Effectiveness of a Driving Intervention on Safe Community Mobility for Returning Combat Veterans
Abstract
As of this writing, over 50,000 Soldiers have been wounded in action in operations in Iraq and Afghanistan, and many of them have sustained injuries affecting multiple parts of their bodies. Traumatic brain injury (TBI) may impair concentration, attention, and memory. Post-traumatic stress disorder (PTSD), resulting from exposures to traumatic events, e.g., improvised explosive device or IED blast, is a medical condition associated with flashbacks, anxiety, irritability, and/or anger. Other blast-related medical conditions include orthopedic conditions, burns, chronic pain, and visual or hearing loss. All of these conditions are threats to long-term safe driving upon return to civilian life. Driving is a key facilitator of daily function that provides access to goods and services, engagement in social activities, and ability to fulfill life roles. Impaired driving skills can pose a serious threat to the combat Veterans (CV), their passengers, and other road users, and place them at risk for crash-related injuries, medical expenses, and legal matters. In fact, motor vehicle crashes (MVC) among returning Veterans are a top cause of injury and disability, hospitalization, and death among CV. MVC death is significantly increased in years immediately following return from the battlefield. At the University of Florida s Institute for Mobility, Activity, and Participation, we study driving performance issues of CV with TBI/PTSD and orthopedic conditions and intervention strategies. In our prior work, we found CVs, mainly young male adults, were making more and different types of driving errors including critical driving errors, i.e., those that may potentially lead to crashes, injuries, or fatalities when compared to controls. These errors include over speeding, decreased attention to environmental demands (e.g., not slowing for pedestrians), and unsafe gap acceptance (e.g., not allowing enough distance when making a turn in front of an approaching car). Based on the pressing need for efficient assessments and interventions to reduce MVC post-deployment, we developed and subsequently conducted a pilot study to determine the efficacy of an occupational therapy driving intervention. Preliminary pilot analyses show a trend toward reduction in driving errors post-intervention. However, those study findings are limited and additional testing is needed to support effectiveness of this intervention with the Veteran population and to show the impact of intervention on real-world driving (measures of driving difficulty; state recorded violations, citations, and crashes). Simulator-based assessment and intervention are increasingly offered in military and Department of Veterans Affairs health care settings, but evidence to support such uses is lacking. Simulator-based driving evaluations provide accurate and objective results in a safe environment, and research has shown driving simulator tasks are representative of real-world driving. Knowing who can or cannot safely drive again and providing rehabilitation for those in need could improve driving fitness and aid avoidance of citations, MV crashes, injuries and/or fatalities. Increased driving fitness may also enhance ability to fulfill life roles, participation in society, and satisfaction with life. We are intending, through the work of this proposal, to determine if the clinical Occupational Therapy Driving Intervention (OT-DI) is effective in reducing the driving errors and improving the driving fitness of combat Veterans (CV). We will enhance the fidelity of simulator drives, including novel CV driving triggers and assessing user satisfaction. The OT-DI will be tested against a traffic safety education program to determine the impact of intervention on reduction of CVs driving errors, including critical errors, such as speeding, that contribute to crashes. Lastly, we will examine through questionnaires and state Department of Motor Vehicles records how interve
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 29, 2016
- Source ID
- W81XWH1510032
Entities
People
- Sandra Winter
Organizations
- United States Army
- University of Florida