Occupational Therapy Driving Intervention for Returning Combat Veterans.
Condition: Traumatic Brain Injury (TBI); Post Traumatic Stress Disorder (PTSD)
MeSH terms: Brain Injuries; Brain Injuries, Traumatic; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      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).
    

Detailed description: 
      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.
    

Intervention name(s): Driving Behavior Interview; Fitness-to-Drive Screening Measure; Clinical Driving Assessment; Propensity for Angry Driving Scale; Community Integration Questionnaire; Satisfaction with Life Questionnaire; Driving simulator evaluation; Focus Group Discussion Interview Guide
Intervention type(s): Behavioral; Behavioral; Other; Behavioral; Behavioral; Behavioral; Procedure; Other
Intervention description(s): This will be completed thrice, at baseline, post-test1 and at post-test2; This will be completed thrice, at baseline, post-test1 and at post-test2 (3 months after post test1); Clinical Driving Assessment includes Optec vision screening, Useful Field of View, Range of Motion, Strength. This will be completed thrice, at baseline, post-test1 and at post-test2 (3 months after post test1); This questionnaire will be completed thrice, at baseline, post-test1 and at post-test2 (3 months after post test1); This questionnaire will be completed thrice, at baseline, post-test1 and at post-test2 (3 months after post test1); This questionnaire will be completed thrice, at baseline, post-test1 and at post-test2 (3 months after post test1); The driving simulator evaluation uses a driving simulator with simulated drives engineered to address Veteran driving concerns such as reactions to other drivers and road conditions (e.g., debris). The simulator is used at baseline and post-tests 1 and 2. The intervention sessions (X3) also occur using simulator.; Focus group discussion will occur once using the interview guide
Other intervention name(s): Road rage questionnaire
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Combat Veterans; Automobile Driving; Fitness to Drive