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Table 2 Driving assessment tools in Parkinson’s disease

From: Physicians’ role in the determination of fitness to drive in patients with Parkinson’s disease: systematic review of the assessment tools and a call for national guidelines

Types Testing methods Advantages Disadvantages
Questionnaires and structure interviews • Structured interview [5355, 58]
• The Epworth Sleepiness Scale [24, 40, 41, 56, 57, 5961]
• Restless legs syndrome questionnaire [61]
• The sudden onset of sleep questionnaire [24]
• SCOPA-sleep scale [62]
• Suitable for screening a large number of patients in a short period of time
• Cost effective
• Ability to capture subjective symptoms, e.g., sleepiness
• No risk for physical injury during the test
• Lack specificity
• Potential bias during recruitment. [12]
• Findings may not be conclusive for final recommendations on driving.
Off-road testing battery • Motor assessment (HY, UPDRS-motor, Webster’s scale, rapid pace walk, disease duration, LEDs, etc.) [4, 21, 25, 37, 75, 77, 82, 88, 91]
• Cognitive assessment (MMSE, Trail making test, Complex figure test, Dot cancellation, block design test, etc.) [13, 67, 69, 7476, 80, 83, 84, 86, 88, 91]
• Visual assessment (UFOV) [13, 25, 75, 80, 82, 84, 91]
• The tests provide clinical information of patients on their ability in motor, cognitive and visual domains.
• Some jurisdictions use an off-road evaluation to predict on-road behavior [27]
• No risk for physical injury.
• Findings may not be conclusive for final recommendations on driving.
• Findings are limited to clinical information on individual patients, not his/her driving performance.
Driving simulators • Various types of driving simulators [4, 19, 20, 37, 6374]. • Ability to control and standardize testing conditions and methods
• Various outcome parameters can be implemented.
• Patients are not exposed to significant risk associated with on-road tests.
• No standardized protocols
• Simulator sickness
• Testing scenarios are not real.
On-road tests • An on-road test with/without instrument vehicle, and accompanied with a driver instructor for rating the driving score [3, 13, 14, 19, 21, 25, 7491]. • Considered as a gold standard driving test for licensing new drivers by most authorities [43, 86]
• Provided realistic driving test
• Standardized outcome parameters
• Potential physical injuries and accidents during the tests
• Unfamiliar testing scenarios
• Not suitable for patients with physical limitations or handicaps
Naturalistic driving • An attached devices equipped in a patients’ own car for collection of driving data [23, 92, 93]. • The most realistic driving test with familiar environment • Potential physical injuries and accidents during the tests
• Potential risk imposed to others on the road
• No standardized testing protocols