Safe Return to Driving after Sustaining Road Traffic Injuries: Driver Assessment and Rehabilitation in Saudi Arabia

Abstract

Background: In Saudi Arabia, motor vehicle crashes are a major cause of injury and disability. Rehabilitation is essential to reduce the severity and long-term disabilities resulting from road traffic injuries and to ensure successful reintegration of individuals into society. Occupational therapy plays a crucial role in this rehabilitation process. Since the occupational therapy profession is relatively new in Saudi Arabia, this thesis aimed to explore utilising occupational therapy services within post-crash rehabilitation and addressing safe return to driving. It also aimed to identify suitable interventions and policies that could enhance rehabilitation practices in the Saudi context. Methods: This research used a mixed methods approach involving quantitative and qualitative methods. Initially, a systematic review of methods to evaluate at-risk drivers was conducted. This was followed by two complementary studies: a quantitative observational retrospective cohort review and a descriptive qualitative study. The quantitative study used existing registry data from a Saudi major trauma centre. Data for 475 trauma registry patients was analysed using descriptive and regression analyses. Then qualitative semi-structured interviews with 13 occupational therapists explored their perspectives on post-crash rehabilitation practices and assessment of at-risk drivers. Data were analysed using reflexive thematic analysis. Results: The systematic review revealed the main approaches used internationally to assess at-risk drivers. Over two-thirds of the reviewed studies used on-road driving performance tests to ii determine driving competence independently or in combination with another method. The quantitative study data revealed that following RTIs, occupational therapy is utilised for several reasons and that the only significant predictor of occupational therapy referral (df=1, p=.049, CI=1.011- 75.27) was combined rehabilitation services use. The qualitative study identified themes highlighting the inaccessibility of post-crash rehabilitation due to multiple factors, including service centralisation and high demand. The rehabilitation pathway was described; there was also a lack of clarity on the occupational therapists’ role among other health professionals. Current limitations of rehabilitation services include insufficient experienced and specialised therapists, the predominance of the biomedical framework and the impairment focus in the current practice. The therapists in this study also reported their lack of knowledge and practical skills for driver assessment and rehabilitation practices, and their need for support and infrastructure to develop this practice area in Saudi Arabia. They also recommended the need for more research and engagement with stakeholders to establish this specialised practice area. Conclusions: This thesis highlighted the current practice challenges for rehabilitation following road traffic injuries in Saudi Arabia and emphasised the importance of a multidisciplinary approach in post-crash care. The thesis advocates a collaborative, participative approach to developing a driver assessment and rehabilitation policy by involving stakeholders, including at-risk drivers, healthcare professionals, and licensing authorities, so as to create a tailored and effective policy for Saudi Arabia. This is a crucial first step toward establishing a safe and sustainable practice framework that can enable therapists to 1) provide needed service to at risk drivers, 2) support at-risk drivers to resume driving safely and have meaningful and fulfilled lives, 3) protect all road users from preventable car crashes, and 4) alleviate the country’s burden from further road traffic injuries.