Date Presented 03/27/20 This cross-sectional exploratory study considers the community mobility and participation of older adults with dementia following a comprehensive driving evaluation. Older adults who stop driving go through changes that may cause health decline. Results of this study show the importance of socially aligned activities and their impact on quality of life, as well as effective areas for OT intervention to minimize the poor outcomes associated with driving retirement. Primary Author and Speaker: Connor Daws Additional Authors and Speakers: Peggy Barco Contributing Authors: David Carr, Michael Wallendorf

Importance: Occupational therapists need valid and reliable tools to help determine fitness to drive of older drivers with medical conditions such as dementia. Objective: To establish the validity and reliability of the Traffic Sign Naming Test (TSNT) and Written Exam for Driving Decisions (WEDD) as measures of fitness to drive of adults with and without dementia. Design: Cross-sectional. Setting: Washington University Medical School in St. Louis in collaboration with the Rehabilitation Institute of St. Louis. Participants: Older drivers diagnosed with dementia (n = 130) and without dementia (n = 34). Drivers with dementia required a physician referral indicating a medical need for a driving evaluation, a diagnosis of dementia, and an Alzheimer Detection 8 score of 2. Drivers without dementia were required to be age 55 yr or older and not meet criteria for dementia. Outcomes and Measures: Participants completed a comprehensive driving evaluation (CDE) that included clinical measures of vision, motor, and cognition; TSNT; and WEDD. The outcome measure was performance on a standardized on-road assessment. Results: The TSNT’s interrater reliability was determined to be strong (κ = .80). The TSNT and WEDD demonstrated convergent validity with cognitive measures (p < .001) and discriminant validity with visual and motor measures in the CDE. The TSNT (area under the curve [AUC] = .74) and WEDD (AUC = .71) had fair ability to predict failure on a standardized on-road assessment. Conclusion and Relevance: TSNT and WEDD are recommended for use by occupational therapists in combination with other performance measures when determining fitness to drive or need for a CDE. What This Article Adds: The TSNT and WEDD can be included as screening tools (in addition to other performance measures) to assist clinicians in determining which clients need to be referred for a CDE. The TSNT and WEDD can also be included as part of a CDE to assist driving rehabilitation specialists in making final recommendations regarding fitness to drive. The scores generated from the TSNT and WEDD address driving knowledge in a way that may be more understandable to clients and more relatable to skills needed to actually drive.

Importance: Few neonatal feeding assessments are currently available, and the Neonatal Eating Outcome Assessment is the only one that identifies feeding impairment while considering the developmental changes that occur from preterm birth to term-equivalent age. Objective: To determine the interrater reliability and concurrent validity of the Neonatal Eating Outcome Assessment. Design: Prospective, observational study. Setting: Level 4 neonatal intensive care unit. Participants: A convenience sample of 7 neonatal therapists participated in reliability testing. For concurrent validity, a prospective cohort of 52 preterm infants born ≤32 wk gestation had feeding assessed at term-equivalent age. Outcomes and Measures: Intraclass correlations (ICCs) and Fleiss’s κ statistics were used to define reliability across therapists, who independently scored five videos of preterm infants orally feeding using the Neonatal Eating Outcome Assessment. Concurrent validity was determined by evaluating relationships between the Neonatal Oral Motor Assessment Scale (NOMAS) and the Neonatal Eating Outcome Assessment using an independent-samples t test and χ² analysis. Results: The ICC for the Neonatal Eating Outcome Assessment total score was 0.90 (confidence interval [CI] [0.70, 0.99]). Fleiss’s κ scores for the 19 scorable items on the Neonatal Eating Outcome Assessment had predominately moderate, fair, and slight agreement, with 3 items having poor agreement. Dysfunctional NOMAS scores were related to lower Neonatal Eating Outcome Assessment scores (t[49.4] = 3.72, mean difference = 12.2, 95% CI [5.60, 18.75], p = .001). Conclusions and Relevance: The Neonatal Eating Outcome Assessment has excellent reliability. Concurrent validity was established. What This Article Adds: This article reports that the final version of the Neonatal Eating Outcome Assessment (Version 5.7) has excellent interrater and concurrent validity and is an important tool to assess the occupation of infant feeding in clinical practice.