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Table 8 Synthesis of intervention studies involving mixed training

From: Are interventions effective at improving driving in older drivers?: A systematic review

Authors

Number (n), Age (yr) Country (c)

R.D.

Objective

Study description

Dependent Variable

Relevant results

QS

Porter, [51]

n = 54

yr = average age 77.6, 77.1 and 73.6 years old.

c = Canada

RCT

The purpose of this study was to examine an alternate form of driver training by utilizing video and global positioning system (GPS) technology, in combination with a classroom-based education program.

The participants were randomized in 3 groups:

-Classroom education (n: 18): 55 Alive Mature Driving program, 2 sessions of 4 h.

-Video (n: 17): received video and GPS feedback + classroom education. The participant watched the video of their own pre-test drive with the driving instructor and were given very specific instructions on how to improve their own driving

-Control (n:19): Not specified

The on-road test were performed in the pre and post.

(S): Driving Test (errors): Participants drove a 26 km in a standardized all test were performed with a digital video camera and then were watching to score the driving errors.

S (−): Participants that carried out the 55 Alive Mature Driving program did not significantly change from pre- to post-testing.

S (+/−): Participants in the video group and GPS feedback significantly reduced their driving errors after the program. In this group 9 of 17 subjects improved, whereas only 4 of 18 improved in the Education group, and just 1 of 19 improved in the Control group.

0,96

Marottoli et al., [52]

n = 126

yr = average age 80.4 and 79.7 years old (ages N/S).

c = USA

RCT

This study was designed to determine whether an education program consisting of classroom and on-road training could enhance driving performance.

The participants were randomized in 2 groups:

-Classroom + On Road driving training (n: 69): This group received 8 h of classroom and 2 h of on road training.

-Control (n: 57): This group receive modules directed at vehicle, home and environmental safety.

Both groups performed their training at 8 weeks and finally had driving and knowledge test.

(S): Driving Performance: The road test was based on the Connecticut Department of Motor Vehicles test and assessed a wide range of driving abilities.

(SA/K): Knowledge Test: 20 road knowledge questions from the AAA Driver Improvement. Program and eight road sign questions used in our earlier studies.

(SA/K): Intervention Participant Perceptions: the participants were asked if they liked the program adherence.

S (+): The program based in a classroom education plus on road driving show some improvements in the driving performance comparing to a control group. After 8 weeks of training the training group was 2.87 points higher than the control group in the road test score.

SA/K (+): Moreover, there were difference in knowledge test score after 8 weeks, 3.45 points higher in the intervention than in the control group. Overall, the participants said that they like this type of program and found it beneficial.

0,89

Bédard et al., [53]

n = 75

yr = between 65 and 87 years old.

c = Canada

RCT

if the combination of an in-class education program with on-road education would lead to improvements in older drivers’ knowledge of safe driving practices and on-road driving evaluations.

Participants were randomized in 2 groups

-Intervention group (n: 38): received the 55-Alive/Mature driving program, as well as 2 sessions of 40-min on road practice.

-Control group (n:37):

The procedure of this study was the initial on road driving evaluation. 4–8 weeks after completing the training were performed the second on road driving evaluation.

(B): Road evaluation: The on-road evaluation lasted approximately 35 min consisted of varying types of roadways and speeds and left and right turns at controlled and uncontrolled intersections.

-Starting/stopping/backing

-Signal violation/right of way/inattention

-Moving in roadway.

-Passing/speed and turning

(SA/K): The knowledge was evaluated with a questionnaire that consists of 15 multiple-choice questions

B (+): On the other hand, the on-road evaluation results suggest improvements on some aspects of safe driving such as moving in the roadway.

SA/K (+): This study revealed a significant improvement after the education and on road practice, with an increase in the knowledge test from 61% of questions correctly answered at baseline to 81% at follow-up.

0,89

Hay et al., [54]

n = 67

yr = average age 75 years old (ages N/S).

c = France

NRCT

Compare the effectiveness of two training programs: pure cognitive training and the same cognitive training coupled with three driving simulator training sessions, both programs being addressed to older drivers presenting a cognitive self-assessment bias.

The participants were divided in 2 groups

-Cognitive training (CT, n:40): had a duration of 35 h for 12 weeks and was composed of 20 cognitive exercises with 15 difficulty levels each, focused on: attention, memory, visuospatial abilities, executive functions

-Cognitive training + driving simulator (CT + DS, n: 27): Was the same training plus 1 h of simulated driving, 3 sessions of 20 min.

The evaluations carried out were before and after training trough the cognitive evaluation and on road evaluation.

(The cognitive performance was evaluated with the:

(S): Trail Making Test (A and B): assessed processing speed, executive function, and visual scanning ability and involved two parts.

(S): Digit Substitution Symbol Test: assessed psychomotor processing speed.

(S): The speed of processing and visual attention was evaluated with the Useful of Field of View.(S): The on-road driving evaluation was based on two different, but equivalent road trips combined urban, suburb and rural circuits and a section of ring road/highway. Also, there were two grid, the first, assessed eleven dimensions of driving. The second grid was completed in real time during the trip by the experimenter seated behind the driver.

S (+): Both group of training shows improvement; a diminution in the number of perseverations in the TMT, an increase in the number of correct symbols for the DSST, shorter interval presentation of the target to which they reacted (visual attention), participants anticipated the traffic and the environmental changes better and driving performance.

S (+): Participants from the CT group tended to make more planning errors than participants from the CT + DS group, regardless of the time of evaluation

S (+/−): The driving simulator experience did not influence the drivers’ behavior on the road. The participants from the CT + DS group did not make significantly fewer driving errors than those from the CT group. Therefore, the addition of driving in a simulator to the cognitive program led to a deterioration in speed adaptation and car control handling performances, whereas the pure CT led to an improvement of these driving performances.

0,82

Casutt et al., [55]

n = 91

yr = between 62 and 87 years old.

c = Switzerland

RCT

NM

The participants were randomized in 3 groups:

-Simulator Training Group (n: 39): A training session took 40 min. The goal of this training approach was to increase the mental work load of correct driving in a realistic multitasking driving setting.

-Cognitive Training Group (n: 26): The goal of this training approach was to increase specific driving relevant cognitive functions. Each of the 10 training sessions was composed of 10 min intrinsic alertness training, followed by 10 min of phasic alertness training and 20 min of vigilance training.

-Control Group (n: 26): No training.

The study design was a pre-post design. During the pre-posttest were conducted the cognitive and on road tests. The experimental groups between the pre-post tests performed the training.

(S): During the on-road test driving assessment the instructors made notes in the evaluation sheet but only evaluating cognitive aspects of driving behavior. Driving performance was measured using driving errors, top speed, mean speed, lane accuracy, lane variability, and reaction time to hazardous events.

(S): Cognitive test battery evaluated: Reaction test, Cognitrone test, determination test, peripheral perception test, adaptive tachistoscopic traffic perception test and adaptive matrices test.

S (+): The driving simulator-training group showed an improvement in on-road driving performance compared to the attention-training group and both training groups increased cognitive performance compared to the control group.

0,82

Romoser, [56]

n = 21

yr = “active learning group” age range = 73–82, avg. = 77.4, SD = 3.47

“control group” age range = 72–81; avg. = 76.5, SD = 3.20

c = USA

NRCT

Determine the long-term effects of active training on older drivers’ scanning in intersections.

Participants who participated in the study of Romoser and Fisher (2009) were recruited.

-Active learning group (n: 11): Received customized feedback from a replay of his own simulator and field drives evaluations.

-Control group (n:10): Received no training

All participants performed 6 individual sessions and the training session was the number 4, the other sessions were designated to the pre and post evaluations (simulator and on road).

(B): Videos showing the individual intersection maneuvers of the participants were analyzed to determine if the driver made a correct secondary look at the intersection. The main outcome is percentage of secondary looks, defined as the number of intersections where the driver took a proper secondary look divided by the total number of intersections the driver navigated, was calculated for

B (+): The 2009 study, older drivers in the active learning group took secondary looks in 46.3% of intersections prior to active training in a simulator and in 79.6% of intersections. Two years later, the same active learning group drivers continued to execute secondary looks in intersections 72.7% of the time a result that was still significantly higher than their 2009 pretraining performance. The 6.9% decrease was not statistically significant

B (+): Older drivers in the control group who received no training in 2009 took secondary looks in 40.7% of intersections during the first field drive and in 38.5% of intersections 6 to 8 weeks later. Two years later, these same control group drivers took secondary looks in 42.9% of intersections again, no statistically significant change in performance.

0,82

Romoser and Fisher, [57]

n = 54

yr = between 70 and 89 years old (range = 70 to 88; sample mean = 77.54; sample STD = 4.55)

c = USA

NRCT

Determine whether older drivers looked less often for potential threats while turning than younger drivers and to compare the effectiveness of active and passive training on older drivers’ performance and evaluation of their driving skills in intersections.

Participants were divided into three age groups (70–74; 75–79; 80–89), then each group were assigned to one of the next 3 groups:

-Active learning group (n: 18): Received customized feedback from a replay of his own simulator and field drives evaluations.

-Passive learning group (n: 18): Received a traditional lecture-style training session consisting of power points slides, texts, figures and animations.

-Control group (n: 18): Received no training

All participants performed 6 individual sessions and the training session was the number 4, the other sessions were designated to the pre and post evaluations (simulator and on road).

(B): Videos showing the individual intersection maneuvers of the participants were analyzed to determine if the driver made a correct secondary look at the intersection. The main outcome is percentage of secondary looks, defined as the number of intersections where the driver took a proper secondary look divided by the total number of intersections the driver navigated, was calculated for

B (+): The participants in the active learning group increase their secondary looks more than the double that they took before training and tended to rate this training to be more effective. Between the active and passive groups there was a significant difference, as was that between the active and control groups in their secondary looks. Finally, there were significant differences between active and passive groups and between active and control groups but not between the passive and control groups.

0,81

Lavallière et al., [58]

n = 22

yr = between 65 and 85 years old. c = Canada

NRCT

If simulator training, coupled with video-based feedback can modify visual search behaviors of older drivers while changing lanes (Feedback drivers).

The participants were randomized in 2 groups

-Feedback group (n:10)

-Control group (n:12)

Then participated in 5 sessions, where the first and last session included the on road and in simulator assessments. The 3 sessions between the pre-post tests were the same for both groups with the general driver refresher course (based on the 55-alive driver safety) and driving simulator training. The only one difference was that the feedback group received driving specific feedback.

(B): All drivers drove 12 km in the same vehicle on the same open road circuit for both the pre and post-training sessions. For each on-road lane change, 20 s of data were extracted from the records; 15 s prior to the initial displacement of the vehicle towards the target lane and 5 s after this initial displacement. The principal outcomes were:

-Frequency of visual inspections during lane changes

-Temporal inspection of the blind spot.

B (+): The participants in the feedback group after the training increased the frequency of verification of the blind spot increasing from 32,3% before the intervention to a 64,9% post intervention. Additionally, there was an increase of visual inspections occurring prior to the onset of the lane changes (after the training, 96% of the verifications occurred prior to the onset of the lane changes).

0,75