Occupational Therapy Driving Intervention for Returning Combat Veterans.
| Status: | Completed |
|---|---|
| Conditions: | Neurology, Psychiatric, Psychiatric |
| Therapuetic Areas: | Neurology, Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 85 |
| Updated: | 12/19/2018 |
| Start Date: | January 2013 |
| End Date: | November 2018 |
Efficacy of a Driving Program on Safe Community Mobility for Combat Veterans
Driving is a portal into general life functioning, and impaired driving skill can pose a
serious threat to the combat veterans (CV), passengers and others; and involves increased
risk of subsequent injuries, medical expenses and legal sequelae. Motor vehicle crashes (MVC)
among post deployed CV are one of the top four causes of injury and disability,
hospitalization, and outpatient visits across the military, and are a leading cause of death
among Army service members. The risk of motor vehicle (MV) death is significantly increased
in years immediately following return from the battlefield. In sum, the effects of Traumatic
Brain Injury (TBI)/ Post Traumatic Stress Disorder (PTSD) and other blast related injuries,
combined with the "battlefield" mindset and lack of community reintegration programs place CV
at risk for MVC and fatalities. On-road assessments, the gold standard, presents a risk for
crash or adverse advents in this population of CV. Alternately, simulated driving evaluation
measures driving performance in a safe, accurate and objective manner with evidence of
absolute and relative validity when compared to real world (on-road) driving. Knowing
participants can or cannot safely resume driving, and providing rehabilitation for those with
a potential for resuming safe driving could result in: increased safe driving behaviors;
avoidance of injuries, collisions, citations and participants residua; and resuming safe
driving with its attendant benefits in the realms of family functioning, participation in
society and satisfaction with life. The overarching objective of this proposal is to discern,
after clinical and simulated driving performance testing , if Occupational Therapy Driving
Intervention (OT-DI) can improve the safe driving performance (less errors) over the short
term (immediately following intervention) and intermediate term (3 months).
serious threat to the combat veterans (CV), passengers and others; and involves increased
risk of subsequent injuries, medical expenses and legal sequelae. Motor vehicle crashes (MVC)
among post deployed CV are one of the top four causes of injury and disability,
hospitalization, and outpatient visits across the military, and are a leading cause of death
among Army service members. The risk of motor vehicle (MV) death is significantly increased
in years immediately following return from the battlefield. In sum, the effects of Traumatic
Brain Injury (TBI)/ Post Traumatic Stress Disorder (PTSD) and other blast related injuries,
combined with the "battlefield" mindset and lack of community reintegration programs place CV
at risk for MVC and fatalities. On-road assessments, the gold standard, presents a risk for
crash or adverse advents in this population of CV. Alternately, simulated driving evaluation
measures driving performance in a safe, accurate and objective manner with evidence of
absolute and relative validity when compared to real world (on-road) driving. Knowing
participants can or cannot safely resume driving, and providing rehabilitation for those with
a potential for resuming safe driving could result in: increased safe driving behaviors;
avoidance of injuries, collisions, citations and participants residua; and resuming safe
driving with its attendant benefits in the realms of family functioning, participation in
society and satisfaction with life. The overarching objective of this proposal is to discern,
after clinical and simulated driving performance testing , if Occupational Therapy Driving
Intervention (OT-DI) can improve the safe driving performance (less errors) over the short
term (immediately following intervention) and intermediate term (3 months).
This research study is being done to determine if Occupational Therapy Driving Intervention
(OT-DI) can improve the safe driving performance (less errors) over the short term
(immediately following intervention) and intermediate term (3 months).
Baseline testing—Pre-test 1-- will include clinical battery of tests and a simulated driving
test, a Brief Driving Questionnaire, Community Integration Questionnaire, and a Satisfaction
with Life Questionnaire. Caregivers/ family members will rate the participants' driving
behaviors using a Fitness-to-Drive Screening Measure( FTDS). After baseline testing the 60
participants (and 60 associated caregivers) will be randomly assigned to a balanced
intervention group (15 participants with Traumatic Brain Injury (TBI)/ Post Traumatic Stress
Disorder (PTSD) and 15 participants with orthopedic conditions and caregivers) and a control
group (15 with TBI/PTSD and 15 with orthopedic conditions and caregivers).
The intervention group receives Occupational Therapy Driving Intervention (OT-DI), consisting
of three x 1 hour sessions will include: Session 1: Driving evaluator reviews explicit
driving errors with participants; Session 2: Driving evaluator provide 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 knowledge of the road discussion; Session 3: drive the simulator without any feedback
from traffic safety professional). Immediately after session 3, Post-test 1 will occur using
the same standardized protocol outlined for baseline testing. Post-test 2 will consist of
testing with the same standardized protocol as administered during baseline testing.
Caregivers/ family members will rate the participant driving behaviors using the FTDS. In
addition, the investigators will obtain driving data from the Department of Motor Vehicles
which will include: citations, violations, driving mishaps, and crashes that have occurred
for each participant.
(OT-DI) can improve the safe driving performance (less errors) over the short term
(immediately following intervention) and intermediate term (3 months).
Baseline testing—Pre-test 1-- will include clinical battery of tests and a simulated driving
test, a Brief Driving Questionnaire, Community Integration Questionnaire, and a Satisfaction
with Life Questionnaire. Caregivers/ family members will rate the participants' driving
behaviors using a Fitness-to-Drive Screening Measure( FTDS). After baseline testing the 60
participants (and 60 associated caregivers) will be randomly assigned to a balanced
intervention group (15 participants with Traumatic Brain Injury (TBI)/ Post Traumatic Stress
Disorder (PTSD) and 15 participants with orthopedic conditions and caregivers) and a control
group (15 with TBI/PTSD and 15 with orthopedic conditions and caregivers).
The intervention group receives Occupational Therapy Driving Intervention (OT-DI), consisting
of three x 1 hour sessions will include: Session 1: Driving evaluator reviews explicit
driving errors with participants; Session 2: Driving evaluator provide 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 knowledge of the road discussion; Session 3: drive the simulator without any feedback
from traffic safety professional). Immediately after session 3, Post-test 1 will occur using
the same standardized protocol outlined for baseline testing. Post-test 2 will consist of
testing with the same standardized protocol as administered during baseline testing.
Caregivers/ family members will rate the participant driving behaviors using the FTDS. In
addition, the investigators will obtain driving data from the Department of Motor Vehicles
which will include: citations, violations, driving mishaps, and crashes that have occurred
for each participant.
Inclusion Criteria:
- A combat veteran with polytrauma (mild traumatic brain injury/with an accompanying
post traumatic stress disorder (PTSD), traumatic limb amputation/ fractures), who
drove prior to the injury/condition;
- have a valid driver's license or are eligible for a driver's license;
- are community dwelling;
- may experience self, physician or other clinical staff identified issues with driving
behaviors;
- have a history of citations, violations or other driving mishaps in real world
driving;
- have potential for following driving safety recommendations (Mini Mental State
Examination, (MMSE 24/30);
- have potential for following community integration strategies (MMSE 24/30);
- are able to participate in driving evaluation battery.
Exclusion Criteria:
- A combat veteran diagnosed with a severe psychiatric (psychoses) or physical
conditions (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, irremediable medical conditions (severe TBI) as per the consulting
physician;
- pregnant females (as determined by a urine test) or those planning pregnancy;
- VA Employees; and
- veterans who have received rehabilitation services for TBI/PTSD and who show, as per
the screening of the driving rehabilitation specialist, a poor prognosis for
improvement based on a driving intervention.
Inclusion Criteria for Caregivers:
- ability to complete a driving questionnaire pre and post intervention.
Exclusion Criteria for Caregivers:
- the presence of a cognitive or physical impairment that would hinder participants
ability to complete the questionnaires or make an active contribution.
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