This research examined the effectiveness of four contrasting training techniques designed to enhance the driving performance of normally aging adults. Each technique is suitable for, or is marketed and sold to a broad cross-section of the older driver population. Training programs designed specifically for an individualized rehabilitation regime (e.g., a stroke recovery program) were not considered. The research team measured training program effectiveness by comparing the on-road and simulator performance of drivers 65 and older in each treatment group to a control group (that received a neutral intervention) before and immediately after training, and again after a 3-month delay. Thus, study results reflected planned comparisons between each treatment group and the control group, rather than one treatment group versus another. The training activities examined in this research included (1) classroom driver education delivered in a group setting, supplemented by an hour of one-on-one, behind the wheel instruction; (2) computer-based exercises designed to improve speed of visual information processing and divided attention; (3) occupational therapy (OT)-based exercises to improve visual skills and attention; and (4) physical conditioning to improve strength, flexibility, and movement. Hospital staff or project consultants provided training to each group, which included 8 hours of direct contact with study participants; the providers identified driver improvement as an explicit goal of participation in the training activities. The control group participants received 8 hours of relaxation training or health and wellness counselling not associated with driver improvement. Twenty volunteer older drivers recruited at the Roger C. Peace Rehabilitation Hospital in Greenville, South Carolina, were randomly assigned to each training group, as well as to the control group, for a total of 100 participants. Attrition over the course of the study reduced the number who finished the post-treatment assessments and were included in analyses of training effectiveness to between 15 and 17 participants per group. The mean age across groups ranged from 71.5 to 74.1 years. A certified driving rehabilitation specialist (CDRS) conducted the on-road performance evaluations. The CDRS, who was blind to the group to which each study participant was assigned, developed different routes of equal driving difficulty to avoid repeated exposure by participants to the same conditions across successive assessments. The CDRS scored competence on 33 subscales comprising tactical and strategic domains of driving performance. The CDRS used an ordinal scoring system, a scale from 0 to 4, where ratings corresponded to approximately how often a driver demonstrated a particular skill or behaviour, in relation to the number of opportunities to demonstrate it that were afforded during each on-road assessment. Normal variability in traffic conditions produced different numbers of opportunities from person to person, and from drive to drive for the same participant. The CDRS provided feedback to study participants about their driving only after the delayed post-treatment assessment (Drive 3), not after the baseline evaluation (Drive 1) or immediate post-treatment evaluation (Drive 2). The CDRS also conducted a feedback session to obtain participants’ views regarding the validity and utility of the driving evaluation and training activities they were exposed to during the study. Because the stated goal of each training activity was to preserve or enhance safe driving behaviour, our research hypotheses were (1) each training group will have a higher percentage than the control group of drivers without deficits at baseline who maintain their performance at the immediate and/or delayed post-treatment assessments; and (2) each training group will have a higher percentage than the control group of drivers with deficits at baseline who improve their performance on Drive 2 and/or Drive 3. Only the group that received the occupational therapy-based exercises to improve visual skills and attention demonstrated a significant gain relative to the control group in the percentage of drivers without performance deficits at baseline who maintained their skills on subsequent evaluations. This effect was significant at p < .05 on the immediate post-treatment assessment and at p < .01 on the delayed assessment. For the few drivers who demonstrated some deficiency on the baseline assessment, two training groups achieved significant (p < .05) gains relative to the control group in the percentage of participants who improved their performance on the immediate post-treatment evaluation — the OT-based exercises group and the classroom plus behind-the-wheel training group. None of the training activities were effective in producing such gains on Drive 3. The apparent efficacy of the OT-based visual skills training is an important finding. This activity, which showed the strongest gains relative to the control group, points to an opportunity for those professionals without the relatively scarce CDRS credential to enhance seniors’ safety behind the wheel. The curriculum and support materials described in this report and appendix certainly merit further research, potentially culminating in the broad implementation of this training in clinical settings across the country. Results for the classroom + behind-the-wheel training also demonstrated performance gains, and more study participants indicated perceived practical value in this intervention than in any other. With regard to the remaining treatments, physical conditioning of course holds the promise of health and wellness benefits well beyond improved driving performance; and computer-based training can be completed at home at the driver’s own pace, providing a convenient and inexpensive training option. The results of the simulator study, which included various response time measures under divided attention conditions, were equivocal: none of the training groups demonstrated significant gains in performance relative to the control group. However, on the most safety-critical measure, peripheral hazard detection latency, the groups with the strongest outcomes were the same as those meriting highest approbation in the on-road assessment–the OT-based visual skills training and the classroom + behind-the-wheel training groups. There were clear limitations in this research due to sample size, and to the restriction in range of driving skill levels for all groups on the baseline assessment. In addition, the training protocols only assured that participants were engaged in the respective training activities for an equal amount of time across groups; performance on the training tasks themselves was not scored nor analysed in relation to the measures of effectiveness. In addition, the CDRS rating system restricts the application of inferential statistics for data analysis, and its scores for isolated behaviours may not fully gauge how well a driver integrates these component skills for successful whole task performance. A future research goal is to develop a more standardized and refined methodology for what is often cited as the “gold standard” for determining fitness to drive. (Author/publisher)
Abstract