Ann-Helen Patomella

P-drive: assessment of driving performance after stroke

OBJECTIVE To investigate aspects of validity and stability of Performance Analysis of Driving Ability (P-Drive), for people with stroke when used in a driving simulator. DESIGN A cross-sectional observational study. SUBJECTS The study included a consecutive series of 101 participants with stroke referred for evaluation or selected from a stroke registry. METHODS P-Drive was used to observe driving performance in order to assess driving ability. P-Drive comprises 20 items assessing the quality of the participants driving performance. Aspects of validity and reliability in P-Drive were evaluated using Rasch statistics. RESULTS The items (95%) and participants (97%) demonstrated acceptable goodness-of-fit and met statistical expectations according to the Rasch model. The results support internal scale validity and person response validity. P-Drive could separate the participants with different driving abilities and the standard errors were within reasonable criteria for drivers with a moderate-to-low ability to drive. CONCLUSION The findings from this study indicated that P-Drive is an assessment tool with properties of internal scale validity, person response validity, and which also contains aspects of reliability in relation to precision of the estimates and separation. P-Drive seems to be a valid and stable assessment tool for assessing the driving ability in a simulator of people with stroke.

Factors that impact the level of difficulty of everyday technology in a sample of older adults with and without cognitive impairment

Swedish Research Council, Swedish Brain Power, Botkyrka Community, The regional agreement on medical training and clinical research (ALF) between the Stockholm County Council and Karolinska Institutet, The American Alzheimer’s Association (Everyday Technologies for Alzheimer’s Care)

Design and Management Features of Everyday Technology That Challenge Older Adults

Introduction: The management of everyday technologies could present too difficult a challenge for older adults with cognitive impairments, leading to their exclusion from participation. The present study aims to identify and describe features that make everyday technologies more or less difficult for older adults, whether with or without cognitive difficulties. Methods: A pre-existent, empirically generated hierarchy of more to less difficult everyday technologies was analysed. A mixed methods design was used to investigate predefined assumptions. Findings: Correlation analysis indicated that the more difficult everyday technologies required a higher frequency of skill actions; a positive correlation between the difficulty of an everyday technology and the need to perform actions in a logical sequence when using it was identified. The analysis indicated that feedback provided to users by less difficult everyday technologies consisted of different modes of stimuli (visual, auditory and tactile), while that from more difficult everyday technologies provided a high frequency of complex visual feedback. The less difficult everyday technologies were designed in a manner that was more intuitive; the design guided the user and fewer errors could be made. Conclusion: This study presents several features in the design of everyday technologies, and the skills required in using them, that could make their management more difficult for older adults.

Awareness of driving disability in people with stroke tested in a simulator.

The aim of this study was to explore and describe awareness of driving disability in people with driving difficulties after stroke. The study comprised a consecutive sample of 38 participants with stroke who showed difficulties in a technically advanced, interactive driving simulator. Driving ability in the simulator was measured using Performance Analysis of Driving Ability (P-Drive). Awareness of driving disability was measured using a modified version of Assessment of Awareness of Disability (AAD), measuring the discrepancy between observed driving actions and self-reported disability after a driving evaluation in a simulator. A majority of the participants (n=36) demonstrated driving ability that was below the cut-off criterion for P-Drive. Furthermore, a majority of the items measuring awareness of driving disability were scored low, indicating that participants with stroke who did not pass a driving evaluation also had limited awareness of driving disability. A General Linear Model analysis indicated that awareness of driving disability and cognitive screening outcome explained 74% of the variance in driving ability. This study indicated that a majority of the people with stroke who fail a driving evaluation also have limited awareness of their disability, which indicates the need to address awareness in driving evaluations.

Changes in the technological landscape over time: Relevance and difficulty levels of everyday technologies as perceived by older adults with and without cognitive impairment

BACKGROUND: Everyday technology, ET (e.g. computers, TV’s and vending machines) perceived as relevant and used in everyday activities change continuously. Not being able to keep up with these changes may hinder participation in activities. OBJECTIVE: To investigate stability and change in perceived relevance of ET, and in levels of perceived ET difficulty across two different occasions in time and between two similar samples of older adults with and without cognitive impairment. METHODS: Data of perceived relevance and difficulty in ET use in the samples (n = 157/118), collected with the Everyday Technology Use Questionnaire (ETUQ) was investigated. RESULTS: Thirty-three (70%) of the ETs in the ETUQ significantly increased in relevance, while the perceived levels of difficulty were statistically similar in 40/47 ETs (85%) across the two time occasions. CONCLUSIONS: The perceived relevance of ET among older adults with and without cognitive impairment was indicated to increase over time, but the levels of perceived levels of difficulty of ETs did not change as much. This knowledge could be used to support and facilitate ET use in the aging population, and in general to influence society’s view of older people as active users of ET in activities at home and in public spaces.

P-Drive on-road: Internal scale validity and reliability of an assessment of on-road driving performance in people with neurological disorders

The aim of this study was to determine internal scale validity and reliability of P-Drive on-road by observing driving performance among people with neurological disorders. The study comprised a consecutive sample of 205 persons with stroke, dementia, or mild cognitive impairment who were remitted for and performed a standardized test in real traffic. Their driving abilities were evaluated with a new assessment tool, P-Drive on-road. Aspects of validity and reliability of the tool were analyzed using a Rasch rating scale model. The results indicated that the rating scale functioned as intended and a principal component analysis indicated that the items formed a unidimensional scale. Acceptable levels of person response validity were found and the scale was also able to distinguish between the abilities of the drivers with a person separation reliability of 0.90. The results indicate that P-Drive on-road is valid and reliable for producing a linear measure of driving ability in people with stroke, dementia and mild cognitive impairment, and has the potential to become a clinically useful assessment tool for on-road driving tests.

Characteristics of residents who thrive in nursing home environments: a cross‐sectional study

AIM To describe what characterizes residents with higher levels compared with those with lower levels of thriving in nursing homes using the Thriving of Older People Assessment Scale. BACKGROUND Thriving is conceptualized as peoples experiences of well-being in relation to the environment where they live. Thriving has the potential to emphasize health-promotion and positive experiences in nursing home residents in addition to current focus on illness and symptoms. DESIGN Cross-sectional design. METHODS Data from a total sample of 191 residents in a large Swedish nursing home facility were separated into two groups; rated as having high and low thriving based on a median split of thriving total score for each participating resident. The characteristics of residents with higher and lower levels of thriving were compared using bivariate analyses to investigate differences. Data were collected in 2013. RESULTS Residents with higher levels of thriving had shorter length of stay at the facility, higher functioning in Activities of Daily Living and less cognitive impairment, lower frequency of behavioural and psychological symptoms and higher assessed quality of life. The ability to walk and possibilities to spend time outdoors were higher among those with higher levels of thriving. CONCLUSION Nursing home residents who experience thriving have a higher level of functioning in activities of daily living, a higher quality of life and are less physically and cognitively impaired.

Driving Behaviour Profile of Drivers with Autism Spectrum Disorder (ASD)

The symptomatology of autism spectrum disorder (ASD) can make driving risky, but little is known about the on-road driving behaviour of individuals with ASD. This study assessed and compared the on-road driving performance of drivers with and without ASD, and explored how the symptomatology of ASD hinders or facilitates on-road driving performance. Sixteen drivers with ASD and 21 typically-developed drivers participated in the study. Drivers with ASD underperformed in vehicle manoeuvring, especially at left-turns, right-turns and pedestrian crossings. However, drivers with ASD outperformed the TD group in aspects related to rule-following such as using the indicator at roundabouts and checking for cross-traffic when approaching intersections. Drivers with ASD in the current study presented with a range of capabilities and weaknesses during driving.

Reliability of P-drive in occupational therapy following a short training session: A promising instrument measuring seniors’ on-road driving competencies

Introduction Occupational therapists could play an important role in facilitating driving cessation for ageing drivers. This, however, requires an easy-to-learn, standardised on-road evaluation method. This study therefore investigates whether use of ‘P-drive’ could be reliably taught to occupational therapists via a short half-day training session. Method Using the English 26-item version of P-drive, two occupational therapists evaluated the driving ability of 24 home-dwelling drivers aged 70 years or over on a standardised on-road route. Experienced driving instructors’ on-road, subjective evaluations were then compared with P-drive scores. Results Following a short half-day training session, P-drive was shown to have almost perfect between-rater reliability (ICC2,1 = 0.950, 95% CI 0.889 to 0.978). Reliability was stable across sessions including the training phase even if occupational therapists seemed to become slightly less severe in their ratings with experience. P-drive’s score was related to the driving instructors’ subjective evaluations of driving skills in a non-linear manner (R2 = 0.445, p = 0.021). Conclusion P-drive is a reliable instrument that can easily be taught to occupational therapists and implemented as a way of standardising the on-road driving test.

Everyday technology use among older adults in Sweden and Portugal

Abstract Background: Technology use is relevant for engaging in everyday occupations and aging in place and difficulties might limit participation. Aim: The aim of the present study was two-fold: to investigate the internal scale validity of the Everyday Technology Use Questionnaire (ETUQ) in a matched Portuguese and a Swedish sample of older adults without known cognitive impairments and to compare everyday technology use (i.e., the relevance of Everyday Technology (ET) and perceived difficulty of using ET). Methods: The Rasch rating scale model was used to investigate the psychometric properties of the data from the two countries. Analyses were then used to compare the samples. Results: There is evidence of internal scale and person response validity in the Swedish and Portuguese ETUQ datasets. The Swedish sample demonstrated almost 25% more ETs to be relevant, as compared to the Portuguese sample (p < .05). The samples’ means of perceived difficulty in using ETs were similar. Conclusions: The results support that the ETUQ is a valid assessment for measuring the relevance of and perceived difficulty of ET use and is able to detect differences and similarities between older adults in these European countries in relation to ET use in the home and society.