Fitness-to-Drive Screening Measure: From Conceptualization to Global Implementation

Fitness-to-Drive Screening Measure: From Conceptualization to Global Implementation

Fitness-to-Drive Screening Measure: From Conceptualization to Global Implementation Sherrilene Classen PhD, MPH, OTR/L, FAOTA Professor & Chair: Department of Occupational Therapy University of Florida Gainesville, Florida 13 March 2019 AOTA 90th Annual Conference & Expo Acknowledgement Academic Institutions University of Florida, USA University of Western Ontario, Canada Mentors Craig Velozo, PhD, FAOTA William C. Mann, PhD Research Labs I-MAP, University of Florida, USA i-Mobile Research Lab, Western University, ON, Canada Centre for Safe Driving, Lakehead University, Thunder bay, ON, Canada Collaborators Funders U.S. Government: NIH; CDC; US DOT State: FL DOT Technical Support Jason Rogers Steve Beaulac

U.S. Canada Japan Korea Students Post-Docs Doctoral MSc(OT) Research Assistants Outline Context for older drivers in North America Early work leading up to FTDS Development of the FTDS Psychometrics Web-based version Keyforms Further developments Older Drivers in the U.S. & Canada About 36M older drivers (>65 yrs.) in U.S. increase to 76M by 20301 About 3M drivers (of 22M) in Canada > 65 2 double in the 10 years North-America 1 of 4 people will be > 65 Leading cause of accidental deaths for persons 65-75 years old is motor vehicle crashes3

Individuals > 75 yrs. have a 3.5 times higher crash rate compared to 35 to 44 year old 4 Want to continue to drive 1. NHTSA, 2015 2. Transport Canada https://www.tc.gc.ca/eng/motorvehiclesafety/tp-tp3322-2004-page11-701.htm 3. Canada Safety Council. Seniors behind the wheel. (2005). http://www.safetycouncil.org/news/sc/2000/Eng-1-00.pdf. 4. National Blueprint for Injury Prevention in Older Drivers Older Driver Older drivers are overall safe A high risk group for crash related injuries and deaths Age related declines Chronic conditions Comorbidities Frailty Medications Living longer and driving longer Capacity 350 CDRS in USA 1: 102,857 25 CDRS Canada1:120,000 Access On-road assessment Benefits Limitations Overcome these issues Fitness-to-Drive Screening Measure http://www.fitnesstodrivescreening.com/ Developed a paper and pen version Web-based To identify at-risk older drivers

Overview Research PHASE 1: SLR PHASE 2 PHASE 7 .. Theoretical Frameworks FARS Meta-Synthesis Mixed Methods Preparation Enrollment Data Collection Analyses Dissemination Three manuscripts 1. Determinants of Safety 2. Qualitative metaSynthesis 3. PH Model 2004- 2007 K-01 2019 FTDS Measure: Video

http://fitnesstodrive.phhp.ufl.edu/us/ Four sections A 1= Demographics rater A 2= Demographics driver B= Driving history and habits C= 54 Driving behaviors 54 Items Observable behaviors Progress in the level of difficulty 4-point adjectival scale Very difficult, somewhat, little, no difficulty Creating the Fitness-to-Drive Screening Measure Adjust mirrors Open door >.50 probability of passing Bn Check blind spot Maintain lane Drive rush

hour Merge highway .50 probability of passing Pass large vehicle Drive night Drive in storm <<<.50%probability of passing Di 9 Rasch Formula log [Pni/1-Pni] = Bn Di Pni = probability of person n passing item i 1- Pni = probability of person n failing item i Bn = ability of person n, Di = difficulty of item i Expected Pattern of Responses for an Individual B1 D1 D2 D3 D4 D5 D6 D7 D8

D9 D10 111|0110110100|000 Modeled/Ideal Transition zone 1 = no difficulty 0 = difficulty 11 Overview Research PHASE 1 PHASE 2 Theoretical Frameworks Item generation FARS Face validity Meta-Synthesis Content validity PHASE 3 PSYCHOMETRICS N= 400 Mixed Methods Preparation Three manuscripts

1. Determinants of Safety 2. Qualitative metaSynthesis 3. PH Model Enrollment Data Collection Two manuscripts 1. Classen et al. (2010), AJOT 2. Winter et al. (2011), CJOT 2004- 2007 Dec 2008-Dec 2012 K-01 NIA: R-21 Analyses Four manuscripts 1. Classen et al. (2012), AJOT 2. Classen et al. (2012), AJOT 3. Classen et al. (2013), AJOT 4. Classen et al. (2015), OTJR Dissemination Procedure Drivers (N=200)

Informed consent FTDS measure Standardized clinical battery Standardized on-road test Protocol standardized across sites IRR driving evaluators = 100% Caregivers (N=200) Informed consent FTDS measure Overview Research PHASE 1 PHASE 2 PHASE 3 Theoretical Frameworks Item generation FINAL PSYCHOMETRICS N= 400 FARS Face validity Meta-Synthesis Content validity

Factor Structure Mixed Methods Preparation Three manuscripts 1. Determinants of Safety 2. Qualitative metaSynthesis 3. PH Model Enrollment Data Collection Five manuscripts 1. Classen et al. (2010), AJOT 2. Winter et al. (2011), CJOT 3. Classen et al. (2012), AJOT 4. Classen et al. (2012), AJOT 5. Classen et al. (2013), AJOT 2004- 2007 Dec 2008- Dec 2012 K-01 NIA: R-21 DOT FDOT Analyses

Dissemination Factor Structure Objective: Confirmatory factor analysis (CFA) examine unidimensionality Mplus 5.1 (Muthen & Muthen, 2006) assumption of Rasch analysis Results: 68 items of the FTDS assessed one overarching construct 3 criteria to evaluate the unidimensionality (Brown, 2006) Comparative fit indices (CFI) 0.90 Tucker-Lewis indices (TLI) 0.90 Root mean square error of approximations (RMSEA) < 0.08 Per CFA criteria excluded 14 items (item numbers 1-8, 10, 11, 13, 14, 16, 17) that did not contribute to the fitness-to-drive construct Overview Research PHASE 1 PHASE 2 Theoretical Frameworks Item generation FARS Face validity Meta-Synthesis

PHASE 3 FINAL PSYCHOMETRICS N= 400 Factor Structure Construct validity Content validity Mixed Methods Preparation Three manuscripts 1. Determinants of Safety 2. Qualitative metaSynthesis 3. PH Model Enrollment Data Collection Five manuscripts 1. Classen et al. (2010), AJOT 2. Winter et al. (2011), CJOT 3. Classen et al. (2012), AJOT 4. Classen et al. (2012), AJOT 5. Classen et al. (2013), AJOT 2004- 2007 Dec 2008- Dec 2012 K-01 NIA: R-21 DOT

FDOT Analyses Dissemination y f i s as l c to l o to t n ie c effi ls. d n leve a e at ility r u b cc a a r an o fou s

i t S n D i T s F iver e h r T d r e old Classen, Wang, Velozo et. al. (2015). OTJR. Overview Research PHASE 1 PHASE 2 Theoretical Frameworks Item generation FARS Face validity Meta-Synthesis

PHASE 3 FINAL PSYCHOMETRICS N= 400 Factor Structure Construct validity Content validity Rater Reliability Mixed Methods Preparation Three manuscripts 1. Determinants of Safety 2. Qualitative metaSynthesis 3. PH Model Enrollment Data Collection Five manuscripts 1. Classen et al. (2010), AJOT 2. Winter et al. (2011), CJOT 3. Classen et al. (2012), AJOT 4. Classen et al. (2012), AJOT 5. Classen et al. (2013), AJOT 2004- 2007 Dec 2008- Dec 2012 K-01 NIA: R-21

DOT FDOT Analyses Dissemination Rater Reliability Results Rater reliability (41 items) Overall ICC = 0.253 (p < 0.001) for three rater groups ICC = 0.14 (p = 0.023) Drivers and Caregivers ICC = 0.17 (p = 0.008) Drivers and Evaluators ICC = 0.40 (p < 0.001) Caregivers and Evaluators Overview Research PHASE 1 PHASE 2 Theoretical Frameworks Item generation FARS Face validity Meta-Synthesis PHASE 3

FINAL PSYCHOMETRICS N= 400 Factor Structure Construct validity Content validity Rater Reliability Mixed Methods Preparation Three manuscripts 1. Determinants of Safety 2. Qualitative metaSynthesis 3. PH Model Enrollment Rater Effects Data Collection Five manuscripts 1. Classen et al. (2010), AJOT 2. Winter et al. (2011), CJOT 3. Classen et al. (2012), AJOT 4. Classen et al. (2012), AJOT 5. Classen et al. (2013), AJOT 2004- 2007 Dec 2008- Dec 2012 K-01 NIA: R-21

DOT FDOT Analyses Dissemination Rater Effects Results The facets ruler No erratic rater groups; E most severe; no sig ceiling effects Fit statistics infit MnSq and outfit MnSq for both rater groups were between 0.93 and 1.15, well within the defined criteria of 0.6 and 1.4 (Bond & Fox, 2001) Fixed Chi-Square 586.1 df=2, p<0.001 showed overall rater effects E more severe rater than C (t=2.33, p= .02) Paired comparisons showed significant rater effects on 19 items E were more severe than C on 10/19 items C were more severe 9/19 items Training video Overview Research PHASE 1 PHASE 2 Theoretical Frameworks Item

generation FARS Face validity Meta-Synthesis PHASE 3 FINAL PSYCHOMETRICS N= 400 Factor Structure Construct validity Content validity Three manuscripts 1. Determinants of Safety 2. Qualitative metaSynthesis 3. PH Model Enrollment Criterion validity Rater Reliability Mixed Methods Preparation Rater Effects Data Collection Five manuscripts 1. Classen et al. (2010), AJOT

2. Winter et al. (2011), CJOT 3. Classen et al. (2012), AJOT 4. Classen et al. (2012), AJOT 5. Classen et al. (2013), AJOT 2004- 2007 Dec 2008- Dec 2012 K-01 NIA: R-21 DOT FDOT Analyses Dissemination Criterion Validity On-road test Failing Passing Failing (a) True positive (b) False positive Passing (c)

False negative (d) True Negative Screening test Sensitivity = a / (a + c): true + rate Specificity = d / (b + d): true - rate Error = (1-sensitivity) + (1-specificity) PPV = a / (a + b): proportion of subjects with a + test result NPV= d / (c + d): proportion of subjects with a - test result AUC = index discriminability Classen, Wang, Velozo, et al. (2013). AJOT Classen et al., (2015). OTJR AUC > .70 Table 7. Sensitivity, Specificity, PPV, NPV and error based on F/C Ratings Cutoff Sensitivity (true positive rate) Specificity (true neg. rate) PPV NPV Error False Positive False Negative Total Misclassification 1=52.630 0.194 0.982 0.667 0.869 0.824

3 25 28 2=68.795 0.581 0.763 0.310 0.908 0.656 40 13 53 3=70.795 0.677 0.680 0.280 0.920 0.642 54 10 64 4=71.915 0.742 0.633 0.271 0.930 0.625 62 8 70 5=73.465 0.806

0.604 0.272 0.944 0.590 67 6 73 Overview Research PHASE 4 Web-based FTDS & Keyform Focus Groups Beta test OTs Manual CDRS Videos Caregivers Scoring & Results Wed-based version Pilot testing Three Manuscripts Jan 2012 October 2012 Florida Dep of Transportation

Implementation Translation Next Steps Final Focus Group Meetings Objective: To share the results of FTDS development with F/C and obtain feedback Participants: Eight F/C who had previously rated a driver in the study (50% Female, 62.5% White) Methods: Three moderated focus groups Visual Analog Scale / Rating Form (VAS, 0-10, 10 being excellent) Assess FTDS formatting, instructions, wording, web features, clarity, and understandability Audio-recorded and transcribed feedback Content analysis Results: Overall VAS score, Mean of 9.13, SD0.52, overall excellent ratings Participants suggested revisions including clarification of proxy rater instructions Participants described FTDS as clear and understandable, well explained through instructions and informative video, with visuals (result outputs) that greatly enhance tool Participants perceived FTDS as a meaningful tool to aid at-risk drivers Conclusions Proxy raters viewed the FTDS as user-friendly, useful, and acceptable Expert Panel Results VAS Mean (SD) Questions Q1. From the case studies does the keyform demonstrate differences in drivers abilities? Q2. How would you rate the ease of use of the keyform? Q3. How would you rate the clarity of the item hierarchy? Q4. Does the keyform adequately illustrate the drivers areas of difficulty? Q5. Does the keyform adequately illustrate the transition zone, i.e., where the ratings shift from No Difficulty to A

Little Difficulty? Q6. How would you rate the readability (font, spacing, orientation) of the keyform? Q7. How would you rate the understandability of the language used to describe the items? Q8. How would you rate the acceptability of the keyform layout? Q9. How would you rate the acceptability of the keyform for occupational therapists? Q10a. How would you rate the acceptability of the keyform for drivers? Q10b. How would you rate the acceptability of the keyform for caregivers? Overall mean and SD 8.1 +1.8 8.3 +1.5 8.2 +1.0 7.9 +1.7 9.4+0.7 8.8 +0.9 7.9 +1.7 8.9 +0.9 8.8 +1.2 7.7 +1.5 8.2 +1.2 8.4 +0.8 Classen, Winter, Velozo, et al., 2013 Table 10. Focus Group 3: F/C Visual Analogue Scale Ratings* Q1a. How well did we explain the purpose of the questionnaire? Q1b. How clear were the

instructions of the questionnaire? Q2a. How well did we explain the purpose of the keyform? Q2b. Is the keyform useful, e.g., does it illustrate your areas of concern ? Q2c. Is the keyform understandable, e.g., does it reflect the drivers difficulties? Q2d. Is the keyform meaningful, e.g., does it provide helpful recommendations regarding follow-up? Mean of Sum SD of Sum Rater Rater Rater Rater Rater Rater Rater Mean A B C D E F G of Sum 8.4 8.7 8.1 9.8 9.9 9.9 10 9.26

SD of Sum 0.82 6.8 8.4 8.1 9.7 6.3 9.8 7.7 8.11 1.33 7.6 8.4 9.1 10 9.5 9.8 9.9

9.19 0.89 8.8 8.3 9.4 10 9.7 9.8 9.9 9.41 0.64 8.3 8.1 7.5 9.9 7.6 9.7 10

8.73 1.10 7.5 9.1 9.4 9.9 9.7 9.9 10 9.36 0.88 7.90 0.73 8.50 0.35 8.60 0.80 9.88 0.12 8.78

1.48 9.82 0.08 9.58 0.92 9.01 -- -1.02 Classen, Winter, Velozo, et al. 2013 Keyforms & Recommendations Results summary Classifies driver Provide recommendations Keyforms helps one to observe What a person can do with/without difficulty What a person cannot do Transition zone Where a person moves from one set of ratings to another Recommendations Algorithm to Classify Drivers Seven Critical Items 9 Stay in Ln 27 Change Ln mod traf 30 Maintain Ln when turn 32 Turn Rt enter traf 39 Let turn into traf 41 Stay within Ln mark

42 Stay within Ln absn Cutoff 1 = 56.68 Cutoff 2 = 73.895 Four Main Groups (A-D) 2 subgroups (A-D: 1-2) A= Accomplished Driver B= Routine Driver C= At-risk Driver D= Misfit the Model Most difficult items Rating scale 1. 2. 3. 4. Very Difficult Somewhat Difficult A Little Difficult Not Difficult Items Easiest items Example of the Web-Based Keyform and Recommendations Driver A Driver B

Somewhat to very difficult A little difficulty Should Driver A continue to drive? Should Driver B continue to drive? What are the next steps for each of the drivers? Who needs referral to a CDRS? If you are the family member for driver A and B what would you do? A little to somewhat difficult No difficulty Overview Research PHASE 4 PHASE 5 PHASE 6 Web-based FTDS & Keyform Implement

Canadian Context Focus Groups Beta test AARP OTs Manual AOTA CDRS Videos Caregivers Pilot Wed-based version Pilot testing Two Manuscripts AAA You Implementation Manuscript Final psychometrics Focus groups

April 2012 FDOT October 2012 Dec 2013 Translation Three Manuscripts Jan 2014-Dec 2015 Next Steps Developing a Canadian-specific version of the FTDS Objective. To identify the FTDS resources/recommendations appropriate for Canadian users; and identify the barriers that Canadian stakeholders experience when promoting older driver fitness. Methods. Twenty stakeholders from 3 provinces (8 OTs, 3 CDRS, 4 physicians, and 5 members of advocacy organizations) participated in semi-structured interviews. We conducted summative and thematic content analysis. Results. A comprehensive set of resources/recommendations was identified. Barriers to older driver fitness decisions included: fear of losing the license, compromising the physician client relationship, insufficient training/resources for healthcare professionals, and inadequate alternative transportation. Conclusions. Canadian context-specific resources/recommendations were integrated into a Canadian version of the FTDS. This version may better serve Canadian older drivers, caregivers and healthcare professionals. Classen, Alvarez, et al. OTJR, 2016 More than 38,000 people has accessed the FTDS from Jan 2013-Feb 2019. Countries are U.S., Canada, Japan, England, Europe and elsewhere Overview Research

PHASE 4 PHASE 5 PHASE 6 Web-based FTDS & Keyform Implement Canadian Context Focus Groups Beta test OTs Manual CDRS Videos Caregivers Pilot Wed-based version Pilot testing Two Manuscripts AARP AOTA

AAA You Implementation Manuscript Final psychometrics Focus groups April 2012 FDOT October 2012 Consumer Patterns Dec 2013 Translation Three Manuscripts Jan 2014-Dec 2015 Next Steps Consumer Patterns Purpose To identify areas in need of improvement for the FTDS by identifying patterns and trends of Canadian users and providing recommendations to increase the usage, reach and potential impact Methods Monthly Google Analytics reports to calculate descriptive statistics for webpage and session specific variables. Variables were separated into Year 1 and Year 2, and were compared using the independent sample ttest.

Results Patterns identified for session and webpage specific variables, e.g., users spend less than the recommended 20 minutes to complete the FTDS. Significant decrease in the number of French speaking users (t (22) = .01, p < .05) from Year 1 to Year 2. Conclusion In its current format, Canadians across the country are able to easily access and utilize the FTDS for screening older drivers. However, implementing suggested recommendations (e.g., short form FTDS), may increase the overall usage, utility and/or reach of the FTDS, and as such may yield additional benefits to potential users. Classen, S., Alvarez, L., & Medhizadah, S. (2016). The Fitness-to-Drive Screening Measure: Patterns and Trends for Canadian Users. The Open Journal of Occupational Therapy. In press. Overview Research PHASE 4 PHASE 5 PHASE 6 Web-based FTDS & Keyform Implement Canadian Context Focus Groups Beta test OTs Manual

CDRS Videos Caregivers Pilot Wed-based version Pilot testing Two Manuscripts AARP AOTA Consumer patterns AAA Korean Version You Implementation Manuscript Final psychometrics Focus groups April 2012 FDOT October 2012 Dec 2013

Translation Three Manuscripts Jan 2014-Dec 2015 Next Steps Korean Version Abstract Objective: To develop a Korean version of the Safe Driving Behavior Measure (K-SDBM) and verify its reliability. Methods: SDBM was adapted to the Korean circumstances. Driving behaviors fitting Korean culture were collected. Drivers and a therapist verified the validity of the content. Results: A total of 37/ 40 items remained after verifying the content validity. A total of 211 elderly drivers over 65 years in age, having a valid drivers license and driving at least once during a 3-month period, participated in this study. The internal consistency (Cronbachs ) for the elderly drivers was .97, and the test-retest reliability (ICC) = .75. Conclusion: This study contributed to the base of evidence and knowledge regarding the reliability of the K-SDBM, and is expected to be useful in planning and implementing intervention for elderly people in the area of driving rehabilitation. Yoon-Ju Jeong, Min-Ye Jung, Eun-Young Yoo, Ji-Hyuk Park, Classen, S., & Winter S. Development and Reliability of Korean Safe Driving Behavior Measure (K-SDBM) (2014). The Journal of Korean Society of Occupational Overview Research PHASE 4 PHASE 5

PHASE 6 PHASE 7 Web-based FTDS & Keyform Implement Canadian Context Japanese Version Focus Groups Beta test OTs Manual CDRS Videos Caregivers Pilot Wed-based version Pilot testing Two Manuscripts AARP

AOTA Consumer Patterns AAA Korean Version You Implementation Manuscript Final psychometrics Focus groups April 2012 FDOT October 2012 Dec 2013 Translation Next Steps Four Manuscripts Jan 2014-Dec 2015 Jan 2016

Japanese version! Feb 11th, 2016 Translated Back translated Pilot testing Policy development Overview Research PHASE 4 PHASE 5 PHASE 6 PHASE 7 Web-based FTDS & Keyform Implement Canadian Context Japanese Version AOTA Consumer Patterns 32-item FTDS AAA

Korean Version Focus Groups Beta test OTs Manual CDRS Videos Caregivers Pilot Wed-based version Pilot testing Two Manuscripts AARP You Implementation Manuscript Final psychometrics Focus groups April 2012 FDOT October 2012

Dec 2013 Translation Four Manuscripts Jan 2014-Dec 2015 Next Steps Two Manuscripts Jan 2016 The 32-item FTDS Purpose To construct and validate a shorter form FTDS Method R software; EFA; N=200 caregivers completed FTDS Determine the factorability (Bartletts test of sphericity, Kaiser-Meyer-Olkin) Number of factors to extract (Scree plot, Parallel analysis) Factor structures (Principal Components Analysis) CCT techniques for item analysis identified the scale reliability (Cronbachs alpha, Alpha-if-deleted) and item reliability (item-total correlations) of the chosen factor model. Validate the concurrent criterion validity of the short form FTDS with ROC Results

Bartletts test of sphericity (p <0.001) and Kaiser-Meyer-Olkin of 0.92 were significant. Scree and parallel analysis results indicated that up to 5 factors could be extracted. The different factor models were evaluated for interpretability and we chose a 3-factor structure model. FTDS was reduced to a 32-item measure. The ROC curve AUC = .75, p <.05; cut-point = 4.87; sensitivity = .74, specificity = .69, PPV= .30, NPV= .93 and 61 (of 200) misclassifications. Summary EFA and item analysis informed the construction of the 32-item FTDS. Reducing the number of items shortens the time commitment Concurrent criterion validity was acceptable; still 61 misclassifications Medhizadah, Classen, & Johnson. (2019). Frontiers Medhizadah, Classen, & Johnson. (2018). OTJR Overview Research PHASE 4 PHASE 5 PHASE 6 PHASE 7 Web-based FTDS & Keyform Implement

Canadian Context Japanese Version Consumer Patterns 32-item FTDS Focus Groups Beta test OTs Manual CDRS Videos Caregivers Pilot Wed-based version Pilot testing Two Manuscripts AARP AOTA AAA You

Implementation Manuscript Final psychometrics Focus groups April 2012 FDOT October 2012 Dec 2013 Korean Version Translation Four Manuscripts Jan 2014-Dec 2015 21- FTDS SF; CAT Next Steps Three Manuscripts Jan 2016 -2019 21- Item FTDS Cut-point 10 error bands

1 and 10 removed Items + 2SE Person Reliability= 81% Item Reliability=96% 21-Item FTDS 3 logits Logits 3.526.73 Youdens index= .36 Cut-point= 3 logits >4.48=accomplished 4.48-1.52= routine <1.52=at-risk Misclassifications= 68/200 59 as failing (false positives) FTDS References 1. Classen, S., Winter, S.M., Velozo, C., Bdard, M., Lanford, D.N., & Brumback, B., Lutz, B. (2010). Item Development and Validity Testing for a Safe Driving Behavior Measure. American Journal of Occupational Therapy, 64 (2), 296-305. 2. Winter, S. M., Classen, S., Bdard, M., Lutz, B., Velozo, C. A., Lanford, D. N., & Brumback, B. (2011). Focus Group Findings for a Self-report Safe Driving Behavior Measure. Canadian Journal of Occupational Therapy, 78(2), 72-79. 3. Classen, S., Wen, P., Velozo, C., Bdard, M., Brumback, B., Winter, S.M., & Lanford, D.N. (2012). Rater Reliability and Rater Effects of the Safe Driving Behavior Measure. American Journal of Occupational Therapy, 16, 69-77. 4. Classen, S., Wen, P., Velozo, C., Bdard, M., Brumback, B., Winter, S.M., & Lanford, D.N. (2012). Psychometrics of the Self-Report Safe Driving Behavior. Measure for Older Adults. American Journal of Occupational Therapy, 66(2), 233- 241. 5. Classen, S., Wang, Y., Velozo, C., Bdard, M., Winter, S.M., & Lanford, D.N. (2013). Concurrent Criterion Validity of the Safe Driving Behavior Measure: A Predictor of On-Road Driving Outcomes. American Journal of Occupational Therapy, 67(1), 108-116. 6. Classen, S., Winter, S. M., Velozo, C., Hannold, E. M., & Rogers, J. (2013). Stakeholder Recommendations to

Refine the Fitness-to-Drive Screening Measure. The Open Journal of Occupational Therapy Vol. 1: Iss. 4, Article 3. http://scholarworks.wmich.edu/ojot/vol1/iss4/3 7. Classen, S., Velozo, C., Winter, S.M., Wang, Y., Bedard, M. (2015). Psychometrics of the Fitness-to-Drive Screening Measure. OTJR: Occupation, Participation and Health, 35(1), 42-52. 8. Classen, S., Medhizadah, S. & Alvarez, L. (2015). The Fitness-to-Drive Screening Measure: Enabling Caregivers to Detect At-risk Older Drivers. Occupational Therapy Now, 17 (5), 12. http://www.caot.ca/otnow/sept15/otnow_9_15.pdf FTDS References 9. Classen, S., Alvarez, L., Chen, C., Ferreira, P., Meyer C., Nywening, A. (2016). Enhancing the Fitness-to-Drive Screening Measure to include Canadian Stakeholders. OTJR: Occupation, Participation and Health, 36(2), 82-91. 10. Yoon-Ju Jeong, Min-Ye Jung, Eun-Young Yoo, Ji-Hyuk Park, Classen, S., & Winter S. Development and Reliability of Korean Safe Driving Behavior Measure (K-SDBM) (2014). The Journal of Korean Society of Occupational Therapy, 22(3), 57-68. 11. Classen, S., Alvarez, L., & Medhizadah, S. (2016).The Fitness-to-Drive Screening Measure: Patterns and Trends for Canadian Users. The Open Journal of Occupational Therapy, 4, 4, Article 4. http://dx.doi.org/10.15453/2168-6408.1227. 12. Classen, S., & Medhizadah, S. (2017). Fitness-to-Drive Screening Measure: A valid and reliable tool for occupational therapy practice. OT Practice, OT Practice. SIS Quarterly Practice Connections, 2 (1), 19-21. ISSN 10844902 13. Medhizadah, S., Classen, S., & Johnson, A. (2018). Constructing the 32-item Fitness-to-Drive Screening Measure. OTJR: Occupation, Participation and Health, 38(2), 89-95. 14. Medhizadah, S., Classen, S., & Johnson, A. (2019). Predictive validity of the 32-item Fitness-to-Drive Screening Measure. Frontiers of Psychology. In press. 15. Classen, S., Medhizadah, S., Romero, S., Lee, M.J. (2018). Constructing and validation of the 21-item Fitness-toDrive Screening Measure Short-Form. Frontiers in Public Health, 6, article 339 (1-9). doi: 10.3389/fpubh.2018.00339 16. Medhizadah, S., Classen, S., Sergio, R., & Lee, M. J. Feasibility of using the Fitness-to-Drive Screening Measure for people with Parkinsons. Manuscript in preparation for PLOS/One. Submission Target: 1st May 2019. Visit web-site On-line FTDS http://fitnesstodrive.phhp.ufl.edu/ Contact Information Dr. Sherrilene Classen [email protected]

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