M J Rapoport1, K Weegar2, Y Kadulina3, M Bédard4, D Carr5, J L Charlton6, J Dow7, I A Gillespie8, C A Hawley9, S Koppel6, S McCullagh10, F Molnar11, M Murie-Fernández12, G Naglie13, D O'Neill14, S Shortt15, C Simpson16, H A Tuokko17, B H Vrkljan18, S Marshall11. 1. From the Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada, University of Toronto, Toronto, ON M5S 2J7, Canada. 2. Ottawa Hospital Research Institute, Ottawa, ON K1H 8M2, Canada. 3. University of Ottawa, Ottawa, ON K1N 6N5, Canada. 4. Centre for Research on Driving, Lakehead University, Thunder Bay, ON P7B 5E1, Canada, St. Joseph's Care Group, Thunder Bay, ON P7B 5G7, Canada. 5. Washington University in St. Louis, St. Louis, MO 63130, USA. 6. Monash University Accident Research Centre, Victoria 3800, Australia. 7. Société de l'assurance automobile du Québec, Québec, QC G1K 8J6, Canada. 8. British Columbia Medical Association, Vancouver, BC V6J 5A4, Canada. 9. University of Warwick, Coventry CV4 7AL, UK. 10. Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada, McMaster University, Hamilton, ON L8S 1C7, Canada. 11. Ottawa Hospital Research Institute, Ottawa, ON K1H 8M2, Canada, University of Ottawa, Ottawa, ON K1N 6N5, Canada. 12. Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain. 13. University of Toronto, Toronto, ON M5S 2J7, Canada, Baycrest Health Sciences, Toronto, ON M6A 2E1, Canada. 14. Trinity College Dublin, Dublin, 2, Ireland, doneill@tcd.ie. 15. Canadian Medical Association, Ottawa, ON K1G 5W8, Canada. 16. Kingston General Hospital, Kingston, ON K7L 2V7, Canada, Queen's University, Kingston, ON K7L 3N6, Canada and. 17. University of Victoria, Victoria, BC V8W 2Y2, Canada. 18. McMaster University, Hamilton, ON L8S 1C7, Canada.
Abstract
BACKGROUND: Medical illnesses are associated with a modest increase in crash risk, although many individuals with acute or chronic conditions may remain safe to drive, or pose only temporary risks. Despite the extensive use of national guidelines about driving with medical illness, the quality of these guidelines has not been formally appraised. AIM: To systematically evaluate the quality of selected national guidelines about driving with medical illness. DESIGN: A literature search of bibliographic databases and Internet resources was conducted to identify the guidelines, each of which was formally appraised. METHODS: Eighteen physicians or researchers from Canada, Australia, Ireland, USA and UK appraised nine national guidelines, applying the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. RESULTS: Relative strengths were found in AGREE II scores for the domains of scope and purpose, stakeholder involvement and clarity of presentation. However, all guidelines were given low ratings on rigour of development, applicability and documentation of editorial independence. Overall quality ratings ranged from 2.25 to 5.00 out of 7.00, with modifications recommended for 7 of the guidelines. Intra-class coefficients demonstrated fair to excellent appraiser agreement (0.57-0.79). CONCLUSIONS: This study represents the first systematic evaluation of national-level guidelines for determining medical fitness to drive. There is substantive variability in the quality of these guidelines, and rigour of development was a relative weakness. There is a need for rigorous, empirically derived guidance for physicians and licensing authorities when assessing driving in the medically ill.
BACKGROUND: Medical illnesses are associated with a modest increase in crash risk, although many individuals with acute or chronic conditions may remain safe to drive, or pose only temporary risks. Despite the extensive use of national guidelines about driving with medical illness, the quality of these guidelines has not been formally appraised. AIM: To systematically evaluate the quality of selected national guidelines about driving with medical illness. DESIGN: A literature search of bibliographic databases and Internet resources was conducted to identify the guidelines, each of which was formally appraised. METHODS: Eighteen physicians or researchers from Canada, Australia, Ireland, USA and UK appraised nine national guidelines, applying the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. RESULTS: Relative strengths were found in AGREE II scores for the domains of scope and purpose, stakeholder involvement and clarity of presentation. However, all guidelines were given low ratings on rigour of development, applicability and documentation of editorial independence. Overall quality ratings ranged from 2.25 to 5.00 out of 7.00, with modifications recommended for 7 of the guidelines. Intra-class coefficients demonstrated fair to excellent appraiser agreement (0.57-0.79). CONCLUSIONS: This study represents the first systematic evaluation of national-level guidelines for determining medical fitness to drive. There is substantive variability in the quality of these guidelines, and rigour of development was a relative weakness. There is a need for rigorous, empirically derived guidance for physicians and licensing authorities when assessing driving in the medically ill.
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