The impact of chronic pain on driving behaviour: a systematic review

The development and validation of a Japanese hazard perception task

OBJECTIVES

This study aimed to validate the hazard perception task developed for Japanese drivers with brain damage.

METHODS

A total of 36 professional driving instructors, 67 older adult drivers, 39 young drivers, and 72 patients with brain damage participated in the study. A video-based hazard perception task measured the hazard perception skills of each group. Participants were instructed to touch the screen as soon as they identified a hazard. Outcome measures included the number of hazards identified and response latency. Comparisons were made between groups for each hazard type: environmental prediction hazard (EPH) and behavioral prediction hazard (BPH).

RESULTS

Patients with brain damage demonstrated fewer hazard detections and longer response latencies than driving instructors and older adult drivers, regardless of the hazard type. The hazard perception skills of patients with brain damage were comparable to those of young drivers across both hazard types. Driving instructors exhibited the highest number of hazard detections and the fastest response latencies among all groups, with differences being more pronounced for EPH than for BPH.

CONCLUSIONS

Thus, the validity of the hazard perception task developed for Japanese drivers with brain damage was confirmed. Future research should examine the predictive validity of the developed task, particularly its relationship with crash rates in individuals with brain damage.

Presenteeism and Traffic Accident Among Taxi Drivers: A Prospective Cohort Study in Japan

Background

Traffic accidents involving professional drivers have serious societal repercussions. Unique occupational stressors and health risks exacerbate the likelihood of traffic accidents among professional drivers. This study explores the association between presenteeism-impaired work performance due to working while unwell-and traffic accident risk among professional taxi drivers in Japan.

Methods

A prospective cohort study was conducted from June 2022 to February 2023, involving taxi drivers from a single company in Fukuoka Prefecture, Japan. Presenteeism was assessed using the Work Functioning Impairment Scale (WFun). Primary outcome involved the number of self-reported minor traffic accidents. The incidence rate ratio (IRR) of minor traffic accident occurrences was estimated using a Poisson regression analysis, adjusted for confounders including sex, age, and driving experience.

Results

Of 838 targeted drivers, 435 were included in the analysis. Higher baseline work functioning impairment was associated with a significant trend of increasing IRR of minor traffic accidents (p for trend = 0.045). A dose-response relationship was seen between the degree of presenteeism and incidence rate of minor traffic accidents.

Conclusion

Higher levels of presenteeism were associated with an increased risk of traffic accidents among taxi drivers. The findings underscore the need for socio-economic support and prioritized health management to mitigate traffic accident risk among professional drivers. This study highlights the importance of managing non-critical health issues alongside serious health conditions for safer driving practices among professional drivers in Japan.

Measurement invariance of the driving inattention scale (ARDES) across 7 countries

The Attention-Related Driving Errors Scale (ARDES) is a self-report measure of individual differences in driving inattention. ARDES was originally developed in Spanish (Argentina), and later adapted to other countries and languages. Evidence supporting the reliability and validity of ARDES scores has been obtained in various different countries. However, no study has been conducted to specifically examine the measurement invariance of ARDES measures across countries, thus limiting their comparability. Can different language versions of ARDES provide comparable measures across countries with different traffic regulations and cultural norms? To what extent might cultural differences prevent researchers from making valid inferences based on ARDES measures? Using Alignment Analysis, the present study assessed the approximate invariance of ARDES measures in seven countries: Argentina (n = 603), Australia (n = 378), Brazil (n = 220), China (n = 308). Spain (n = 310), UK (n = 298), and USA (n = 278). The three-factor structure of ARDES scores (differentiating driving errors occurring at Navigation, Manoeuvring and Control levels) was used as the target theoretical model. A fixed alignment analysis was conducted to examine approximate measurement invariance. 12.3 % of the intercepts and 0.8 % of the item-factor loadings were identified as non-invariant, averaging 8.6 % of non-invariance. Despite substantial differences among the countries, sample recruitment or representativeness, study results support resorting to ARDES measures to make comparisons across the country samples. Thus, the range of cultures, laws and collision risk across these 7 countries provides a demanding assessment for a cultural-free inattention while-driving. The alignment analysis results suggest that ARDES measures reach near equivalence among the countries in the study. We hope this study will serve as a basis for future cross-cultural research on driving inattention using ARDES.

Exploring chronic pain related attentional experiences, distress and coping strategies among Arabic-speaking individuals in Jordan and the United Kingdom

Introduction

The lived experiences of chronic pain (CP) among Arabic-speaking populations remain underexplored. A better understanding of these experiences and their associations with attention difficulties, coping mechanisms, and treatment options could lead to improved support for this group.

Methods

This qualitative study utilised a descriptive design and involved one-to-one interviews with 51 participants with CP who had just completed two attention tasks. Interviews were conducted using a semi-structured topic guide, transcribed verbatim and translated from Arabic to English before agreeing on the coding framework. Themes and subthemes were extracted using a framework analysis approach.

Results

The study identified six main themes: Factors contributing towards developing or exacerbating CP, the impact of CP on psychosocial functions, including attention, the perceived role of social support, coping strategies for managing CP, perceptions about available treatments and recommendations for interventions.

Discussion

CP significantly impacts individuals' physical and psychosocial functions, and it is reciprocally associated with attentional difficulties. Despite using various approaches to manage their CP, none of the participants used psychological interventions or counselling. Understanding the diverse impacts of CP and the coping strategies employed to develop culturally sensitive interventions, review current related policies, and improve healthcare services is crucial to managing CP among this population.

Sharing roads with automated vehicles: A questionnaire investigation from drivers', cyclists' and pedestrians' perspectives

Despite the promised benefits, the introduction of Automated Vehicles (AVs) on roads will be confronted by many challenges, including public readiness to use those vehicles and share the roads with them. The risk profile of road users is a key determinant of their safety on roads. However, the relation of such risk profiles to road users' perception of AVs is less known. This study aims to address the above research gap by conducting a cross-sectional survey to investigate the acceptance of Fully Automated Vehicles (FAVs) among different non-AV-user groups (i.e., pedestrians, cyclists, and conventional vehicle drivers). A total of 1205 road users in Queensland (Australia) took part in the study, comprising 456 pedestrians, 339 cyclists, and 410 drivers. The Theory of Planned Behaviour (TPB) is used as the theoretical model to examine road users' intention towards sharing roads with FAVs. The risk profile of the participants derives from established behavioural scales and individual characteristics are also included in the acceptance model. The study results show that pedestrians reported lowest intention in terms of sharing roads with FAVs among the three groups. Drivers and cyclists in a lower risk profile group were more likely to report higher intention to share roads with FAVs than those in a higher risk profile group. As age increased, pedestrians were less likely to accept sharing roads with FAVs. Drivers who had more exposure time on roads were more likely to accept sharing roads with FAVs. Male drivers reported higher intention towards sharing roads than female drivers. Overall, the study provides new insights into public perceptions of FAVs, specifically from the non-AV-user perspective. It sheds light on the obstacles that future AVs may encounter and the types of road users that AV manufacturers and policymakers should consider closely. Specifically, groups such as older pedestrians and road users who engage in more risky behaviours might resist or delay the integration of AVs.

Association between prescribed opioid dose and risk of motor vehicle crashes

ABSTRACT

Opioid-involved motor vehicle traffic fatalities have increased over the past 2 decades. However, the extent to which prescribed opioids increase the risk of motor vehicle crashes remains uncertain. This study used real-world healthcare claims data to examine the association between prescription opioid dose and motor vehicle crash risk. Using nationwide US commercial insurance claims data for 2010 to 2018, we identified 772,404 adults who received incident, noncancer opioid therapy. We examined associations between daily prescription opioid dose, calculated in morphine milligram equivalents (MME) from filled prescription claims, and risk of motor vehicle crashes, assessed as diagnoses of motor vehicle injuries in claims for emergency visits, inpatient hospitalizations, and ambulance transportation. We estimated associations using a within-individual design, which ruled out all time-stable confounding. We complemented the design with time-varying statistical adjustment for other pharmacotherapies and a negative control pain pharmacotherapy analysis (with incident cyclic antidepressant prescriptions). During 2,150,009 person-years of follow-up, there were 12,123 motor vehicle crashes (5.64 crashes per 1000 person-years). In within-individual comparisons, crash risk was greater during opioid prescription periods involving doses ≤60 MME/day (odds ratio [OR], 3.86; 95% confidence interval [CI], 3.54, 4.21), >60 to 120 MME/day (OR, 5.46; 95% CI, 4.44, 6.73), and >120 MME/day (OR, 3.45; 95% CI, 2.31, 5.15) than during off-treatment periods. The negative control analysis supported the specificity of the results to opioids rather than to other processes associated with pharmacologic pain management. These findings suggest that the receipt of prescription opioids, even at doses ≤60 MME/day, is associated with an increased risk of motor vehicle crashes.

Is distraction on the road associated with maladaptive mobile phone use? A systematic review

Maladaptive Mobile Phone Use (MMPU) (also known as Smartphone Addiction, Nomophobia, Fear of Missing Out, or Problematic Mobile Phone Use) is a growing mental health problem. However, the health and safety consequences of MMPU remain unexplored in many real-life contexts. A potential setting where MMPU may have some negative repercussions is on the road. It is well established that road users (e.g., drivers, motorcyclists, pedestrians, and cyclists) increasingly injure themselves or others due to distractions such as phone use while on the road. Emerging research suggests that MMPU is a possible determinant of this risky behaviour. Therefore, it is essential to investigate the relationship between MMPU and mobile phone use behaviour on the road, as it could help guide and improve interventions aimed at increasing road safety. This systematic review investigated the relationship between maladaptive mobile phone use and mobile phone use behaviour on the road in terms of attitudes and risk perception, intention, phone use engagement, performance changes, and safety outcomes. A total of 44 studies were identified with 47 unique samples of road users, of which 68.1% (32/47) were comprised of drivers, 19.1% (9/47) were pedestrians, 8.5% (4/47) were unspecified road users, and there was one group of motorcyclists and cyclists. Our findings confirmed that MMPU is related to risky behaviour on the roads. In the 29 studies considering observed or self-reported behaviour, 90.9% (30/33) found that road users who scored higher in MMPU are more likely to use their phones on the road as cyclists, drivers, motorcyclists, and pedestrians. Of the nine studies that analysed performance changes, 55.6% (5/9) showed evidence that MMPU changes the performance of road users engaging in mobile phone use, meaning that there is evidence suggesting that MMPU determines the level of impairment. Of the nine studies that analysed the safety-related-outcomes, 66.7% (6/9) found that the higher the MMPU score, the more likely road users are to experience safety-critical traffic events. This review contributes to the literature by showing a pathway between the negative health consequences of MMPU and road trauma. We also identified that the quality of the studies was generally low due to study design and blinding aspects. This field of research also lacks standard practices as researchers avoid using established and well-validated questionnaires, often creating new ones to measure MMPU. This hinders the generalisability of the findings and raises questions about the construct validity and external validity of MMPU. The usefulness of future research would be enhanced by a consistent methodological approach using the same scales based on standard behavioural definitions. The cross-disciplinary nature of MMPU effects means that transport and road safety professionals need to work with healthcare professionals and technology organisations to understand and address MMPU as a contributing factor to road crashes.

How distracting is chronic pain? The impact of chronic pain on driving behaviour and hazard perception

In road safety research, few studies have examined driving behaviour in chronic pain cohorts. The aim of this study was to investigate driving behaviour among drivers experiencing chronic pain. We compared individuals with chronic pain with age-gender matched healthy controls. Participants completed: (i) an anonymous online survey that included participant demographics, transport characteristics, self-reported driving behaviour, and pain characteristics (ii) a response-time hazard perception test and a verbal-response hazard prediction test for drivers, and (iii) a driving diary in which participants recorded their driving over two weeks. The results showed that participants with chronic pain were not significantly worse than controls for hazard perception and prediction test scores, self-reported attention-related errors, driving errors, driving violations, and involuntary distraction. Drivers with chronic pain did report significantly more driving lapses but this effect became non-significant when variables confounded with chronic pain, such as fatigue, were adjusted for. We also found that participants who reported particularly high levels of chronic pain performed worse in the hazard prediction test compared to the control group (and this effect could not be accounted for by other variables associated with chronic pain). In addition, participants with chronic pain reported significantly higher driving workload (mental demand, physical demand, effort, and frustration) compared with controls. The findings of this study provide new insights into driving behaviour in individuals with chronic pain and recommendations for future research in terms of driving assessment and self-regulation strategies are provided.

Kognition und Kraftfahreignung bei chronischem Schmerzsyndrom

Kognitive Auffälligkeiten bei Patienten mit chronischen Schmerzen finden in wissenschaftlichen Untersuchungen zunehmend Beachtung. Die Folgen dieser kognitiven Störungen in Bezug auf die Schmerzbewältigung, die Alltagsgestaltung und die Kraftfahreignung werden in der klinischen Praxis jedoch kaum berücksichtigt, obwohl die Hälfte aller Patienten davon betroffen ist. Die vorliegende Arbeit fasst die aktuelle Studienlage zusammen und diskutiert Möglichkeiten der Integration in die klinische und therapeutische Versorgung.

Exploring driving behaviour from the perspectives of individuals with chronic pain and health professionals

Chronic pain affects one in five Australians, and this could impact daily activities such as driving. Driving is a complex task, which requires the cognitive and physical ability to predict, identify, and respond to hazards to avoid crashing. However, research exploring the factors that influence safe driving behaviour for chronic pain individuals is limited. A qualitative study was conducted which involved semi-structured interviews with 23 people who had experienced persistent pain for at least three months and 17 health professionals who had experience working with individuals with chronic pain. The aim of this study was to obtain a deeper understanding of the experiences and challenges that people with chronic pain may have in their day-to-day driving. Participants were also asked about currently available driving assessments and strategies for individuals with chronic pain in the Australian healthcare system. The themes emerging from the interviews highlighted the need for clearer guidelines and educational materials regarding the impact of chronic pain on an individual's ability to drive. These themes included the physical and cognitive challenges resulting from chronic pain, as well as the potential side effects of pain medications. In addition, participants identified a number of self-regulation strategies and driving assessments currently available for monitoring safe driving behaviour in Australia. This study improves our understanding of how chronic pain affects driving behaviour, as reported by individuals experiencing the pain and relevant health professionals. Recommendations for improving the safety of drivers with chronic pain are discussed, including possible technological interventions and better public education.

Understanding sexual activity while driving as a form of distracted driving

Sexual activity while driving has been reported in emerging research. Sexual activity while driving is a form of distracted driving because it includes an individual (the driver) who deviates resources from the primary task (driving) towards a secondary task (sexual activity). However, most of our current knowledge about the range of sexual activities while driving is based on self-reported data or media reports. Thus, an in-depth understanding of sexual activities while driving and their interactions with non-sexual driving behaviours and vehicle control is missing. Additionally, there is limited information on the context of where sexual activities while driving occurs and the influence of factors such as the environment, the vehicle, interactions with other road users, and other in-vehicle distractions. To cover this gap, a content analysis of sexually explicit media (SEM) was conducted on a sample of 270 videos depicting real driving. We conducted descriptive analyses and used decision tree analysis to explore the association between sexual activities while driving and their interactions with non-sexual driving behaviours and vehicle control. The videos portrayed a naturalistic driving situation of a driver of a moving vehicle engaging in sexual activity. The results show that when engaging in sexual activity, drivers do not present safe vehicle control. Sexual activity imposes additional cognitive, physical, and visual demands on the driver, thereby decreasing safety. Similar to other distractions, drivers engaging in sexual activity while driving appear to mitigate risks. Concerning the potential for legal sanctions, it appears that drivers may attempt to conceal sexual activity by reducing their visible nudity and minimising interactions with other road users. Finally, mobile phones and cameras appear to interact with sexual activities while driving, by imposing potential restrictions on the range of sexual activities. Implications for policymakers and practitioners are discussed.