University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska.
University of Nebraska Medical Center, Omaha.
Arthritis Care Res (Hoboken). 2023 Feb;75(2):252-259. doi: 10.1002/acr.24769. Epub 2022 Sep 23.
To quantify vehicle control as a metric of automobile driving performance in patients with rheumatoid arthritis (RA).
Naturalistic driving assessments were completed in patients with active RA and controls without disease. Data were collected using in-car, sensor-based instrumentation installed in the participants' own vehicles to observe typical driving habits. RA disease status, disease activity, and functional status were associated with vehicle control (lateral [steering] and longitudinal [braking/accelerating] acceleration variability) using mixed-effect linear regression models stratified by road type (defined by roadway speed limit).
Across 1,292 driving hours, RA drivers (n = 33) demonstrated differences in vehicle control compared to controls (n = 23), with evidence of significant statistical interaction between disease status and road type (P < 0.001). On residential roads, participants with RA demonstrated overall lower braking/accelerating variability than controls (P ≤ 0.004) and, when disease activity was low, lower steering variability (P = 0.03). On interstates/highways, RA was associated with increased steering variability among those with moderate/high Clinical Disease Activity Index scores (P = 0.04). In models limited to RA, increases in disease activity and physical disability over 12 weeks of observation were associated with a significant increase in braking/accelerating variability on interstate/highways (both P < 0.05).
Using novel naturalistic assessments, we linked RA and worsening RA disease severity with aberrant vehicle control. These findings support the need for further research to map these observed patterns in vehicle control to metrics of driver risk and, in turn, to link patterns of real-world driving behavior to diagnosis and disease activity.
量化车辆控制作为评估类风湿关节炎（RA）患者驾驶表现的指标。
对处于活动期的 RA 患者和无疾病的对照组进行自然驾驶评估。使用车内基于传感器的仪器收集数据，这些仪器安装在参与者自己的车辆中，以观察典型的驾驶习惯。使用混合效应线性回归模型，根据道路类型（通过道路限速定义）对 RA 疾病状态、疾病活动度和功能状态与车辆控制（横向[转向]和纵向[制动/加速]加速度变异性）进行关联。
在 1292 个驾驶小时内，RA 驾驶员（n=33）与对照组驾驶员（n=23）相比，在车辆控制方面存在差异，疾病状态与道路类型之间存在显著的统计学交互作用（P<0.001）。在住宅区道路上，RA 患者的制动/加速变异性总体低于对照组（P≤0.004），且在疾病活动度较低时，转向变异性也较低（P=0.03）。在州际公路/高速公路上，RA 与中度/高度临床疾病活动指数评分患者的转向变异性增加有关（P=0.04）。在仅包括 RA 患者的模型中，在 12 周的观察期间，疾病活动度和身体残疾的增加与州际公路/高速公路上制动/加速变异性的显著增加相关（均 P<0.05）。
使用新的自然驾驶评估方法，我们将 RA 和 RA 疾病严重程度的恶化与异常的车辆控制联系起来。这些发现支持进一步研究的必要性，以便将这些观察到的车辆控制模式与驾驶员风险指标相映射，并将真实世界的驾驶行为模式与诊断和疾病活动相联系。
