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Goel R, Tiwari G, Varghese M, Bhalla K, Agrawal G, Saini G, Jha A, John D, Saran A, White H, Mohan D. Effectiveness of road safety interventions: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1367. [PMID: 38188231 PMCID: PMC10765170 DOI: 10.1002/cl2.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Background Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge. Objectives The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels. Search Methods The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019. Selection Criteria The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes. Data Collection and Analysis The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2. Main Results The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality. Authors' Conclusions The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.
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Affiliation(s)
- Rahul Goel
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Geetam Tiwari
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Kavi Bhalla
- Department of Public Health SciencesUniversity of ChicagoChicagoIllinoisUSA
| | - Girish Agrawal
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Abhaya Jha
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Denny John
- Faculty of Life and Allied Health SciencesM S Ramaiah University of Applied Sciences, BangaloreKarnatakaIndia
| | | | | | - Dinesh Mohan
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
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Pan Y, Evans A, Benedetti MH, Zhu M. Mandatory Vision Test for Driver License Renewal in Association With Traffic Fatality and Injury Among Older Road Users in Utah. J Appl Gerontol 2024; 43:215-223. [PMID: 38064224 PMCID: PMC10840955 DOI: 10.1177/07334648231204789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Abstract
In 2011, Utah began requiring that drivers aged 65 years and older pass a vision test at each license renewal. This study aims to investigate if the mandatory vision test associated with motor vehicle fatality and injury rates in older road users. We fit controlled interrupted time series analysis models to compare fatality and injury rates for older adults (65+) affected by the law to younger adults (45-64) unaffected by the law. The models yielded estimates of differential level and slope changes in fatality and injury rates, which we used to estimate policy associations. We did not find evidence that implementing an accelerated vision test for older adults in Utah was associated with a reduction in injury or fatality rates among older (65+) drivers and non-drivers relative to those aged 45-64. Other strategies might be considered to prevent fatal motor vehicle crashes (MVCs) in older adults.
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Affiliation(s)
- Yuhan Pan
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Alexander Evans
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Marco H Benedetti
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Motao Zhu
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
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Ishii H, Okubo Y, Doi T, Tsutsumimoto K, Nakakubo S, Kurita S, Uemura K, Misu S, Sawa R, Hashiguchi Y, Shimada H, Arai H. Effect of driving training on car crashes and driving skills in older people: A systematic review and meta-analysis. Geriatr Gerontol Int 2023; 23:771-778. [PMID: 37828779 DOI: 10.1111/ggi.14702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/13/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023]
Abstract
The primary aim of this systematic review was to examine the efficacy of driving interventions with regard to a reduction in motor vehicle crashes and improvements in driving skills among older people. The secondary aim was to identify the optimal type (on-road or off-road) and dosage (period, sessions, and duration) of driving interventions for improving driving skills in older people. We searched MEDLINE, EMBASE, PsycINFO, and Scopus of Systematic Reviews for papers published from their inception to December 1, 2020, as well as the reference lists of the included papers. The selected studies were randomized controlled trials examining the effects of driving interventions among community-dwelling older drivers aged 65 years and over. A meta-analysis of two studies (n = 960) showed that driving interventions significantly reduced the number of motor vehicle crashes per person-years. Ten studies (n = 575) were included in the meta-analysis showing that the interventions significantly improved the driving skill scores. Driving skill scores significantly improved after on-road training, and in interventions of at least 3 h, 3 sessions, and 3 weeks. Driving interventions significantly improve driving skills and reduce motor vehicle crashes among older drivers aged 65 years and over. On-road training is more efficacious than off-road training and driving interventions of at least 3 h taking place in 3 sessions over a period of 3 weeks may be required to improve driving skills in older drivers. Geriatr Gerontol Int 2023; 23: 771-778.
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Affiliation(s)
- Hideaki Ishii
- Department of Physical Therapy, School of Health Sciences at Narita, International University of Health and Welfare, Narita City, Japan
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu City, Japan
| | - Yoshiro Okubo
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Takehiko Doi
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu City, Japan
| | - Kota Tsutsumimoto
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu City, Japan
| | - Sho Nakakubo
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu City, Japan
| | - Satoshi Kurita
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu City, Japan
| | - Kazuki Uemura
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu City, Japan
- Graduate School of Rehabilitation Science, Osaka Metropolitan University, Habikino City, Japan
| | - Shogo Misu
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu City, Japan
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
| | - Ryuichi Sawa
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu City, Japan
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Yu Hashiguchi
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu City, Japan
- Department of Physical Therapy, Faculty of Rehabilitation, Gunma Paz University, Takasaki-shi, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu City, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu City, Japan
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Seol J, Lim N, Nagata K, Okura T. Effects of home-based manual dexterity training on cognitive function among older adults: a randomized controlled trial. Eur Rev Aging Phys Act 2023; 20:9. [PMID: 37087432 PMCID: PMC10121426 DOI: 10.1186/s11556-023-00319-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/06/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND The relationship between manual dexterity and cognitive function among older adults is well known; however, few studies have focused on manual dexterity training that confirms cognitive load of training in older adults through functional near-infrared spectroscopy (fNIRS) and verifies the effect of training. This study examined the effects of home-based manual dexterity training on cognitive function in older adults using a digital trail-making peg test device combining two conventional assessment tools namely, the peg and trail-making tests. METHODS For 12 weeks, 57 healthy older adults aged 65-88 years participated in a parallel-group, randomized controlled trial, wherein home-based manual dexterity training was performed for approximately 20 min daily. To quantify the cognitive load in different manual dexterity conditions, we assessed the cortical activation patterns of the prefrontal cortex via a wearable four-channel fNIRS device. Participants in the control group were asked to continue their usual daily routines during the intervention period. Cognitive function was assessed using the Stroop Color and Word and Cognitive Impairment Tests. Manual dexterity was assessed using the Purdue Pegboard Test. All outcomes were estimated before and after the intervention. RESULTS We observed significant differences in prefrontal cortical activation between the different manual dexterity conditions. Only the intervention group showed a significant improvement in Stroop interference (169.0-108.9 ms, p = 0.032) and an executive function and assembly task of the Purdue Pegboard Test (22.5-26.4 counts, p < 0.001). Additionally, except the clock drawing task, cognitive function had a larger effect size (Cohen's d) in the intervention group (d = 0.26-0.45) than in the control group (d = 0.11-0.28). CONCLUSIONS Home-based manual dexterity training can improve performance in a complex manual dexterity task and executive functioning in older adults. TRIAL REGISTRATION UMIN-CTR Clinical Trial, UMIN000047203. Registered 17 March 2022 - Retrospectively registered, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000053844&type=summary&language=E.
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Affiliation(s)
- Jaehoon Seol
- Research Center for Overwork-Related Disorders, National Institute of Occupational Safety and Health, Japan (JNIOSH), Kawasaki, Japan.
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan.
- R&D Center for Tailor-Made QOL, University of Tsukuba, 1-2 Kasuga, Tsukuba, Ibaraki, 305-8550, Japan.
| | - Namhoon Lim
- Doctoral Program in Physical Education, Health and Sports Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Koki Nagata
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Tomohiro Okura
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
- R&D Center for Tailor-Made QOL, University of Tsukuba, 1-2 Kasuga, Tsukuba, Ibaraki, 305-8550, Japan
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
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Yamamoto Y, Yamagata B, Hirano J, Ueda R, Yoshitake H, Negishi K, Yamagishi M, Kimura M, Kamiya K, Shino M, Mimura M. Regional Gray Matter Volume Identifies High Risk of Unsafe Driving in Healthy Older People. Front Aging Neurosci 2020; 12:592979. [PMID: 33343333 PMCID: PMC7744700 DOI: 10.3389/fnagi.2020.592979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/09/2020] [Indexed: 12/02/2022] Open
Abstract
In developed countries, the number of traffic accidents caused by older drivers is increasing. Approximately half of the older drivers who cause fatal accidents are cognitively normal. Thus, it is important to identify older drivers who are cognitively normal but at high risk of causing fatal traffic accidents. However, no standardized method for assessing the driving ability of older drivers has been established. We aimed to establish an objective assessment of driving ability and to clarify the neural basis of unsafe driving in healthy older people. We enrolled 32 healthy older individuals aged over 65 years and classified unsafe drivers using an on-road driving test. We then utilized a machine learning approach to distinguish unsafe drivers from safe drivers based on clinical features and gray matter volume data. Twenty-one participants were classified as safe drivers and 11 participants as unsafe drivers. A linear support vector machine classifier successfully distinguished unsafe drivers from safe drivers with 87.5% accuracy (sensitivity of 63.6% and specificity of 100%). Five parameters (age and gray matter volume in four cortical regions, including the left superior part of the precentral sulcus, the left sulcus intermedius primus [of Jensen], the right orbital part of the inferior frontal gyrus, and the right superior frontal sulcus), were consistently selected as features for the final classification model. Our findings indicate that the cortical regions implicated in voluntary orienting of attention, decision making, and working memory may constitute the essential neural basis of driving behavior.
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Affiliation(s)
- Yasuharu Yamamoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Bun Yamagata
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Jinichi Hirano
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Ueda
- Office of Radiation Technology, Keio University Hospital, Tokyo, Japan
| | - Hiroshi Yoshitake
- Department of Human and Engineered Environmental Studies, The University of Tokyo, Tokyo, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Mika Yamagishi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Mariko Kimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Graduate School of Psychology, Rissho University, Tokyo, Japan
| | - Kei Kamiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Motoki Shino
- Department of Human and Engineered Environmental Studies, The University of Tokyo, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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Ichikawa M, Inada H, Nakahara S. Increased traffic injuries among older unprotected road users following the introduction of an age-based cognitive test to the driver's license renewal procedure in Japan. ACCIDENT; ANALYSIS AND PREVENTION 2020; 136:105440. [PMID: 31962239 DOI: 10.1016/j.aap.2020.105440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND To deal with the increasing number of motor vehicle collisions (MVCs) among older drivers, a cognitive test has been introduced to a license renewal procedure for drivers aged ≥75 years since June 2009. This might have prompted the reduction or cessation of driving by older drivers. We therefore examined whether older drivers' chance of experiencing MVCs as unprotected road users has increased after the test was introduced. METHODS Using police-reported national data on MVCs from January 2005 through December 2016, we calculated the monthly injury rates (including deaths, severe injuries, and minor injuries) among unprotected road users (bicyclists and pedestrians) by sex and age group (70-74, 75-79, 80-84, and ≥85 years). The ratios of the injury rates of unprotected road users in the three oldest age groups (who were subjected to the test) to those aged 70-74 years (not subjected to the test) were also calculated. Then, we conducted an interrupted time-series analysis based on the injury rate ratios to control for extraneous factors affecting MVCs over the study period. RESULTS There was a significant increase in traffic injuries of unprotected road users at the time the test was introduced among females aged 75-84 years, and at a later time among males aged ≥80 years and females aged ≥85 years. CONCLUSION Licensing policies for older drivers should be rigorously evaluated, taking into account the safety of older unprotected road users, and should be balanced against it.
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Affiliation(s)
- Masao Ichikawa
- Department of Global Public Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Haruhiko Inada
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Shinji Nakahara
- Graduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki, Kanagawa, Japan
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