarthritis: Results From the Scotland Registry for Ankylosing Spondylitis

Driving Difficulties in Patients With Axial Spondyloarthritis: Results From the Scotland Registry for Ankylosing Spondylitis

Driving Impairment and Healthcare Provider Counseling in Rheumatoid Arthritis and Osteoarthritis Patients: A Cross-Sectional Survey

Vehicle Control as a Measure of Real‐World Driving Performance in Patients With Rheumatoid Arthritis

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