Clinical Interpretation of the Occupational Therapy–Drive Home Maze Test in Fitness-to-Drive Assessment

This study examined the diagnostic accuracy and clinical interpretation of the Occupational Therapy-Drive Home Maze Test (OT-DHMT) in an Australian fitness-to-drive assessment pathway. Participants were 136 drivers referred because of age-related or neurological fitness-to-drive concerns. Maze completion time and error count were recorded before an occupational therapy on-road assessment. On-road outcomes were dichotomized as pass, indicating eligibility for an unrestricted license, or fail, indicating not meeting criteria for an unrestricted license. Drivers who failed completed the OT-DHMT more slowly and made more errors than those who passed. Completion time showed fair discrimination (area under the curve [AUC] = .74), whereas error count showed poor discrimination (AUC = .68). An empirically derived threshold of >38.5 s provided more balanced sensitivity and specificity, whereas a locally used >60 s threshold was highly specific but had low sensitivity. Findings suggest that the OT-DHMT may support clinical reasoning but should not be used as a standalone predictor of on-road outcome.