[One of the authors responds:]
Medical fitness to drive can be affected by many impairments, both physical and psychological. We conducted our survey via written questionnaire and therefore there were limitations on the number and types of questions that could be asked. In fact, we did not directly address a number of important impairments in this survey, including epilepsy, dementia, traumatic brain injury and alcoholism, each of which is well known to affect driving.[1–11] Sleep apnea is also known to affect crash rates.[12–14] In particular, we did not include epilepsy, one of the most common reasons to report impairment regarding fitness to drive, because driving restrictions for epilepsy vary among Canadian provinces and American states and we felt that the respondents' answers may have been confounded because of these differences.15
We used multiple-choice questions in our survey, a format that has been shown to be the best for sampling a large body of knowledge.16 We believe that our study reflects the knowledge and attitudes of the respondents.
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