Critically Appraised Papers Emerging evidence that older driver retraining can improve knowledge and on-road driving skills Synopsis Korner-Bitensky, N., Kua, A., von Zweck, C. & Van Benthem, K. (2009). Older driver retraining: an updated systematic review of evidence of effectiveness. Journal of Safety Research, 40, 105–111. Objective of the review: To establish the quality of evi- dence, and the effect of older driver retraining, on improving driving knowledge, driving-related skills and reduced crash rates. This study represents an updated review from that published in 2007. Search strategies: A search was conducted of databases from January 2004 to January 2008 including MEDLINE, CINAHL, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, ISI Web of Science, and the Canadian Driving Research Initiative for Vehicular Safety in the Elderly (CanDRIVE) database. Reference lists were also searched. Key words were provided and sample search strategies summarised. Selection criteria: Type of studies: Limited to studies pub- lished in English, experimental and descriptive designs. Not specified if limited to full-text articles. Population: People aged 55 years and over. Types of interventions: Skill-specific driving retraining including on-road train- ing, education and physical retraining (physical therapy and conditioning). Studies were excluded if aimed at people with neurological conditions. Primary outcomes: Measures of driving awareness / knowledge, on-road driving skills and crash rates. Methods of review: Retrieved articles were categorised according to intervention, using the Population, Interven- tion, Comparison / control and Outcome (PICO) format. Two reviewers rated each randomised controlled trial (RCT) independently for internal validity using the Phys- iotherapy Evidence Database (PEDro) Scale (score 0–10). Discrepancies were resolved by discussion between reviewers and re-review of studies. PEDro scores were then translated into Foley’s quality assessment which rates studies methodologically as ‘‘excellent’’, ‘‘good’’, ‘‘fair’’ or ‘‘poor.’’ Matched pairs cohort studies were reviewed based on the Newcastle-Ottawa Scale which descriptively evaluates the dependability of the method- ology. For each PICO question created, intervention effec- tiveness was rated for specific outcomes and assigned a level of evidence combining pre- and post-2004 findings. Results: Four studies met the inclusion criteria (three RCTs and one matched pair cohort design). The number of studies identified was not specified. All four studies involved comparison with a control group. The matched pairs cohort design investigated the effect of an education programme. Of the three RCTs, two evaluated the effectiveness of an educational programme and on-road training; methodological quality was rated as 6 and 7 respectively (both ‘‘good’’). The third RCT evaluated the effectiveness of physical retraining and was rated as 7 (‘‘good’’) for methodological quality. Duration of on-road training sessions: two 30- to 60-minute sessions. Duration of education sessions: two 3- to 4-hour sessions. Strong evidence (Level 1a) existed from one cohort study that education alone can improve driving performance / driv- ing knowledge. Moderate evidence (Level 1b) existed that education alone was not effective in reducing crashes. Strong evidence was found (Level 1a) that education combined with on-road training improves driving perfor- mance, moderate evidence (Level 1b) that it improves knowledge, and Level 5 evidence, or no experimental study, of an effect on crash rates. Moderate evidence (Level 1b) existed that physical retraining improves driv- ing performance / knowledge, and Level 5 evidence, or no experimental study, that it reduces crashes. Conclusions: The authors concluded that physical retrain- ing and an educational intervention combined with an on-road driving component improve driving knowledge and driving-specific skills in older adults. Contact details of original author: nicol.korner-biten sky@mcgill.ca. Stacey George CAPs Advisory Board Member Email: stacey.george@health.sa.gov.au Commentary The identification and training of impaired driving skills in older adults is extremely important as older adults who decide to cease driving report less social wellbeing, mobility and independence (Ragland, Satariano & MacLeod, 2005). This systematic literature review sum- marises relevant studies and provides useful insights regarding the efficiency of different older driver training  C 2012 The Authors Australian Occupational Therapy Journal  C 2012 Occupational Therapy Australia Australian Occupational Therapy Journal (2012) 59, 103–106 doi: 10.1111/j.1440-1630.2011.00992.x Australian Occupational Therapy Journal