title: An international study of the quality of national-level guidelines on driving with medical illness.
abstract: BACKGROUND
  Medical illnesses are associated with a modest increase in crash risk, although many individuals with acute or chronic conditions may remain safe to drive, or pose only temporary risks. Despite the extensive use of national guidelines about driving with medical illness, the quality of these guidelines has not been formally appraised.
  
  
  OBJECTIVE
  To systematically evaluate the quality of selected national guidelines about driving with medical illness.
  
  
  METHODS
  A literature search of bibliographic databases and Internet resources was conducted to identify the guidelines, each of which was formally appraised.
  
  
  METHODS
  Eighteen physicians or researchers from Canada, Australia, Ireland, USA and UK appraised nine national guidelines, applying the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.
  
  
  RESULTS
  Relative strengths were found in AGREE II scores for the domains of scope and purpose, stakeholder involvement and clarity of presentation. However, all guidelines were given low ratings on rigour of development, applicability and documentation of editorial independence. Overall quality ratings ranged from 2.25 to 5.00 out of 7.00, with modifications recommended for 7 of the guidelines. Intra-class coefficients demonstrated fair to excellent appraiser agreement (0.57-0.79).
  
  
  CONCLUSIONS
  This study represents the first systematic evaluation of national-level guidelines for determining medical fitness to drive. There is substantive variability in the quality of these guidelines, and rigour of development was a relative weakness. There is a need for rigorous, empirically derived guidance for physicians and licensing authorities when assessing driving in the medically ill.
authors: From the Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada, University of Toronto, Toronto, ON M5S 2J7, Canada.
authors: M J
authors: MJ
authors: Rapoport
authors: Ottawa Hospital Research Institute, Ottawa, ON K1H 8M2, Canada.
authors: K
authors: K
authors: Weegar
authors: University of Ottawa, Ottawa, ON K1N 6N5, Canada.
authors: Y
authors: Y
authors: Kadulina
authors: Centre for Research on Driving, Lakehead University, Thunder Bay, ON P7B 5E1, Canada, St. Joseph's Care Group, Thunder Bay, ON P7B 5G7, Canada.
authors: M
authors: M
authors: Bédard
authors: Washington University in St. Louis, St. Louis, MO 63130, USA.
authors: D
authors: D
authors: Carr
authors: Monash University Accident Research Centre, Victoria 3800, Australia.
authors: J L
authors: JL
authors: Charlton
authors: Société de l'assurance automobile du Québec, Québec, QC G1K 8J6, Canada.
authors: J
authors: J
authors: Dow
authors: British Columbia Medical Association, Vancouver, BC V6J 5A4, Canada.
authors: I A
authors: IA
authors: Gillespie
authors: University of Warwick, Coventry CV4 7AL, UK.
authors: C A
authors: CA
authors: Hawley
authors: Monash University Accident Research Centre, Victoria 3800, Australia.
authors: S
authors: S
authors: Koppel
authors: Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada, McMaster University, Hamilton, ON L8S 1C7, Canada.
authors: S
authors: S
authors: McCullagh
authors: Ottawa Hospital Research Institute, Ottawa, ON K1H 8M2, Canada, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
authors: F
authors: F
authors: Molnar
authors: Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain.
authors: M
authors: M
authors: Murie-Fernández
authors: University of Toronto, Toronto, ON M5S 2J7, Canada, Baycrest Health Sciences, Toronto, ON M6A 2E1, Canada.
authors: G
authors: G
authors: Naglie
authors: Trinity College Dublin, Dublin, 2, Ireland, doneill@tcd.ie.
authors: D
authors: D
authors: O'Neill
authors: Canadian Medical Association, Ottawa, ON K1G 5W8, Canada.
authors: S
authors: S
authors: Shortt
authors: Kingston General Hospital, Kingston, ON K7L 2V7, Canada, Queen's University, Kingston, ON K7L 3N6, Canada and.
authors: C
authors: C
authors: Simpson
authors: University of Victoria, Victoria, BC V8W 2Y2, Canada.
authors: H A
authors: HA
authors: Tuokko
authors: McMaster University, Hamilton, ON L8S 1C7, Canada.
authors: B H
authors: BH
authors: Vrkljan
authors: Ottawa Hospital Research Institute, Ottawa, ON K1H 8M2, Canada, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
authors: S
authors: S
authors: Marshall
mesh_terms: D000208:Acute Disease; D001334:Automobile Driving; D002908:Chronic Disease; D019317:Evidence-Based Medicine; D006801:Humans; D007391:International Cooperation; D015588:Observer Variation; D017410:Practice Guidelines as Topic / Q000592:standards*; D018570:Risk Assessment