The Effectiveness of Two Driving Interventions on Real-World Driving Events in Combat Veterans

Motor vehicle crashes (MVCs) are a leading cause of death for returning combat Veterans. Driving simulators are an effective modality to assess fitness-to-drive; however, no studies exist on simulated driving interventions to improve Veterans’ real-world driving. This study assessed the effectiveness of an occupational therapy driving intervention (OT-DI) versus a traffic safety intervention (TSE) on driving simulator errors and real-world events (i.e., traffic violations and MVCs) among returning combat Veterans. Returning combat Veterans from Operations Enduring Freedom, Iraqi Freedom and/or New Dawn with deployed-related polytrauma conditions (≥2 combat injuries) who reported driving traffic offenses and/or driving anxiety were allocated to receive the OT-DI or TSE via a randomized controlled clinical trial. In the OT-DI arm (n = 23), an occupational therapist driver rehabilitation specialist identified driving errors in a high-fidelity driving simulator and provided tailored-strategies to mitigate these errors. The TSE arm (n = 19) consisted of a Florida Basic Driver Improvement Course covering vehicle safety, traffic laws, and crash prevention. Wilcoxon rank-sum tests were used to quantify between-group differences in simulated driving errors at baseline and post-intervention, and compare Veterans’ real-world events before baseline and post-intervention. Veterans in the OT-DI group vs. TSE had fewer over-speeding errors (p <.001) and total number of driving errors (p = .002), post-intervention. Descriptively, both interventions reduced the frequency of violations (OT-DI 23%; TSE 46% decrease), speeding violations (OT-DI 9%; TSE 26% decrease), and crashes (OT-DI 25%; TSE 50% decrease). Both groups had a reduction in driving simulator errors and real-world driving events post-intervention. These findings help inform clinicians to identify driving interventions to reduce real-world driving violations and crashes for at-risk returning combat Veterans.

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