Assessing Fitness to Drive

In this section

5.2.1. Clinical assessment

5.2.2. Chronic pain associated with musculoskeletal conditions

5.2.3. Functional and practical assessment

5.2.4. Congenital or non-progressive conditions

5.2.5. Use of prosthetic devices

5.2.6. Short-term musculoskeletal conditions

See reference 2.

Given the variability in vehicles and driving tasks, driver assessment should be individualised and based on their defined functional requirements, together with the associated impacts of their condition and treatment.

The clinical assessment aims to identify whether a driver’s condition is likely to result in difficulty undertaking the driving task and whether and how they might be supported to drive safely.

Several factors need to be considered:

• the person’s driving and mobility requirements
• the person’s functional capacity relative to the driving task
• muscle strength
• flexibility
• endurance
• sensory abilities (sensation, proprioception, kinaesthesia)
• the presence of pain that may impede concentration, attention or movement
• the potential impairment from prescription medications balanced against the patient’s improvement in function and health more generally
• the likely progression of the condition/disability
• the person’s current use of adaptive strategies and equipment, including impacts on functionality and outcomes such as endurance on the driving task
• the impact of comorbidities and age- related change.

Assessment and management of chronic pain should consider the functional and cognitive impacts on driving. This includes whether pain or pain treatments (refer to Part A section 2.2.9. Drugs and driving) are likely to affect attention, concentration or decision making, or the person’s ability to respond appropriately in the driving environment. The functional and cognitive impacts may fluctuate.

Fitness to drive will depend on the demands of the driving task and whether these can be managed or modified. It will also depend on self-management and compensatory strategies and the driver’s insight into the impact of their chronic pain. A practical driver assessment may assist in some cases to evaluate the impact of chronic pain on driving (refer to Part A section 2.3.1. Practical driver assessments).

See reference 3.

In addition to a clinical examination, a functional assessment and/or practical driver assessment may be required to assess functional limitations and identify requirements for vehicle adaptation or personal restrictions (refer to Table 6 for examples).^4,5

Processes for initiating and conducting driver assessments vary between the states and territories. Practical assessments may be conducted by occupational therapists or others approved by the driver licensing authority (refer to Part A section 2.3.1. Practical driver assessments). The assessments may be initiated by the examining health professional or by the driver licensing authority. Recommendations following assessment may relate to:

• licence status
• the need for rehabilitation or retraining
• licence conditions such as vehicle modification or personal restrictions
• requirements for reassessment.

If a person installs or upgrades a vehicle modification, reassessment is generally only required if a different class of device will be used. The device classes include:

• hand-operated brake and accelerator lever controls, requiring a steering aid
• hand-operated brake and accelerator controls, maintaining two hands on the steering wheel
• pedal modifications, maintaining operation by the lower limbs (e.g. left foot accelerator, pedal extensions)
• steering aids
• secondary control modifications (e.g. park brake, gear selector).

Information about the options for practical driver assessment in the relevant state or territory can be obtained by contacting the local driver licensing authority (Appendix 9. Driver licensing authority contacts). For information about occupational therapists qualified in driver assessment, contact Occupational Therapy Australia (refer to Appendix 10. Specialist driver assessors).

In the case of a driver seeking a conditional commercial vehicle licence, the person will have to initially demonstrate proficiency in driving a light vehicle (car) before being assessed in a commercial vehicle. For the commercial vehicle licence, an on-road driver assessment will need to be undertaken in the commercial vehicle and with modifications if required. This assessment should be conducted as required by the driver licensing authority.

Motorcyclists with a musculoskeletal disability will require a practical driver assessment (refer to Part A section 2.3.1. Practical driver assessments).

* These are not mandatory requirements and may be unsuitable in some circumstances.

Drivers who have conditions of a non- progressive nature (e.g. congenital loss or incapacity of a limb) require a medical assessment for the first issue of a licence.

Periodic review is not usually required if the condition is static and there are no comorbidities impacting on fitness to drive.

Prosthetic devices are an alternative to vehicle modification and may be suitable for people who are learning to drive or returning to driving after a significant injury. These devices should be recommended by an occupational therapist specialising in the area, with confirmation that:

• the prosthesis manufacturer has not specified that the prosthesis is unsuitable for driving
• the person has demonstrated:
• the ability to drive safely while using the prosthesis, including maintaining uninterrupted observation of the road (i.e. not needing to visually check the prosthesis’ position)
• adequate strength and endurance to maintain prosthetic use while driving
• the therapist has assessed appropriate sensation (superficial and proprioception) in the stump and remaining limb
• the therapist has confidence in the fit of the prosthesis
• the prosthesis-vehicle control interfaces have been evaluated and addressed (e.g. upper limb prostheses may require a suitably designed steering aid if used to maintain steering control).

Periodic review may not be required where the driver’s health is stable and there are no other medical conditions that may impair driving.

People with severe musculoskeletal pain and/ or reduced mobility associated with short-term conditions such as injury or surgery should be advised not to drive for the duration of their treatment. Return to driving should be determined by the treating doctor and is not a licensing issue. Considerations include the impact of pharmacological treatments (refer to Part A section 2.2.9. Drugs and driving) and non-pharmacological treatments such as soft collars or braces.

Some loss of neck movement is allowable if the vehicle is fitted with adequate internal and externally mounted mirrors or cameras, and provided the driver meets the visual standards for driving and has no cognitive or insight limitations that might affect adopting compensatory strategies.

The opinion of an occupational therapy driver assessor may be obtained if there is ongoing limitation of function.

Guidance for managing short-term conditions is included in Part A section 2.2.3. Temporary conditions.