Grant: Knowledge Synthesis Grant

<html> <body> <b><i>Background.</i></b> The Canadian Medical Association&rsquo;s (CMA) Driver&rsquo;s Guide is widely used by physicians across Canada to guide decision-making about assessing the impact of medical conditions and treatments on driving abilities, advising patients of the risks and reporting to transportation authorities. The CMA Driver&rsquo;s Guide and other similar international guidelines are limited in their currency, applicability, rigour of development, and integration of knowledge-user perspectives. Those most affected by the guidelines, healthy drivers, patients and caregivers have not provided input.<br> <br> <b><i>Objective.</i></b> The objective is to create an up-to-date knowledge synthesis and clinical guidelines on driving risks with two topics of high priority for updating: traumatic brain injury (TBI) and dementia. The knowledge synthesis will leverage skills of Canadian and international knowledge experts, and incorporate the input of clinician and transportation knowledge-users as well as drivers, patients and caregivers. <br> <br> <b><i>Method.</i></b> Recommendations from existing international guidelines on driving with TBI and dementia will be summarized and reviewed and precise questions will be refined and prioritized to shape a revised search strategy for an updated knowledge-synthesis. Data addressing the prioritized questions from the references from existing guidelines and systematic reviews as well as the updated literature search will be extracted and the quality of evidence and risk of bias will be rated by the synthesis team. Revised guidelines based on the knowledge synthesis will be developed, and clinician- and transportation- knowledge-users will provide feedback on their clarity, currency, applicability and acceptability. The values, preferences and perspectives of healthy drivers as well as individuals and caregivers with TBI and dementia regarding the revised guidelines and interpretations of risk will be ascertained. <br> <br> <b><i>Relevance.</i></b> Motor vehicle collisions are predicted to be the 3^rd leading cause of disability-adjusted life years lost by 2020⁸. Current estimates predict that within the next 20 years there will be almost 100,000 drivers with dementia in Ontario⁹, and 1.1 million Canadians with dementia¹⁰, many of whom will drive for years after diagnosis¹¹. Additionally, by 2031, it is estimated that 730,000 patients will be hospitalized annually for traumatic brain injury (TBI) in Canada¹², and since most individuals with TBI are not hospitalized¹³, this is a vast under-estimate. Driving is a risk with both of these conditions¹. No recent synthesis has been done with the aim of creating quality guidelines for clinicians. A well-executed knowledge synthesis incorporating knowledge-user input will increase confidence of clinicians using the guidelines⁴¹, inform transportation policy, and provide a model for updating syntheses and Canadian and other international guidelines for other health conditions and driving. <br> <br> <b><i>Knowledge Translation.</i></b> Knowledge-users will be involved throughout the knowledge synthesis process, knowledge syntheses will be published in open-access journals, presented at international conferences, and the corresponding chapters of the CMA Driver&rsquo;s Guide will be updated in electronic and print format. The process refined in the present grant will be used to advocate for further internationally-developed knowledge syntheses of medical illness and driving and high quality, knowledge-user informed clinical practice guidelines.</body> </html>