Driving performance and turning reaction time following hip arthroscopy for FAIS: does capsular repair matter?

PURPOSE

(1) To compare the pre- and postoperative driving performance in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS); (2) to examine the differences in driving performance between patients with versus without capsular repair.

METHODS

Patients who underwent arthroscopic hip surgery for FAIS were included. Driving performance of participating patients was collected using a driving simulator preoperatively and at 2 weeks, 4-6 weeks and 8-12 weeks postoperatively. Data collected included demographics, surgery laterality, intraoperative procedures, left and right turn reaction time, total turn reaction time, gas off time (GOF), and break reaction time (BRT). Repeated measures analysis of variance (ANOVA) was used for statistical analysis.

RESULTS

21 subjects (9 males, 12 females) with a mean age of 30 ± 9 years were included and 57.1% of the subjects had right-sided surgery. There was no difference between the mean preoperative and the 2-week postoperative left (0.72 seconds and 0.75 seconds, respectively) right (0.77 seconds and 0.75 seconds, respectively), and total (0.74 seconds and 0.75 seconds, respectively) turn reaction times as well as GOF (0.62 seconds and 0.60 seconds, respectively) and BRT (0.92 seconds and 0.93 seconds, respectively), indicating that the patients' driving performance returned to the preoperative level as early as 2 weeks following hip arthroscopy for FAIS. There was no significant difference amongst any of the driving variables between patients who underwent capsular repair (50%) and those who did not. There was no significant difference amongst any of the driving variable s between patients who underwent left versus right hip arthroscopy.

CONCLUSIONS

Patients' driving performance returns to the preoperative level as early as 2 weeks after hip arthroscopy for FAIS. Surgery laterality nor capsular repair make any significant difference in the time for driving abilities to return to baseline. The impact of intraoperative procedures performed, and the analgesic medications used postoperatively on the driving ability of patients undergoing hip arthroscopy warrants further investigation in larger patient populations.

Predictors of Driving Cessation in Older Adults: A 12-year Population-based Study

BACKGROUND

Changes in physical health and cognition during aging can result in some older adults to stop driving. In this population-based longitudinal study, we describe potential predictors of driving cessation in older adults.

METHODS

Age-stratified random population cohort of 1982 adults aged 65 years and older drawn from voter registration lists. Participant characteristics were measured using demographics, physical and self-rated health, sleeping habits, driving status, cognitive screening, modified Center for Epidemiologic Studies-Depression scale, clinical dementia rating, and mini-mental state examination.

RESULTS

Over 12 years of follow-up, 390 participants stopped driving. These individuals were older, more likely to be women and to have a clinical dementia rating score ≥1, had worse self-reported health, and more symptoms of depression, compared with those who were still driving. In addition, individuals with lower test performance in all cognitive domains, loss of visual acuity and fields, and bilateral hearing loss were more likely to stop driving.

CONCLUSIONS

Age, sex, cognitive impairments, physical health, and depressive symptoms were associated with driving cessation in this cohort. By identifying potential driving cessation predictors, health care providers and families may better recognize these risk factors and begin the driving cessation discussion early.

How Tired is Too Tired to Drive? A Systematic Review Assessing the Use of Prior Sleep Duration to Detect Driving Impairment

Driver fatigue is a contributory factor in approximately 20% of vehicle crashes. While other causal factors (eg, drink-driving) have decreased in recent decades due to increased public education strategies and punitive measures, similar decreases have not been seen in fatigue-related crashes. Fatigued driving could be managed in a similar way to drink-driving, with an established point (ie, amount of prior sleep) after which drivers are "deemed impaired". This systematic review aimed to provide an evidence-base for the concept of deemed impairment and to identify how much prior sleep may be required to drive safely. Four online databases were searched (PubMed, Web of Science, Scopus, Embase). Eligibility requirements included a) measurement of prior sleep duration and b) driving performance indicators (eg, lane deviation) and/or outcomes (eg, crash likelihood). After screening 1940 unique records, a total of 61 studies were included. Included studies were categorised as having experimental/quasi-experimental (n = 21), naturalistic (n = 3), longitudinal (n = 1), case-control (n = 11), or cross-sectional (n = 25) designs. Findings suggest that after either 6 or 7 hours of prior sleep, a modest level of impairment is generally seen compared with after ≥ 8 hours of prior sleep (ie, well rested), depending on the test used. Crash likelihood appears to be ~30% greater after 6 or 7 hours of prior sleep, as compared to individuals who are well rested. After one night of either 4 or 5 hours of sleep, there are large decrements to driving performance and approximately double the likelihood of a crash when compared with well-rested individuals. When considering the scientific evidence, it appears that there is a notable decrease in driving performance (and associated increase in crash likelihood) when less than 5h prior sleep is obtained. This is a critical first step in establishing community standards regarding the amount of sleep required to drive safely.

A Cross-Sectional Study of Determinants of Type 2 Diabetes Mellitus Among Professional Drivers in the Perambalur Municipality Area of Tamil Nadu, India

Background Professional drivers have a powerful impact on public safety. They are also at a higher risk of obesity, hypertension, and type 2 diabetes mellitus (T2DM) because of their lifestyle. Diabetes and its complications can affect driving and cause increased road traffic accidents. This study aimed to estimate the prevalence of T2DM and determine the risk factors contributing to the development of T2DM among professional drivers in the Perambalur Municipality of Tamil Nadu, India. Methodology This cross-sectional study was carried out between September 2022 and December 2022 among 118 private bus drivers and full-time, professional, three-wheeler drivers in the Perambalur Municipality. A pre-tested semi-structured proforma was used to collect information on the driver's socio-demographic profile and to inquire about their diabetes history, which was verified with their records. We elicited the risk factors of T2DM among those drivers. We recorded the anthropometric measurements and blood pressure. Data analysis was done using IBM SPSS Statistics for Windows, Version 21.0 (Released 2012; IBM Corp., Armonk, New York, United States). Results Out of 118 study participants, the majority were in the age group of 51-65 (37.3%). Seventy-seven of the participants have completed their secondary education, and 38 of them belong to the class 2 socioeconomic class. Three-fourths of the sample (83.1%) belonged to nuclear families. Around one-third were current smokers, one-fourth had the habit of chewing tobacco, and more than half of the participants consumed alcohol. Nearly 83.7% had moderate physical activity, followed by 11.9% who had heavy activity, and 5.1% who did not do any physical activity. The prevalence of T2DM among professional drivers was 11.9%. The risk factors that contributed to the development of T2DM among professional drivers were age, education, smoking, tobacco chewing, hypertension, elevated BMI, and elevated WC, which are statistically significant (p˂0.05). Conclusion We found the proportion of obesity, hypertension, and diabetes to be higher among professional drivers than among the general population. This demands an urgent need for preventive and health-promotive interventions to address these chronic diseases.

Under pressure: Effect of a ransomware and a screen failure on trust and driving performance in an automated car simulation

One major challenge for automated cars is to not only be safe, but also secure. Indeed, connected vehicles are vulnerable to cyberattacks, which may jeopardize individuals' trust in these vehicles and their safety. In a driving simulator experiment, 38 participants were exposed to two screen failures: silent (i.e., no turn signals on the in-vehicle screen and instrument cluster) and explicit (i.e., ransomware attack), both while performing a non-driving related task (NDRT) in a conditionally automated vehicle. Results showed that objective trust decreased after experiencing the failures. Drivers took over control of the vehicle and stopped their NDRT more often after the explicit failure than after the silent failure. Lateral control of the vehicle was compromised when taking over control after both failures compared to automated driving performance. However, longitudinal control proved to be smoother in terms of speed homogeneity compared to automated driving performance. These findings suggest that connectivity failures negatively affect trust in automation and manual driving performance after taking over control. This research posits the question of the importance of connectivity in the realm of trust in automation. Finally, we argue that engagement in a NDRT while riding in automated mode is an indicator of trust in the system and could be used as a surrogate measure for trust.

Back on the Road: Comparing Cognitive Assessments to Driving Simulators in Moderate to Severe Traumatic Brain Injuries

Objective: To compare established clinical outcome assessments for predicting behind the wheel driving readiness and driving simulator results across age groups and in traumatic brain injury. Methods: Participants included adults who had a traumatic brain injury ranging in age from 31 to 57 years and a non-impaired adult population ranging in age from 18 to 80 years. Physical and cognitive outcomes measures were collected included range of motion and coordination, a “Rules of the Road Test” a “Sign Identification Test,” Trails A and B, and the clock drawing test. Visual measures included the Dynavision D2 system and motor-free visual perceptual test-3 (MVPT-3). Finally, the driving simulators (STIÒ version M300) metro drive assessment was used, which consisted of negotiating several obstacles in a metropolitan area including vehicles abruptly changing lanes, pedestrians crossing streets, and negotiating construction zones. Results: Our findings suggest that the standard paper-pencil cognitive assessments and sign identification test significantly differentiate TBI from a non-impaired population (Trails A, B and Clock drawing test p < 0.001). While the driving simulator did not show as many robust differences with age, the TBI population did have a significantly greater number of road collisions (F3, 78 = 3.5, p = 0.02). We also observed a significant correlation between the cognitive assessments and the simulator variables. Conclusions: Paper-pencil cognitive assessments and the sign identification test highlight greater differences than the STI Driving Simulator between non-impaired and TBI populations. However, the driving simulator may be useful in assessing cognitive ability and training for on the road driving.

Factors Influencing Driving following DBS Surgery in Parkinson's Disease: A Single UK Centre Experience and Review of the Literature

Parkinson's disease (PD) is a complex neurodegenerative disorder, leading to impairment of various neurological faculties, including motor, planning, cognitivity, and executive functions. Motor- and non-motor symptoms of the disease may intensify a patient's restrictions to performing usual tasks of daily living, including driving. Deep Brain Stimulation (DBS) associated with optimized clinical treatment has been shown to improve quality of life, motor, and non-motor symptoms in PD. In most countries, there are no specific guidelines concerning minimum safety requirements and the timing of return to driving following DBS, leaving to the medical staff of individual DBS centres the responsibility to draw recommendations individually regarding patients' ability to drive after surgery. The aim of this study was to evaluate factors that might influence the ability to drive following DBS in the management of PD. A total of 125 patients were included. Clinical, epidemiological, neuropsychological, and surgical factors were evaluated. The mean follow-up time was 129.9 months. DBS improved motor and non-motor symptoms of PD. However, in general, patients were 2.8-fold less likely to drive in the postoperative period than prior to surgery. Among the PD characteristics, patients with the akinetic subtype presented a higher risk to lose their driving licence postoperatively. Furthermore, the presence of an abnormal postoperative neuropsychological evaluation was also associated with driving restriction following surgery. Our data indicate that restriction to drive following surgery seems to be multifactorial rather than a direct consequence of DBS itself. Our study sheds light on the urgent need for a standardised multidisciplinary postoperative evaluation to assess patients' ability to drive following DBS.

Return to driving following anatomic and reverse shoulder arthroplasty: a comparative analysis

BACKGROUND

The currently recommended time to return to driving following shoulder arthroplasty is controversial. The purpose of this study was to determine patient-specific factors associated with early return to driving after anatomic (aTSA) and reverse total shoulder arthroplasty (RTSA).

METHODS

All patients aged >18 years undergoing primary aTSA or RTSA at a single institution over a 3-year period were retrospectively identified. Patients were emailed a questionnaire to determine time to postoperative return to driving and frequency of driving prior to and following surgery. Patients who did not drive prior to surgery or did not complete the questionnaire were excluded from analysis. Multivariate analysis was used to determine patient-specific factors associated with early return to driving (within 2 weeks following surgery) and delayed return (>6 weeks following surgery).

RESULTS

Four hundred six patients were included for analysis (aTSA = 214, RTSA = 192). Patients undergoing aTSA were significantly younger (68 vs. 74 years) and drove more frequently both pre- and postoperatively than the RTSA cohort. One hundred percent of patients returned to driving postoperatively. Patients undergoing aTSA more commonly demonstrated earlier return to driving than RTSA patients (34% vs. 20%). Factors associated with increased odds of early return to driving included male sex (aTSA) and compliance with surgeon instruction (aTSA). Decreased odds of early return was associated with waiting to drive until cessation of sling use (RTSA), older age (RTSA), and increased body mass index (RTSA). The presence of surgical complications (aTSA) and prolonged use of narcotics (RTSA) were associated with return to driving >6 weeks following surgery. No difference in the rate of motor vehicle accidents was found between patients returning to driving <2 vs. >2 weeks postoperatively.

CONCLUSION

Patients undergoing aTSA return to driving sooner than those undergoing RTSA. Early return to driving appears to be influenced by patient sex, age, BMI, narcotic and sling use, and compliance with surgeon instruction, but does not appear to result in a high incidence of postoperative MVA.

Driving ability and predictors for driving performance in Multiple Sclerosis: A systematic review

OBJECTIVE

To provide an overview of the evidence on driving ability in persons with multiple sclerosis (PwMS), specifically to (i) study the impact of MS impairment on driving ability and (ii) evaluate predictors for driving performance in MS.

METHODS

To identify relevant studies, different electronic databases were screened in accordance with PRISMA guidelines; this includes reference lists of review articles, primary studies, and trial registers for protocols. Furthermore, experts in the field were contacted. Two reviewers independently screened titles, abstracts, and full-texts to identify relevant articles targeting driving in people with MS that investigated driving-related issues with a formal driving assessment (defined as either an on-road driving assessment; or naturalistic driving in a car equipped with video cameras to record the driving; or a driving simulator with a steering wheel, a brake pedal, and an accelerator).

RESULTS

Twenty-four publications, with 15 unique samples (n = 806 PwMS), were identified. To assess driving ability, on-road tests (14 papers) and driving simulators (10 papers) were used. All studies showed moderate to high study quality in the CASP assessment. About 6 to 38% of PwMS failed the on-road tests, showing difficulties in different areas of driving. Similarly, PwMS showed several problems in driving simulations. Cognitive and visual impairment appeared to most impact driving ability, but the evidence was insufficient and inconsistent.

CONCLUSION

There is an urgent need for more research and standardized guidelines for clinicians as one in five PwMS might not be able to drive safely. On-road tests may be the gold standard in assessing driving ability, but on-road protocols are heterogeneous and not infallible. Driving simulators assess driving ability in a standardized way, but without standardized routes and driving outcomes, comparability between studies is difficult. Different aspects, such as cognitive impairment or vision problems, impact driving ability negatively and should be taken into consideration when making decisions about recommending driving cessation.

SYSTEMATIC REVIEW REGISTRATION

Identifier [10.17605/OSF.IO/WTG9J].

Decision strategies while intoxicated relate to alcohol-impaired driving attitudes and intentions

OBJECTIVE

Approximately 28 million individuals engage in alcohol-impaired driving (AID) every year. This study investigated individuals' AID decision making strategies under intoxication, their variability across the breath alcohol concentration (BrAC) curve, and the association between strategy and AID attitudes, intentions, and behavior.

METHOD

Seventy-nine adults (mean 23.9 years, 57% female) who drank alcohol ≥2 days per week and lived >2 miles away from their typical drinking locations completed an alcohol administration protocol and AID decision making task. AID attitudes, intentions, and behaviors were assessed repeatedly across the BrAC curve. Bayesian cognitive modeling identified decision strategies used by individuals on the AID decision making task, revealing whether alcohol consumption level and/or ride service cost factored into individuals' decisions to drive while impaired or obtain a ride. Additional analyses tested whether AID attitudes and intentions were related to individuals' decision strategies.

RESULTS

Two decision strategies were examined on the ascending and descending limbs of the BrAC curve: compensatory (both consumption level and ride service cost factored into AID decisions) and non-compensatory (only consumption level factored into AID decisions). Switching to a compensatory strategy on the descending limb was associated with lower perceived intoxication, perceiving AID as less dangerous, and being willing to drive above the legal BrAC limit.

CONCLUSIONS

Results suggest that risk for engaging in AID is higher for those using a cost-sensitive, compensatory strategy when making AID decisions under intoxication. Future research is needed to test whether AID countermeasures (e.g., subsidized ride services) are differentially effective according to decision strategy type. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Navigating the pathway to ceasing driving-A voyage of discovery

BACKGROUND

Ceasing driving for older people is a life transition and can be associated with a sense of loss and decreased wellbeing. Nurses can play a key role in supporting the older person to manage the transitions, especially as the work involved in ceasing driving is often hidden. For example, finding alternative and accessible means of travel and maintaining mobility. Travel itself can be viewed as essential, for example attending health appointments and shopping. Discretionary travel may not be viewed as essential, but provides an important means of maintaining activity and social connection.

METHOD

A case study is presented of Mike's journey in ceasing driving. The concept of transition helps in co-creating with Mike his journey of discovery. Semi-structured interviews took place with Mike over a six-month period and a journey pathway created, which was subject to further iterations during subsequent interviews.

RESULTS

Ceasing driving involves a number of transitions encompassing a series of losses, managing uncertainty, problem-solving and learning new skills. Being able to access and adapt to maintain mobility and travel are influenced by structural and environmental barriers.

CONCLUSION

The World Health Organization's strategy to create age-friendly cities and communities is admirable. Like any other strategy this is a long-term plan, and in meantime action needs to happen to support older people in ceasing driving and creating a non-driving life and limit a decrease in well-being. Starting conversations on transitional travel planning is proposed, with nurses playing a central role in making this process happen.

Exploring Psychosocial Dynamics Underpinning Driver Identity in an Older Adult Sample

Many older adults consider driving a crucial aspect of their daily routine and the prospect of driving cessation to be disruptive to their current lifestyle. Driving cessation is associated with multiple adverse consequences, including poorer health trajectories, and increased depressive symptoms. Research suggests that driving cessation may be disruptive to identity. This study aimed to explore the characteristics that are associated with driver identity and whether identity impacted people's readiness for mobility changes. Of interest was whether stopping driving was perceived as either a positive or negative event. Participants, (N = 410) older adults recruited via Prolific survey panel between July and November 2021, responded to questions about transport and travel behaviors, driver identity, and perceptions of mobility changes. Driving cessation was generally perceived as a negative change. However, individuals with self-reported low readiness for mobility change also had higher overall scores for Identity, and for the subscales, Centrality and Ingroup Affect. These findings suggest that people with more concerns for mobility transition may think about and have more of an emotional investment regarding driving. The findings provide novel insight into the psychosocial dynamics of driving and the factors that influence driver identity, however further research, co-designed with older drivers and retired drivers is required.

Rein tension in harness trotters during on-track exercise

Horseracing is under public scrutiny with increasing demands to safeguard horse welfare. It is accepted that, as a result of bit pressure and/or equipment, mouth lesions accompany many types of horse use, including racing. However, there are currently no data available on the range of bit pressures in driven trotters. Our aim was to investigate whether rein tension (RT, proxy for bit pressures) differs among gaits, between tempo within gait, between horses and drivers, and between left/right reins. Standardbreds (n = 9), driven by experienced drivers (n = 11), performed exercise tests on a racetrack (cross-over design; total 31 tests, data available from 26 tests). Horses' motion symmetry was measured before tests (trotting in hand). Rein tension, speed and heart rate were measured during exercise. A moving-window filter was applied to RT raw data. Median, maximum and interquartile range for the estimated stride median RT were determined for each rein (left/right) and segment: walk; circling in slow trot followed by transition to faster trot; fast (racing) trot; and slowing down to walk. Mixed models were used for statistical analysis. Least square means for segment median RT ranged between 17-19 N in walk, 34-40 N during circling-accelerating, 51-62 N in fast trot, and 53-71 N for slowing down. Segment maximum RT was between 60-81 N in walk, 104-106 N during circling-accelerating, 72-86 N in fast trot, and 86-129 N during slowing down. Interquartile ranges were between 7-9 N in walk, 28-31 N during circling-accelerating, 8-10 N in fast trot, and 12-18 N for slowing down. Hind limb asymmetry exceeded the recommended threshold in three horses and was associated with higher median (48 N) and maximum (106 N) RT than symmetric horses (29 N and 73 N, respectively, p < 0.01). Consistent left-right asymmetry in RT was more common among horses than among drivers. Rein tension increased with increasing heart rate (p ≤ 0.0006). Rein tensions were higher than those reported during riding or in horses worked from the ground. The findings of high RT, taken together with the high reported prevalence of oral injuries in harness trotters, call for further research into RT, motion symmetry and use of equipment.

Ecological validity of executive function tests in predicting driving performance

Almost all of our everyday activities depend on executive function (EF) skills. In line with the increasing attention to the ecological validation of neuropsychological assessment and intervention methods, this study aimed to explore the ecological validity of a relevant set of widely used EF tests, mostly from well-known paradigms of EF assessment, in predicting driving ability. Ninety-six healthy novice drivers (Mage = 26.2 years, SD = 8.4; 48 female) completed four stages of our data collection including psychological, EF, and driving assessments. For the psychological assessment, validated measures of sensation-seeking, risk-taking, personality traits, ADHD symptoms, depression, anxiety, and stress were administered. For the EF assessment, selected tests from the Delis-Kaplan Executive Function System (D-KEFS: Trail Making, Design Fluency, and Tower) and the Behavioral Assessment of the Dysexecutive Syndrome (BADS: Key Search, Zoo Map, and Modified Six Elements) along with a computerized Stroop test were administered. For the driving assessment, we used a simulated driving test comprising of 14 key dimensions of driving skills. Several correlations and multiple regression analyses were conducted. Significant correlations were found between all the EF measures and driving performance. Moreover, the EF measures predicted the driving ability over and above the effects of previous driving experience and the psychological variables. These results provide supporting evidence for the ecological validity of the EF tests in predicting driving performance. The incorporation of assessment and intervention targeting multiple domains of EF into driving rehabilitation and education programs could be a focus of future research.

Eye Movement Abnormalities in Glaucoma Patients: A Review

Glaucoma is a common condition that relies on careful clinical assessment to diagnose and determine disease progression. There is growing evidence that glaucoma is associated not only with loss of retinal ganglion cells but also with degeneration of cortical and subcortical brain structures associated with vision and eye movements. The effect of glaucoma pathophysiology on eye movements is not well understood. In this review, we examine the evidence surrounding altered eye movements in glaucoma patients compared to healthy controls, with a focus on quantitative eye tracking studies measuring saccades, fixation, and optokinetic nystagmus in a range of visual tasks. The evidence suggests that glaucoma patients have alterations in several eye movement domains. Patients exhibit longer saccade latencies, which worsen with increasing glaucoma severity. Other saccadic abnormalities include lower saccade amplitude and velocity, and difficulty inhibiting reflexive saccades. Fixation is pathologically altered in glaucoma with reduced stability. Optokinetic nystagmus measures have also been shown to be abnormal. Complex visual tasks (eg reading, driving, and navigating obstacles), integrate these eye movements and result in behavioral adaptations. The review concludes with a summary of the evidence and recommendations for future research in this emerging field.

Driving Performance of Experienced Young Adult Drivers with and without Autism Spectrum Disorder While Listening to Music on Two Scenarios: Hazards versus Wayfinding

This study explored the effect of music on the driving performance of experienced young adult drivers with and without autism spectrum disorder (ASD) using an interactive driving simulator with two types of scenarios. A 2 (Group: autism/neurotypical) × 2 (Music: music/no music) × 2 (Scenario: hazards/wayfinding) factorial design was used with the order of scenarios and music conditions counterbalanced. Participants were 34 neurotypical drivers and 5 drivers with ASD, all with at least 3 years of driving experience. Paired sample t-tests demonstrated no effect of music for any condition. Overall, the drivers with ASD had higher performance means than the neurotypical group with significant differences in the wayfinding scenario and the category for following regulations. Neurotypical drivers had better performance on the wayfinding scenario than the hazard scenario in maneuvers and being attentive to the environment. Although this study had a low number of drivers with ASD, it suggests drivers with ASD can perform better than neurotypical drivers, possibly because they follow road rule guidelines more consistently than neurotypical peers. In addition, this is the first study to examine wayfinding skills in teens/young adults with and without ASD.

Driving, work, wound care and rehabilitation after carpal tunnel release: Consensus recommendations from a UK Delphi study

Introduction

There is variability in the information available for patients after carpal tunnel release (CTR). We aimed to establish (i) what advice should be provided regarding return to driving after CTR; (ii) how work activities should be categorised and defined in relation to CTR, and when patients should be recommended to return to these activities; (iii) what wound care and rehabilitation advice should be provided after CTR.

Methods

We developed consensus recommendations from an expert panel of hand surgeons, primary care surgeons and hand therapists using an electronic Delphi process. Participants were recruited from clinical organisations using pre-defined criteria. Delphi questionnaires included open text and tick-box responses. Consensus was defined as ≥75% agreement and summary feedback was provided after each round.

Results

There were 33 panellists (21 surgeons and 12 hand therapists), of which 27 (82%) completed all rounds. Expected return to driving was agreed as 5-14 days. Expected timescales were also agreed for return to seven selected occupational activities. Post-operative advice focused on using and moving the hand, rather than specific rehabilitation. While consensus was reached for most items, there were important areas of disagreement, including divergent views on driving with sutures in situ and the need to inform car insurers.

Conclusion

Recommendations from this study expand on existing advice by including functional descriptors for occupational activities and guidance timescales generated through a formal consensus process. Areas where consensus was not reached warrant further exploration to assess whether different practices impact clinical and functional outcomes for patients.

A Deep Learning Approach to Classify Sitting and Sleep History from Raw Accelerometry Data during Simulated Driving

Prolonged sitting and inadequate sleep can impact driving performance. Therefore, objective knowledge of a driver's recent sitting and sleep history could help reduce safety risks. This study aimed to apply deep learning to raw accelerometry data collected during a simulated driving task to classify recent sitting and sleep history. Participants (n = 84, Mean ± SD age = 23.5 ± 4.8, 49% Female) completed a seven-day laboratory study. Raw accelerometry data were collected from a thigh-worn accelerometer during a 20-min simulated drive (8:10 h and 17:30 h each day). Two convolutional neural networks (CNNs; ResNet-18 and DixonNet) were trained to classify accelerometry data into four classes (sitting or breaking up sitting and 9-h or 5-h sleep). Accuracy was determined using five-fold cross-validation. ResNet-18 produced higher accuracy scores: 88.6 ± 1.3% for activity (compared to 77.2 ± 2.6% from DixonNet) and 88.6 ± 1.1% for sleep history (compared to 75.2 ± 2.6% from DixonNet). Class activation mapping revealed distinct patterns of movement and postural changes between classes. Findings demonstrate the suitability of CNNs in classifying sitting and sleep history using thigh-worn accelerometer data collected during a simulated drive. This approach has implications for the identification of drivers at risk of fatigue-related impairment.

Driving Simulator Brake Reaction Parameters After Total Hip Arthroplasty According to Different Surgical Approaches

BACKGROUND

The aim of this study is to validate the point of normalization of braking following total hip arthroplasty (THA) and to determine the relevance of the surgical approach.

METHODS

Brake reaction parameters (BRPs), including brake reaction time, total brake time, and brake pedal depression force were measured in 90 patients who underwent primary arthroplasty of the right hip (42 with direct anterior approach and 48 with posterolateral approach) using a modern driving simulator. The driving parameters were measured preoperatively and every 2 weeks postoperatively until the eighth week. BRPs were measured in 40 subjects without hip problems, and the results were used as a control. Statistical assessment was performed to analyze when the patients' reaction to braking recovered to that of the control group with respect to different surgical approaches and also according to the pain.

RESULTS

Preoperative BRPs of the patients undergoing THA were prolonged compared to the control group and were normalized at the sixth week following the operation. Although BRPs of the direct anterior approach group showed significantly better improvement compared to the posterolateral approach group (total brake time at week 2, brake reaction time and brake pedal depression at week 4), both groups reached baseline value at week 6. In addition, we found no correlation between the pain score and BRPs.

CONCLUSION

The results of the current study indicate that the response to braking events normalizes at 6 weeks following THA in young active patients and is irrelevant to the surgical approach.

Three-dimensional multiple object tracking improves young adult cognitive abilities associated with driving: evidence for transfer to the useful field of view

OBJECTIVES

3-dimensional multiple object tracking (3D-MOT) and the useful field of view (UFOV) both claim to measure and train cognitive abilities, such as selective and divided attention implicated in driving safety. 3D-MOT is claimed to improve even young adult cognitive ability. If true, one would expect to observe the transfer of 3D-MOT training to UFOV performance mediated by way of shared underlying cognitive mechanisms.

METHODS

We test this notion by assessing whether ten 30-min sessions of 3D-MOT training spread across 5 weeks improves UFOV performance relative to an active control group trained on a visual task and a challenging puzzle game (participants aged between 23 and 33 years old).

RESULTS

The 3D-MOT training group exhibited significantly improved UFOV performance whereas the active control group exhibited only a small, statistically nonsignificant improvement in the task.

CONCLUSIONS

This suggests that 3D-MOT and UFOV performance are likely dependent on overlapping cognitive abilities and helps support the assertion that these abilities can be trained and measured even in young adults. Such training could have implications for improving driver safety in both young and older adults.

Effect of variable priority training on police officer driving performance and workload

Motor vehicle crashes are a leading cause of police injuries and deaths in line of duty. These crashes have been mainly attributed to the use of in-vehicle technologies while driving. Police officers receive extensive training on driving skills; however, limited training is provided on the use of in-vehicle technologies. Variable priority training (VPT) is a computer-based training that has shown promising results in improving multi-tasking performance. Eighteen police officers participated in a driving simulation study to assess the effect of VPT on officers' performance and workload. Findings suggested that although VPT was effective in improving officers' performance in dual and multi-task simulations across the training sessions, this effect was not generally transferred to driving. However, the VPT might be effective for training of high-demand situations involving pursuit driving and multiple secondary tasks. The findings can be beneficial for police agencies to improve training protocols. Practitioner summary: A driving simulation study was conducted to assess the effect of a computer-based training approach on police officers' driving performance and cognitive workload. The findings suggested that the proposed training approach might be effective for training of high-demand situations involving pursuit driving and multi-tasking.

Having the conversation about vision for safe driving with older adults: an exploratory study of eyecare professional experiences in England and Australia

CLINICAL RELEVANCE

Eyecare professionals assess older adults against the vision requirements for driving and discuss this with them on a regular basis. Improved access to resources/training would be beneficial and help eyecare professionals navigate more difficult conversations about driving, e.g., following acute vision changes.

BACKGROUND

The numbers of drivers aged >65 years is increasing in many countries, in line with ageing populations. In most countries the onus is on the driver to self-monitor their vision for driving, by engaging in regular eye tests. Eyecare professionals therefore could play an important role in older driver decision-making about their fitness to drive. There is limited guidance for eyecare professionals regarding how to approach conversations with older drivers about their vision, and when these conversations should be had.

METHODS

Semi-structured interviews were undertaken with eyecare professionals involved in vision assessments and decision-making about medical fitness to drive for older adults (optometrists, orthoptists, ophthalmologists). Framework analysis identified challenges and facilitators to conversations with older drivers about vision.

RESULTS

Twenty-six eyecare professionals from Australia (n = 17) and England (n = 9) participated from urban and regional/rural areas. Themes were divided into facilitators (clear standards and comprehensive testing; positive approach; preparation and patient self-awareness; relationships and trust; importance of multiple options in guiding a transition to driving retirement) and challenges (acute loss of visual function; limited self-awareness of the impact of visual problems on driving; and perceived lack of resources and need for training).

CONCLUSIONS

Eyecare professionals prefer to have early and regular conversations with older adults about their vision for driving. Acute visual field/acuity loss or onset of double vision, necessitating rapid changes to driving behaviour, were both identified as major challenges for eyecare professionals. Improved access to resources and training would be beneficial, to help eyecare professionals navigate these especially difficult conversations and signpost older drivers to appropriate support.

The association between whole body vibration exposure and spine degeneration on imaging: A systematic review

BACKGROUND

Low frequency vibrations from motorized vehicles and heavy equipment have been associated with musculoskeletal disorders. Spine degeneration on diagnostic imaging provides direct and objective measures of the possible effects of such exposures on the spine.

OBJECTIVE

The objective of this systematic review was to evaluate the association of exposure to whole-body vibration (WBV) with spine degeneration on imaging.

METHODS

We conducted electronic searches in MEDLINE, CINAHL, EMBASE, and Web of Science to July 2021. Two reviewers independently screened search results, assessed quality, and extracted data. Studies evaluating the exposure to WBV and lumbar spine degeneration on imaging were included.

RESULTS

Fifteen studies (16 manuscripts) were included. Seven studies including a meta-demonstrated moderate quality evidence of no association between WBV and disc degeneration. There was also moderate quality evidence of no association between WBV and disc height narrowing and osteophytes. Overall, there was low level evidence of no association between WBV and other degenerations findings.

CONCLUSIONS

There was moderate to low quality evidence suggesting no association between WBV exposures with spine degeneration on imaging. The results of this study currently do not support assertion that motorized vehicle and WBV exposure accelerates degeneration and causes structural damage to the spine.

[Driving improvement in spinal cord injury patients using virtual reality. Systematic review]

INTRODUCTION

Spinal cord injury is a pathology which causes motor and sensory impairment under the region damaged by the lesion. This results in limitations in daily activities such as driving. In recent years, improvement in this task has been achieved by means of virtual reality treatment in the rehabilitation of patients with spinal cord injury. The aim of the present study was to analyze, through a systematic review, the effectiveness of using virtual reality on driving skills in patients with spinal cord injury.

MATERIALS AND METHODS

The literature search was carried out using the following databases: PubMed, Web of Science, PEDro, Cochrane Central Register of Controlled Trials, Medline, Scopus and CINAHL, including articles published from January 2000 to May 2021.

RESULTS

After the research process, out of a total of 51 articles, 7 were included: 2 applied immersive VR and 5 semi-immersive VR. Road driving simulation was addressed by 4 of them: 1 on sailing, 1 on motorbike and 1 on bicycle.

CONCLUSIONS

The use of virtual reality in driving skills training has led to improvements in quality of life, driving skills and reduction of fear of driving. Despite these findings, more research, patients, sessions and improvements are needed for a clearer understanding of this topic and its usefulness.

Correlations of Obstructive Sleep Apnea Syndrome and Daytime Sleepiness with the Risk of Car Accidents in Adult Working Population: A Systematic Review and Meta-Analysis with a Gender-Based Approach

Obstructive sleep apnea syndrome (OSAS) is an under-recognized clinical condition and is correlated with sleepiness and impaired cognitive function. Objectives: The primary aim of this systematic review, developed within the Sleep@OSA project, was to determine the correlations of obstructive sleep apnea syndrome, daytime sleepiness and sleep-disordered breathing with the risk of car accidents in adult working populations; a secondary aim was to analyze the epidemiologic data with a gender-based approach to identify differences between women and men in the data and in associated risk factors. Methods: Clinical trials and studies reporting data on the frequency of car accidents involving adult working population with daytime sleepiness and/or OSAS compared with a control group of participants were included. Literature searches of free text and MeSH terms were performed using PubMed, Google Scholar, the Cochrane Library and Scopus from 1952 to 3 May 2021. Results and Conclusions: The search strategy identified 2138 potential articles. Of these, 49 papers were included in the qualitative synthesis, and 30 were included in the meta-analysis. Compared with controls, the odds of car accidents were found to be more than double in subjects with OSAS (OR = 2.36; 95% CI 1.92−2.91; p < 0.001), with a similar risk between commercial motor vehicle drivers (OR = 2.80; 95% CI 1.82−4.31) and noncommercial motor vehicle drivers (OR = 2.32; 95% CI 1.84−2.34). No significant correlation was found between sleepiness and car crashes, but subjects with sleep-disordered breathing were at increased risk of car accidents (OR = 1.81; 95% CI 1.42−2.31; p < 0.001). To our surprise, although epidemiological studies on the risk of road accidents in the adult population with OSAS and daytime sleepiness are currently very abundant, specific data on the female population are not available.