CHAPTER 50: FITNESS TO DRIVE SCREENING MEASURE (FTDS)

Description

The Fitness to Drive Screening Measure (FTDS) is a self-report or informant-based questionnaire of driving ability which has shown to be especially useful for family members, caregivers, or practitioners to help identify potentially at-risk older drivers. Maintained by the University of Florida and accessed remotely via the Internet, the tool enables the rater to quantify performance relative to 54 driving skills over a 90-day time frame. The FTDS is based on three theoretical models:

1. The Precede-Proceed Model of Health Promotion, which is designed to guide the assessment of both the personal and environmental factors that influence health as well as planning targeted interventions.
   
2. The Haddon’s Matrix for Injury Prevention, which provides a framework for crash prevention and injury reduction focusing on interactions among the person, his or her car, and the physical and social environment.
   
3. Michon’s Model of Driving Behavior, which categorizes driving behaviors as operational (on the sub-conscious level), tactical (car handling and maneuvers), and strategic (driving decisions and planning).

The FTDS is also comprised of the following three interrelated constructs relative to driving skill:

1. The Person-Vehicle, which includes behaviors related to use of car controls or features, such as the driver’s use of emergency brake.
   
2. The Person-Environment, which are those behaviors in response to physical factors such as terrain, weather, or social factors such as interactions with passengers.
   
3. The Person-Vehicle-Environment, which encompasses skills, attitudes, and behaviors in the use of vehicle features or controls and a response to environmental factors such as controlling one’s car on an icy road (Classen et al., n.d.).

The FTDS has four sections: (1) demographics and general information about the rater, (2) demographics and general information about the driver, (3) driving history profile, and (4) ratings of driving difficulty pertaining to 54 driving skills. As the FTDS is web-based, upon completion a scoring matrix is generated which classifies the driver into one of three categories: at-risk driver, routine driver, or accomplished driver. Recommendations are also generated relative to the subject’s overall score and includes such things as an evaluation by a physician, an occupational therapist, or a certified driver rehabilitation specialist for at-risk or routine drivers, while suggestions for accomplished drivers include guidelines for maintaining their fitness-to-drive such as receiving regular health care check-ups or taking a driving class (Classen et al., n.d.). In addition to recommendations, resources to assist in the transition to driving retirement are given including local transportation options (Classen et al., n.d.). The FTDS requires access to a computer and can be completed in 20 minutes.

Psychometrics

Research into the development of the FTDS with 80 older drivers, 80 caregivers, and 2 raters found that item reliability had a range of r = 0.93 to 0.96, while strong Cronbach alphas were demonstrated with a range of α = 0.96 to 0.99, suggesting excellent item correlation (Classen et al., 2012). A study to obtain proxy rater input on the clarity, usefulness, understandability, and meaningfulness of the measure of 7 subjects (median age 69 years old) found an overall high level of acceptance (9.13/10) relative to 6 questions pertaining to the usability of the measure (range 8.61 to 9.31) with the lowest rating given for the question “Is the key form meaningful?” (i.e., does it provide helpful recommendations regarding follow-up steps for the driver?) while the highest rating was for the question, “How well was the purpose of the key form explained?” (Winter, Classen, & Shanahan, 2015).

Advantages

Due to self-report bias, which can arise at the possible loss of a valued occupation, such as driving, a screening by way of proxy may be preferable (Classen Winter, Velozo, Hannold, & Rogers, 2013). The FTDS is also able to provide recommendations for follow-up as well as relevant resources. Finally, the FTDS is a free web-based measure developed in conjunction with the University of Florida, which maintains a helpful interactive website devoted to the assessment.

Disadvantages

There is a limited amount of independent research pertaining to the FTDS (i.e., that not indirectly involving its creators). Some have also argued that results of a off-road evaluations, are not necessarily valid predictors of on-road driving performance in subjects with mild traumatic brain injury (TBI) however, they could be considered valid for those with moderate to severe TBI (Classen et al., 2009).

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