Investigating feasibility and preliminary efficacy of a simulator-based driving intervention for people with acquired brain injury: A randomised controlled pilot study

Abstract

Objective:

To investigate the feasibility and preliminary efficacy of a driving simulator intervention on driving outcomes following acquired brain injury.

Design:

Pilot randomised controlled trial.

Setting:

Occupational therapy driver assessment and rehabilitation service.

Subjects:

Individuals post-acquired brain injury aiming to return to driving.

Intervention:

Eight sessions of simulated driver training over four weeks, in addition to usual care. Control: Usual care only.

Main measures:

Feasibility outcomes: Participant recruitment and retention; data completeness; therapy attendance and fidelity; adverse events. Performance outcomes: on-road driving performance; Simulator Sickness Questionnaire; Brain Injury Driving Self-Awareness Measure and Driving Comfort Scale – Daytime, assessed at baseline and five weeks post-randomisation.

Results:

Out of 523 individuals screened, 22 (4%) were recruited and randomised, with 20 completing their allocated group (n = 12 Simulator, n = 8 Usual Care). For those who completed training, session attendance was 100% with simulator sickness rated, on average, as mild. Six individuals (50%) in the Simulator group failed the on-road assessment, versus two (25%) in the Usual Care group (P = 0.373). On average, the Simulator group reported a positive change in confidence ratings (M = 5.77, SD = 13.96) compared to the Usual Care group, who reported a negative change (M = −6.97, SD = 8.47), P = 0.034. The Simulator group (M = 0.67, SD = 3.34) demonstrated no significant change in self-awareness relative to the Usual Care group (M = −0.83, SD = 1.83, P = 0.325).

Conclusions:

With adjustments to inclusion criteria and recruitment strategies, it may be feasible to deliver the intervention and conduct a larger trial. There is potential benefit of simulator training for improving driver confidence after acquired brain injury.

Keywords

Driving simulator acquired brain injury self-efficacy self-awareness rehabilitation interventions

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References

Rapport

Hanks

Bryer

RC.

Barriers to driving and community integration after traumatic brain injury. J Head Trauma Rehabil 2006; 21(1): 34–44.

Finestone

Guo

O’Hara

, et al. Driving and reintegration into the community in patients after stroke. PM R 2010; 2(6): 497–503.

Marshall

Molnar

Man-Son-Hing

, et al. Predictors of driving ability following stroke: a systematic review. Top Stroke Rehabil 2007; 14(1): 98–114.

Ponsford

Returning to the community. In: Ponsford

Sloan

Snow

(eds) Traumatic brain injury: rehabilitation for everyday adaptive living. 2nd ed. East Sussex: Taylor & Francis Group, 2013, pp.192–225.

Ross

Di Stefano

Charlton

, et al. Interventions for resuming driving after traumatic brain injury. Disabil Rehabil 2018; 40(7): 757–764.

De Winter

Van Leeuwen

Happee

. Advantages and disadvantages of driving simulators: a discussion. In: Spink

Grieco

Krips

, et al. (eds) Proceedings of measuring behavior. Utrecht, The Netherlands: Noldus Information Technology BV, 2012, pp.47–50. Noldus Information Technology BV

George

Crotty

Gelinas

, et al. Rehabilitation for improving automobile driving after stroke. Cochrane Database Syst Rev 2014; CD008357(2): 1–33.

Imhoff

Lavallière

Teasdale

, et al. Driving assessment and rehabilitation using a driving simulator in individuals with traumatic brain injury: a scoping review. NeuroRehabilitation 2016; 39(2): 239–251.

Akinwuntan

De Weerdt

Feys

, et al. Effect of simulator training on driving after stroke: a randomized controlled trial. Neurology 2005; 65(6): 843–850.

10.

Mazer

Gélinas

Duquette

, et al. A randomized clinical trial to determine effectiveness of driving simulator retraining on the driving performance of clients with neurological impairment. Br J Occup Ther 2015; 78(6): 369–376.

11.

Austroads. Assessing fitness to drive for commercial and private drivers 2016: medical standards for licensing and clinical management guidelines (as amended up to August 2017). Sydney, Australia: Austroads, 2017.

12.

Shores

Marosszeky

Sandanam

, et al. Preliminary validation of a clinical scale for measuring the duration of post-traumatic amnesia. Med J Aust 1986; 144(11): 569–572.

13.

Heinemann

Linacre

Wright

, et al. Relationships between impairment and physical disability as measured by the functional independence measure. Arch Phys Med Rehabil 1993; 74(6): 566–573.

14.

Smith

Symbol digit modalities test. Los Angeles, CA: Western Psychological Services, 1991.

15.

Reitan

Wollfson

The Halstead Reitan neuropsychological test battery. Tucson, AZ: Neuropsychology Press, 1988.

16.

Colarusso

Hammill

DD.

Motor-free visual perception test. 3rd ed. Novato, CA: Academic Therapy Publications, 2003.

17.

Burgess

Shallice

The Hayling and Brixton tests. Thurston, Suffolk: Thames Valley Test Company, 1997.

18.

Meyers

Rey complex figure test and recognition trial: professional manual. Lutz, FL: Psychological Assessment Resources, 1995.

19.

Zigmond

Snaith

RP.

The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67(6): 361–370.

20.

Kennedy

Lane

Berbaum

, et al. Simulator sickness questionnaire: an enhanced method for quantifying simulator sickness. Int J Aviat Psychol 1993; 3(3): 203–220.

21.

Myers

Paradis

Blanchard

RA.

Conceptualizing and measuring confidence in older drivers: development of the day and night driving comfort scales. Arch Phys Med Rehabil 2008; 89(4): 630–640.

22.

Gooden

Ponsford

Charlton

, et al. The development and initial validation of a new tool to measure self-awareness of driving ability after brain injury. Aust Occup Ther J 2017; 64(1): 33–40.

23.

Dimech-Betancourt

Ross

Ponsford

, et al. The development of a simulator-based intervention to rehabilitate driving skills in people with acquired brain injury. Disabil Rehabil Assist Technol. Epub ahead of print 9 October 2019. DOI: 10.1080/17483107.2019.1673835.

24.

Vlahodimitrakou

Charlton

Langford

, et al. Development and evaluation of a driving observation schedule (DOS) to study everyday driving performance of older drivers. Accid Anal Prev 2013; 61: 253–260.

25.

Dimech-Betancourt

Ponsford

Charlton

, et al. User experiences and perspectives of a driving simulator intervention for individuals with acquired brain injury: a qualitative study. Neuropsychol Rehabil. Epub ahead of print 2 March 2020. DOI: 10.1080/09602011.2020.1731555.

26.

Ettenhofer

Guise

Brandler

, et al. Neurocognitive driving rehabilitation in virtual environments (NeuroDRIVE): a pilot clinical trial for chronic traumatic brain injury. NeuroRehabilitation 2019; 44(4): 531–544.

27.

Kendig

Stacey

Driving, cessation of driving, and transport safety issues among older people. Health Promot J Austr 1997; 7(3): 175–179.

28.

Marottoli

Richardson

. Confidence in, and self-rating of, driving ability among older drivers. Accid Anal Prev 1998; 30(3): 331–336.

29.

McKay

Rapport

Coleman Bryer

, et al. Self-evaluation of driving simulator performance after stroke. Top Stroke Rehabil 2011; 18(5): 549–561.

30.

Gooden

Ponsford

Charlton

, et al. Self-awareness and self-ratings of on-road driving performance after traumatic brain injury. J Head Trauma Rehabil 2017; 32(1): E50–E59.

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