title: Canadian epileptologists' counseling of drivers amidst guideline inconsistencies.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Jirsch
authors.forename: Donald W
authors.initials: DW
authors.lastname: Gross
authors.forename: Nathalie
authors.initials: N
authors.lastname: Jette
authors.forename: Paolo
authors.initials: P
authors.lastname: Federico
authors.forename: Francois
authors.initials: F
authors.lastname: Dubeau
authors.forename: Jose F
authors.initials: JF
authors.lastname: Tellez-Zenteno
authors.forename: Bernd
authors.initials: B
authors.lastname: Pohlmann-Eden
authors.forename: Jorge G
authors.initials: JG
authors.lastname: Burneo
authors.forename: Richard
authors.initials: R
authors.lastname: McLachlan
authors.forename: Syed N
authors.initials: SN
authors.lastname: Ahmed
authors.forename: Charles
authors.initials: C
authors.lastname: Deacon
authors.forename: Manouchehr
authors.initials: M
authors.lastname: Javidan
authors.forename: Dang K
authors.initials: DK
authors.lastname: Nguyen
authors.forename: R Mark
authors.initials: RM
authors.lastname: Sadler
authors.forename: Allison
authors.initials: A
authors.lastname: Spiller
authors.forename: Tiffany
authors.initials: T
authors.lastname: Townsend
authors.forename: Martin
authors.initials: M
authors.lastname: Veilleux
authors.forename: Richard A
authors.initials: RA
authors.lastname: Wennberg
authors.forename: Samuel
authors.initials: S
authors.lastname: Wiebe
authors.forename: Alexei
authors.initials: A
authors.lastname: Yankovsky
mesh_terms: D001291:Attitude of Health Personnel; D001334:Automobile Driving / Q000592:standards*; D002170:Canada / Q000453:epidemiology; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards*; D010817:Physician-Patient Relations; D010820:Physicians / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011795:Surveys and Questionnaires