‘Fitness to Drive’: A Rapid Scoping Review Report for the Road Safety Trust

Organisation: The Road Safety Trust

Date of Publication: March 2022

Uploaded to Knowledge Centre: 2 August 2022

Background to report
The Road Safety Trust seeks to base its Main Theme grant rounds on evidence that identifies where its funds would best be utilised to improve road safety in the UK.

‘Fitness to Drive’ is the theme for the round of grants which opens for applications in September 2022.

As Fitness to Drive (FTD) is such a broad theme, the Trust commissioned a scoping review to help determine which specific areas within this theme it should focus on. This fits within the Trust’s strategic priority of ‘Intelligence that defines’.

The scoping review report, authored by Dr Carol Hawley and Helen Wesson, provides useful information about the research that currently exists about FTD and a series of recommendations about where more research and work needs to be done on this topic.

Conclusions & recommendations
The report concludes that while a great deal of research spending and effort has created a wealth of information on FTD, there are many areas where the evidence is either inconclusive or where no research has been carried out.

The authors identified research gaps by highlighting the following 10 topic areas within FTD where they feel more research is required in order to influence policy and improve road safety.

Older drivers
The report identifies a need for the development of self-assessment tools for drivers to assess their FTD.It also says that older drivers are more likely than younger drivers to have multiple medical conditions and be prescribed multiple medications, and research is needed to examine this more fully and explore the advice provided by health professionals on driving with multiple conditions.

Brain injury
The report says there is a need for research to determine a consistent and standardised approach to assessing FTD following traumatic brain injury (TBI), particularly mild TBI.

Dementia (all types)
The report identifies a need for effective screening tests to identify patients in the early stages of dementia who are unfit to drive, and goes on to recommend that all forms of dementia and FTD is a topic which requires more research.

The authors say there are clear research gaps in the area of diabetes and driving. Suggested research topics are: the relationship between diabetes and crash risk for commercial drivers; the best ways of identifying drivers susceptible to experiencing hypoglycaemia; and diabetic peripheral neuropathy and driving (as this may contribute to pedal confusion).

Prescription drugs
The report acknowledges the importance of the topic of prescription medications/drugs and over the counter medications to FTD. It recommends that research should examine how combinations of medications may affect FTD, and what advice is given to patients regarding the effects of medications on driving. Research should also be carried out to examine the relationship between medication use, driving impairment and crash risk.

Sleep and fatigue
The authors suggest further research should be carried out on sleep disorders and FTD using a population-based controlled study which includes measures of comorbidities and medication use. They also say that due to a lack of current evidence, research should also be carried out on sleep disorders and crash risk among Group 2 drivers.

The report recommends that research is carried out to assess the collision risk attributable to impaired vision.

Professional and commercial drivers
The report found significant research gaps in the literature regarding FTD and commercial drivers, and therefore recommends that this topic should be considered for future research.

Health professionals
The report highlights evidence from earlier studies that health professionals often do not feel sufficiently knowledgeable about the medical rules for driving. It therefore recommends that the current state of knowledge on FTD among doctors is assessed, and education and training packages on giving patients advice on FTD are developed. It also says that research in this area has the potential to improve doctors’ knowledge of medical aspects of FTD and ensure that patients who should not drive receive appropriate advice, assessment and support. It also has the potential to improve the reporting of medical conditions to the DVLA and thus improve road safety.

Download the report from the following link: