Abstract
Combat veterans may face driving difficulties, impaired fitness to drive, and increased crash risk. Our randomized trial examined a simulator-based occupational therapy driving intervention with findings regarding driving error reduction suggesting efficacy.
Primary Author and Speaker: Sandra Winter
Contributing Authors: Stephanie Sursky, Sherrilene Classen, Abraham Yarney, Miriam Monahan, Kyle Platek, Amanda Lutz, Charles Levy
Combat veterans (CVs) from Operation Enduring Freedom and Operation Iraqi Freedom may report driving difficulties and limitations in community mobility and social participation (Hwang, Peyton, Kim, Nakama-Sato, & Noble, 2014), and they face increased crash and injury risk (Woodall, Jacobson, & Crum-Cianflone, 2014). Causes of risky driving among veterans are multifactorial but may include medical conditions such as mild traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), polytrauma, or deployment exposures (Zamorski & Kelley, 2012).
Our participants were returning combat veterans from conflicts in Iraq and Afghanistan with diagnoses of mild TBI, PTSD, or orthopedic injuries who also reported driving difficulty postdeployment.
In this occupational therapy driving intervention (OT–DI) efficacy trial, we randomized 20 CV participants to either control (traffic safety education) or intervention (OT–DI). Following baseline testing (vision, cognition, motor skills, and simulated driving assessment), participants underwent three OT–DI or traffic safety education sessions. Driving errors were measured at baseline, directly after intervention (Posttest 1), and 3 mo after (Posttest 2). Using a Wilcoxon rank-sum test, we analyzed driving error differences for baseline and Posttest 2 within and between groups.
Control mean driving errors were 32.80 (standard deviation [SD] = 13.64) at baseline and 25.40 (SD = 12.79) at Posttest 2 (W = 75.00, p ≤ .112). Intervention mean driving errors were 32.50 (SD = 8.45) at baseline and 14.50 (SD = 6.92) at Posttest 2 (W = 58.00, p ≤ .0001), a significant reduction. Posttest 2 results comparing control versus intervention indicated a significant difference favoring intervention (W = 75.00, p ≤ .011).
This preliminary analysis lacks the sample size and rigor to make definitive conclusions; however, initial results are promising.
Hwang, E. J., Peyton, C. G., Kim, D. K., Nakama-Sato, K. K., & Noble, A. E. (2014). Postdeployment driving stress and related occupational limitations among veterans of Operation Iraqi Freedom and Operation Enduring Freedom. American Journal of Occupational Therapy, 68, 386–394. http://dx.doi.org/10.5014/ajot.2014.011668
Woodall, K. A., Jacobson, I. G., & Crum-Cianflone, N. F. (2014). Deployment experiences and motor vehicle crashes among U.S. service members. American Journal of Preventive Medicine, 46, 350–358. http://dx.doi.org/10.1016/j.amepre.2013.11.015
Zamorski, M. A., & Kelley, A. M. (2012). Risky driving behaviour: Psychological aspects of deployment and health behaviours (NATO report TR-HFM-164, pp. 1-11). Neuilly-sur-Seine, France: Research and Technology Organisation of the North Atlantic Treaty Organisation. Retrieved from http://natorto.cbw.pl/uploads/2012/5/$$TR-HFM-164-ALL.pdf