Effectiveness of a Driving Intervention on Safe Community Mobility for Returning Combat Veterans

This research study is being done to determine if Occupational Therapy Driving intervention
(OT-DI) can improve the safe driving performance immediately following intervention and
intermediate term (3months).

Baseline testing to post test1 will include Clinical battery of tests and a Simulated Driving
test, a Brief Driving Questionnaire, Community Integration Questionnaire, and Satisfaction
with Life Questionnaire. Caregivers/family member will rate the participants' driving
behaviors using a Fitness-to-Drive Screening Measure (FTDS). After baseline testing the 260
participants (and associated caregivers) will be randomly assigned to balanced intervention
and control groups.

The intervention group receives Occupational Therapy Driving Intervention (OT-DI) consisting
of three x 1hour sessions will include Sessions1: Driving evaluator reviews explicit driving
errors with participants; Session 2: Driving evaluator provides tailored strategies to
mitigate errors; Session 3: Participants drive simulator with targeted feedback from driving
evaluator.

The control group will receive from a driving safety professional, three x 1 hour general
safety sessions (session 1: general traffic safety discussion; Session 2: Rules of the road
and acknowledgement of the road discussion; Session 3: drive the simulator without any
feedback from a driving safety professional). Immediately after session 3, Post test1 will
occur using the same standardized protocol outline for baseline testing.

Post test2: will consist of testing with the same standardized protocol as administered
during baseline testing. Caregivers/family members will rate the participants driving
behavior using FTDS in addition the investigators will obtain driving data from the
Department of Motor Vehicles which include citations, violations, driving mishaps that have
occurred for each participant.

To ascertain impact of the OT-DI and driving safety education on real world driving, a subset
of 30 participants will be created from the control and intervention groups to perform
on-road driving test. The results from this test will be compared with driving performance on
the simulated drives.

Inclusion Criteria:

- Combat Veterans with polytrauma (mild traumatic brain injury (TBI)/ with accompanying
post-traumatic stress disorder (PTSD), traumatic limb amputation/fractures) who drove
prior to injury/condition.

- Have a valid driver's license or are eligible for a driver's license.

- Are community dwelling.

- Combat Veterans without formal diagnoses who report driving issues (either formal such
as violations, citations or motor vehicle crashes, or informal including risky driving
or driving stress and/or anxiety)

- Have potential for following driving safety recommendations Mini-Mental State
Examination (MMSE 24/30)

- Are able to participate in a driving evaluation battery.

- Inclusion criterion for caregivers is based on their ability to complete a driving
questionnaire pre and post intervention.

Exclusion Criteria:

- Combat Veterans who have severe psychiatric (e.g., psychoses) or physical conditions
(e.g., missing both arms and/or legs) that will limit ability to drive;

- Have multiple psychotropic medications that may impact mental or physical (due to
side-effects) functioning as per the consulting physician;

- Have severe, un-remediable medical conditions (e.g., severe TBI) as per the consulting
physician;

- Pregnant females or those planning pregnancy as determined by self-report.

- Exclusion criterion for caregivers is based on the presence of a cognitive or physical
impairment that would hinder their ability to complete the questionnaires or make an
active contribution.