Reliability and validity of on-road driving tests in vulnerable adults: a systematic review.
Tatsunori Sawada, Kounosuke Tomori, Haruka Hamana and 4 others
PMID 31469673WHAT IT FOUND
Only a few on-road driving tests for older adults and people with health conditions have strong evidence.
WURT/RIRT, P-drive, and TRIP had the most consistent scores and the best links to other driving assessments, but many gaps remain.
Key findings
01The review included 37 studies of on-road driving tests, but many of the tests had only one study.
02WURT/RIRT and P-drive had the most high-quality COSMIN items, followed by K-score and TRIP, although K-score was based on only one study.
03No studies tested intrarater reliability or measurement error, and none verified cross-cultural validity, responsiveness, or interpretability.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Only English-language studies were included, so on-road tests used in non-English-speaking countries were not reviewed. The COSMIN checklist did not fit all validity methods used in the papers, such as some construct validity and ecological validity analyses. Cross-cultural validity was not adequately captured because real-world driving depends on context, such as driving on the left or right, not only language. Many tests had only one study, and K-score, despite high-quality items, was based on only one study. No studies tested intrarater reliability or measurement error, so it is unclear how much score change is real versus error. No studies verified responsiveness or interpretability, so these tools cannot yet be judged for change after training. Some studies did not report subject age clearly, and several tests included fewer than 40% female subjects. On-road test settings varied: standardized route was used in 60.0%, fixed distance in 55.0%, and both in 40%.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not treat WURT/RIRT, P-drive, or TRIP as proven gold standards for all vulnerable drivers. No studies checked score error, cultural fit, ability to detect change, or how to interpret scores, and many tests had only one study, so use outside the tested groups and settings is uncertain.