Driving Intervention for Returning Combat Veterans

Abstract

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.

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

“…Retrospective and prospective data from an OT-DI and TSE intervention of an ongoing trial (Classen et al, 2017). The study is registered with ClinicalTrials.gov U.S. (registration number: NCT02765672).…”

“…MVCs often occur because of driving errors, such as speeding, lane maintenance, visual scanning, signaling, adjustment-to-stimuli, gap acceptance, and yielding (Classen & Owens, 2011; Classen et al, 2010). Simulator studies confirmed that while these errors occur, they can also be decreased with an OT-DI or TSE (Classen et al, 2017; National Traffic Safety Institute, 2011). However, a critical gap exists in the literature to quantify the relationship between simulated driving errors and violations and/or MVCs occurring during real-world events, in returning combat Veterans.…”

“…The two major risk factors related to driving for Veterans are battle-mind driving tactics (driving skills developed during combat zone) and deployment-related polytrauma conditions (≥ 2 injuries) (Lew et al, 2010; Van Voorhees et al, 2018). As both risk factors negatively affect Veterans’ fitness-to-drive, driving simulators are an effective and reliable modality to assess fitness-to-drive (Amick et al, 2013; Classen et al, 2011, 2017; Cox et al, 2010). For example, using a driving simulator, Veterans with polytrauma made more errors (e.g., speeding and lane maintenance) than healthy controls (Classen et al, 2011, 2014; Hannold et al, 2014).…”

“…Veterans’ fitness-to-drive has been assessed via the use of driving simulators (Amick et al, 2013; Classen et al, 2011, 2017; Cox et al, 2010), which hold no risk for crashes (Casutt et al, 2014; Lee et al, 2003). Simulators present advantages, such as controllability, reproducibility, and standardization (Campos et al, 2017; de Winter et al, 2012).…”

“…For example, Veterans from OEF/OIF/OND made more speeding errors and had more total number of driving errors in the driving simulator. Moreover, they also had worse lifetime real-world driving records when compared with civilians (Amick et al, 2013; Classen et al, 2011, 2017; Cox et al, 2010), suggesting that simulators may be considered as a valid and reliable mode to assess fitness-to-drive performance in Veterans (Lee et al, 2003).…”