Table 5 Synthesis of intervention studies involving computer-based training

Edwards et al., [40]

n = 500

yr = average age 74 and 75 years old (ages N/S). c = USA and UK

Cohort

The current analyses were conducted to examine whether completing this speed of processing training regimen delays driving cessation.

The cohort was formed by participants from 2 different study.

The intervention was based in 10 speed of processing training sessions led by a trainer in which the subjects practiced computerized exercises of visual attention aimed at enhancing the speed and accuracy of visual performance. The sessions lasted 1 h, twice a week for 5 weeks.

The assessment carried out at baseline, immediately post training, and was repeated 3 years after training.

(B): Driving status and the number of days per week driven was evaluated with the Mobility Driving Habits Questionnaire.

-Far visual acuity was evaluated with a standard letter chart.

-Mental status was assessed with the Mini-Mental State Examination.

B (+): Speed of processing training participation was protective against driving cessation, mainly in those drivers who drove more often and those with better vision. Thus, the participants who completed the training were 40% less likely to cease driving across the subsequent 3 years as compared with controls

Ball et al., [41]

n = 908

yr = between 65 and 91 years old.

c = USA

RCT

To test the effects of cognitive training on subsequent motor vehicle collision (MVC) involvement of older drivers.

Participants were randomized in 4 groups:

-Control group (n:298): No training

-Memory training (n: 103): Based in mnemonic strategies.

-Reasoning training (n: 133): Based in strategies for finding the pattern in a letter or word series and identifying the next item in the series.

-Speed of processing training (n: 129): based in practice of visual attention skills and the ability to identify and locate visual information quickly in increasingly demanding visual displays.

The sessions were led by trainers, conducted in groups of 2–4 participants during approx. 70 min sessions over a period of 5 to 6 weeks. In each intervention condition, 10 training sessions were carried out twice a week over a 5-week period

Participants completed assessments at baseline, immediately following, and annually at 1, 2, 3, and 5 years.

(CR): The primary outcome was state-recorded motor vehicle collision (MVC) obtained from the Departments of Motor Vehicles in the states of Alabama, Indiana, Maryland, and Pennsylvania.

The variable were: Total collisions, at-fault collisions, person-time (in years), person-miles, at-fault crashes/year, at-fault crashes/mile rate ratios. Mileage—The number of miles driven per week was reported by participants on the Mobility Driving Habits Questionnaire and was used to calculate the dependent variable of interest, rate of MVCs per person mile driven

CR (−): The participants who carried out the memory training do not show a significant association in the reduction of rate of at fault MVC per year

CR (+): The participants under speed processing training and reasoning training experienced a significantly lower rate of at fault MVC per year of driving exposure or per person mile driven.

Horswill et al., [42]

n = 75

yr = between65 and 89 years old.

c = Australia

RCT

Examine the longer-term effects of hazard perception.

Participants were randomized in 3 groups:

-Training without booster (n: 26): performed the hazard perception training that consisted in an instructional video followed by video-based exercises.

-Training with booster (n: 25): After one month of receive the same training of the group without booster they received 22 min of additional training video.

-Placebo (n: 24): they had a placebo intervention watching another video with clips of a driving instructor discussing aspects of safe driving.

All the groups performed the hazard perception test in the first session prior to the training and then after one and three-month post intervention.

(S): Simple spatial RT test: the participants must touch as quickly as possible 15 high contrast rectangles that appeared one after another on the computer screen at random intervals.(S): Hazard perception tests: 4 hazard perception tests per participant were generated from a pool of 153 videos filmed from the driver’s perspective.

S (+): The participants that carried out the training responded 0.81 s faster than baseline compared with those in the placebo condition. This difference it was maintained after one and three months of following with 0,67 s and 0,45 s faster, respectively.

S (+): The participants who were under intervention had a significant immediate effect of training on hazard perception

S (+/−): The hazard perception training with booster did not show a significant difference relative to baseline than training without booster based on the hazard perception test scores.

Edwards et al., [43]

n = 500

yr = average age 72.08, 74.13 and 74.52 years old (ages N/S).

c = UK

RCT

To examine how cognitive speed of processing training affects driving mobility across a 3-year period among older drivers.

Based upon their UFOV test performance the participants were randomized in 2 groups:

-Cognitive speed of processing training (n: 66): the tasks in the computer involved identified and localize visual and auditory targets.

-Computer contact internet training (n: 68): participants received instructions on computer hardware, how to use a mouse, how to use and e-mail and how to access and use web pages.

The intervention had 10 sessions, 60 min in duration, guided by a trainer and involving 1–3 participants per class.

Once finalized the training follow up interviews occurred within 3 years +/−  3 months of the participants last assessment.

(B): Driving behaviors was assessed with the Mobility Questionnaire:

-Driving exposure: Total number of challenging conditions encountered while driving-Driving space: Extent into environment driven-Driving difficulty 3 (Alone, Lane and changes): Left-hand: Rating of difficulty while driving in each situation; 1 = no difficulty to 4 = extreme difficulty.-Driving difficulty 5 (Rush hour, High traffic, Night, Rain and Merging into traffic): Rating of difficulty while driving in each situation; 1 = no difficulty to 4 = extreme difficulty.

B (+): The participants that did not receive the speed of processing training experienced steeper decline in driving mobility across the 3-year period relative to the reference group as indicated by increased driving difficulty and decreased driving exposure and space.

B (−): The participants that completed the speed of processing training experienced increased driving difficulty across time when driving alone, making lane changes, and making left-hand turns across oncoming traffic than did the reference group (driving difficulty three-item composite).

B (−): The participants that were trained did not differ across time from the reference group in driving exposure, driving space, or the degree of driving difficulty as indicated by the five-item composite

Cuenen et al., [44]

n = 56

yr = average age 70.84, 69.84 and 73.06 years old (ages N/S).

c = Belgium and Holland

RCT

The purpose of the present study was to investigate the effect of a computerized WM training on aspects of older drivers’ cognitive ability and driving ability.

Participants were randomized in 2 groups and the control group was collected:

-Adaptative Training Group (n: 19): the difficulty level of the training was automatically adjusted on a trial-by-trial basis.

-Non Adaptative Training Group (n:19): the difficulty level of the training was not adjusted

-Control Group (n:18): No Training

The two-training intervention group consisted in working memory training based in 3 subtasks: visuo-spatial task, a backward digit span task and a letter span task. The training was conducted at home, on a PC, via the internet with a total number of sessions between 20 and 25.

After the training the participants developed the post-test that was the same pre-test and consisted in cognitive tasks and driving in a simulator scenario.

(S): Three Cognitive measures were evaluated:

-Working memory

-Attention -Inhibition (S): Six specific driving measures were evaluated:

-Driving speed (km/h)

-SDLP (m)

-Gap acceptance (s)

-Complete stops at stop signs

-Giving right of way

-Crashes (number)

S (+): The participants under computer training achieved a significant difference for working memory and the driving measure of giving right of way. In particular, participants who not were under training had lower working memory capacity and gave less right of way than the other two training groups. However, there was an improvement in the adaptive training group in cognitive ability, smaller in the non-adaptive training group and only minimal in the no-training control group supported for working memory.

S (−): The effects of the training did not achieve a statistically significant difference for the cognitive abilities of attention and inhibition.

S (+): The driving abilities such as driving speed and complete stops at stop signs achieved only marginally a significant effect. However, the other driving measures such as SDLP, gap acceptance, giving right of way, and crashes did not find statistically significant difference.

Cassavaugh and Kramer, [45]

n = 21

yr = average age 71.7 years old (ages N/S).

c = USA

Pre-Post test

The present study’s main objective was to investigate whether training in laboratory tasks would transfer to driving performance in older adults.

All the participants were under the same computer-based training.

The intervention consisted in 8-training session lasted 90 min and carried out in different days. The program had different tasks (attention, visuo-spatial working memory, manual control and dual tasks).

The assessment consisted in two initial driving in simulator and two final post-intervention driving simulator session, identical to the first.

(S): Response accuracy and response time were measured in the selective attention and N-back tasks. Root mean square tracking error and time-on-target were analyzed for the tracking task.

-Tracking task

-Visual selective attention task

-Visual–spatial N-back task

-Dual tasks

(S): Driving Simulator

-Lane position and following distance were assessed in terms of root mean square error.-Response time to lead-vehicle brake events was measured in milliseconds.

S (+): The participants who were under a computer-based training achieved improvements in single and dual cognitive tasks. These improvements were translate to an improvement in driving simulator performance across the course of the study

Johnston et al., [46]

n = 53

yr = average age 68.83 years old (ages N/S).

c = Canada

NRCT

The current study assessed the effectiveness of DriveSharp in training older drivers in a naturalistic class setting

The participants were divided in 2 groups:

-Control group (n:18)

-Experimental group (n:24)

The intervention was the Drivesharp course that lasted 5 weeks with 2 sessions for week and each session was led by a facilitator with a duration of 60 min. This course was developed in a classroom environment on individual desktop computer with 3 games that incorporates divided attention and multiple object, intended to enlarge the UFOV and trains speed of processing.

All participants completed trails that assess visual search, memory, and attention and a short version of the Hazard Perception Test in the pre-testing. After the 5 five weeks of training the participants attended the post-testing session that was the same pre-testing with only one difference that the experimental group completed a usability questionnaire.

(S): A brief version of the Hazard Perception Test was utilized

(S): Trails A and B: were utilized to measure the processing speed, working memory, and executive control.

S (−): After the five weeks of training the analysis of performance data did not revealed any significant benefits to the Drivesharp course.