Simulated Driving Errors: Indicators of Real-World Driving Events in Returning Combat Veterans.

Motor vehicle crashes is a leading cause of death for Veterans. We quantified the efficacy of an Occupational Therapy Driving Intervention (OT-DI) and a Traffic Safety Education (TSE) intervention on real-world driving in combat Veterans. Via a randomized trial, we assessed 42 Veterans' fitness-to-drive abilities using a CDS-250 driving simulator and driving records, to determine differences in simulated driving and real-world events pre- and post-interventions. The OT-DI group (vs. TSE) had fewer over-speeding errors (p < .001) and total number of driving errors (p = .002) post-intervention. At Post-Test 2, the OT-DI (vs. TSE) had a reduction in real-world speeding (p = .05). While statistically not significant, both interventions showed reductions in real-world speeding, number of violations (OT-DI: 23% and TSE: 46% decrease) and crashes (OT-DI: 25% and TSE: 50% decrease). Veterans showed early evidence of efficacy in improving their real-world fitness-to-drive abilities via an OT-DI and TSE intervention.

Driving Intervention for Returning Combat Veterans.

Increased crash incidence following deployment and veterans' reports of driving difficulty spurred traffic safety research for this population. We conducted an interim analysis on the efficacy of a simulator-based occupational therapy driving intervention (OT-DI) compared with traffic safety education (TSE) in a randomized controlled trial. During baseline and post-testing, OT-Driver Rehabilitation Specialists and one OT-Certified Driver Rehabilitation Specialist measured driving performance errors on a DriveSafety CDS-250 high-fidelity simulator. The intervention group ( n = 13) received three OT-DI sessions addressing driving errors and visual-search retraining. The control group ( n = 13) received three TSE sessions addressing personal factors and defensive driving. Based on Wilcoxon rank-sum analysis, the OT-DI group's errors were significantly reduced when comparing baseline with Post-Test 1 ( p < .0001) and comparing the OT-DI group with the TSE group at Post-Test 1 ( p = .01). These findings provide support for the efficacy of the OT-DI and set the stage for a future effectiveness study.

Efficacy of an occupational therapy driving intervention for returning combat veterans.

Polytrauma, including mild traumatic brain injury, posttraumatic stress disorder, and orthopedic conditions, is common among combat veterans (CVs) from Operations Enduring Freedom and Iraqi Freedom. Medical conditions, coupled with deployment-related training, may affect CVs' fitness to drive and contribute to post-deployment crash and injury risks. However, empirical interventions are lacking. Therefore, the study purpose was to examine the efficacy of an occupational therapy driving intervention (OT-DI) with pre and post testing of CVs. Using a DriveSafety 250 simulator, Occupational Therapy-Driver Rehabilitation Specialists recorded driving errors. Eight CVs (mean age = 39.83, SD = 7.80) received three OT-DI sessions, which incorporated strategies to address driving errors and visual search retraining. We determined baseline driving errors (mean = 31.63, SD = 8.96) were double the number of posttest errors (mean = 15.38, SD = 9.71). At posttesting, a significant (p < 0.05) decrease was noted for total errors and lane maintenance. Despite study constraints, preliminary data support the efficacy of the OT-DI.

Evidence-based review of interventions for medically at-risk older drivers.

OBJECTIVE. To conduct an evidence-based review of intervention studies of older drivers with medical conditions. METHOD. We used the American Occupational Therapy Association's classification criteria (Levels I-V, I = highest level of evidence) to identify driving interventions. We classified studies using letters to represent the strength of recommendations: A = strongly recommend the intervention; B = recommend intervention is provided routinely; C = weak evidence that the intervention can improve outcomes; D = recommend not to provide the intervention; I = insufficient evidence to recommend for or against the intervention. RESULTS. For clients with stroke, we recommend a graded simulator intervention (A) and multimodal training in traffic theory knowledge and on-road interventions (B); we make no recommendation for or against Dynavision, Useful Field of View, or visual-perceptual interventions (I). For clients with visual deficits, we recommend educational intervention (A) and bioptic training (B); we make no recommendation for or against prism lenses (I). For clients with dementia, we recommend driving restriction interventions (C) and make no recommendation for or against use of compensatory driving strategies (I). CONCLUSION. Level I studies are needed to identify effective interventions for medically at-risk older drivers.