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Canadian Epileptologists’ Counseling of Drivers Amidst Guideline Inconsistencies

Published online by Cambridge University Press:  20 October 2014

Jeffrey Jirsch ,
Donald W. Gross ,
Nathalie Jette ,
Paolo Federico ,
Francois Dubeau ,
Jose F. Tellez-Zenteno ,
Bernd Pohlmann-Eden ,
Jorge G. Burneo ,
Richard McLachlan  and
Syed N. Ahmed
...Show all authors
Jeffrey Jirsch*
Affiliation:
Division of Neurology, University of Alberta, Edmonton
Donald W. Gross
Affiliation:
Division of Neurology, University of Alberta, Edmonton
Nathalie Jette
Affiliation:
Department of Clinical Sciences and Hotchkiss Brain Institute, Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, Alberta
Paolo Federico
Affiliation:
Department of Clinical Sciences and Hotchkiss Brain Institute, Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, Alberta
Francois Dubeau
Affiliation:
Montreal Neurological Institute, McGill University
Jose F. Tellez-Zenteno
Affiliation:
Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewn
Bernd Pohlmann-Eden
Affiliation:
Division of Neurology, Dalhousie University, Halifax, Nova Scotia
Jorge G. Burneo
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario, London
Richard McLachlan
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario, London
Syed N. Ahmed
Affiliation:
Division of Neurology, University of Alberta, Edmonton
Charles Deacon
Affiliation:
Division of Neurology, University of Sherbrooke, Sherbrooke, Quebec
Manouchehr Javidan
Affiliation:
Division of Neurology, University of British Columbia, Vancouver, B.C.
Dang K. Nguyen
Affiliation:
Division of Neurology, University of Montreal, Montreal
R. Mark Sadler
Affiliation:
Division of Neurology, Dalhousie University, Halifax, Nova Scotia
Allison Spiller
Affiliation:
Division of Neurogy, Queen’s University, Kingston
Tiffany Townsend
Affiliation:
Division of Neurology, University of British Columbia, Vancouver, B.C.
Martin Veilleux
Affiliation:
Montreal Neurological Institute, McGill University
Richard A. Wennberg
Affiliation:
Division of Neurology, University of Toronto, Toronto, Ontario
Samuel Wiebe
Affiliation:
Department of Clinical Sciences and Hotchkiss Brain Institute, Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, Alberta
Alexei Yankovsky
Affiliation:
Division of Neurology, University of Manitoba, Winnipeg, Manitoba, Canada
*
2e3-31 WMC, 8440-112 St, Edmonton, Alberta, Canada. Email: jeff.jirsch@ualberta.ca.
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Abstract

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Background:

Epilepsy is a common medical condition for which physicians perform driver fitness assessments. The Canadian Medical association (CMA) and the Canadian Council of Motor transportation administrators (CCMTA) publish documents to guide Canadian physicians’ driver fitness assessments.

Objectives:

We aimed to measure the consistency of driver fitness counseling among epileptologists in Canada, and to determine whether inconsistencies between national guidelines are associated with greater variability in counseling instructions.

Methods:

We surveyed 35 epileptologists in Canada (response rate 71%) using a questionnaire that explored physicians’ philosophies about driver fitness assessments and counseling practices of seizure patients in common clinical scenarios. Of the nine scenarios, CCMTA and CMA recommendations were concordant for only two. Cumulative agreement for all scenarios was calculated using Kappa statistic. Agreement for concordant (two) vs. discordant (seven) scenarios were split at the median and analyzed using the Wilcoxon signed rank sum test.

Results:

Overall the agreement between respondents for the clinical scenarios was not acceptable (Kappa=0.28). For the two scenarios where CMa and CCMta guidelines were concordant, specialists had high levels of agreement with recommendations (89% each). A majority of specialists disagreed with CMa recommendations in three of seven discordant scenarios. The lack of consistency in respondents’ agreement attained statistical significance (p<0.001).

Conclusions:

Canadian epileptologists have variable counseling practices about driving, and this may be attributable to inconsistencies between CMa and CCMta medical fitness guidelines. This study highlights the need to harmonize driving recommendations in order to prevent physician and patient confusion about driving fitness in Canada.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 41 , Issue 4 , July 2014 , pp. 413 - 420
Copyright
Copyright © The Canadian Journal of Neurological 2014

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