Better Drive 2: Effect of computerised cognitive training and on-road skills training on driving safety in older adults

Arm 1: On-road skills training, involving driving lessons, tailored to the individuals own driving difficulties. This skills-based intervention will involve two, one-hour driver refresher training sessions within a three-week period, delivered by a qualified driving instructor. The driver-trained occupational therapist conducting all baseline on-road assessments will generate tailored written lesson plans for the driving instructor, and will train the instructor to administer the interventions. The trial blinding process requires that baseline and follow-up assessment will be undertaken by different driving instructors to those delivering driving skills instruction. Lesson plans will be tailored to include refresher material specific to the individual, to address those areas indicated in participant assessment as requiring improvement (i.e. the components contributing to the On-road Driver Safety Rating detailed below). Instruction will be enhanced through the use of the individualised video footage feedback gathered during baseline assessment and used to illustrate the participant’s specific skill deficits. The first training session will be conducted in a dual-brake vehicle, and the second will take place in the participant’s own vehicle. Sessions will include instructor-guided driving practice using routes near or within the participant’s usual driving environment, will employ the tailored training focussed on an individual’s identified skill deficits, and involve instructor-assisted adjustment of seat and mirrors (although will not include the use of complex vehicle modifications, such as after-market spinner knobs, because of the variation it would introduce to lessons). After the lessons, participants will be given written recommendations for practice of new skills and habits over the 12 week intervention, and a logbook for self-monitoring barriers and progress in practicing these skills in their everyday driving. At the close of the 12 week period, participants will complete a questionnaire on intervention acceptability, and participant motivation and satisfaction. Qualitative and quantitative questionnaire responses and participant log data will then be examined to allow an exploration of intervention implementation. Arm 2: Computerised cognitive training, consisting of computer-based speed of processing training (SOPT) and cognitive-motor reaction time training (CMRT) programs. This home-based computer training intervention is self-administered, with a required exposure of one to two hours per week over the 12 week intervention period. Prior to the intervention, a trained researcher will visit the participant’s home to install necessary computer software and peripherals, and instruct participants in accessing necessary websites, using project software, and safe home computer usage to minimise any risks associated with overuse. The trial coordinator will contact participants via phone on a weekly basis during the intervention phase, to provide support, to address any concerns or issues, and to encourage and monitor compliance. Participants will also log the number of hours spent and progress in training over the 12 weeks. At the close of the 12 week period, participants will complete a questionnaire on intervention acceptability, and participant motivation and satisfaction. Qualitative and quantitative questionnaire responses and participant log data will then be examined to allow an exploration of intervention implementation. The SOPT training will employ a proprietorial computer-based brain training program (Double Decision, from BrainHQ® by Posit Science) designed to improve field of view and visual processing speed, and based on the Useful Field of View (UFOV, Trademark) task. The task will be accessed via a 3-month subscription to the program, provided without cost to participants. In this task the participant must (1) identify a briefly presented and then masked central image of a schematic vehicle, and (2) note the position, from a possible eight peripheral locations, of a simultaneously (briefly) presented and then masked road sign. The software increases background complexity and reduces presentation duration over time, to adapt to participant improvement. The CMRT training utilises a choice reaction task in which a photo of an object (belonging to a particular class e.g. vehicles) is briefly presented onscreen, in one of four quadrants corresponding the left and right hands (button press) or left and right feet (pedal press). Participants must respond as rapidly as possible to one specific example of the object class (a target), but inhibit responses to examples of non-target objects in the class (i.e. distractors). Presentation duration will be reduced to adapt to participant improvement. The object class from which targets and distractors are drawn will vary over task progress to enhance any potential generalisability of effects, and will include a wide range of everyday objects (e.g., vehicles, road signs, fruit, animals, faces, buildings, etc.).