Predictors of Return to Driving in Patients With Acquired Brain Injury: A Systematic Review With Meta-Analysis.
Sujin Hwang, Chiang-Soon Song
PMID 42265885WHAT IT FOUND
Simulator and VR driving training reduced driving errors and improved the odds of passing an on-road test in people recovering from brain injury.
Those with more severe initial injuries were less likely to return to driving.
Key findings
01Simulator and VR-based driving training reduced driving errors compared with control conditions across three RCTs (62 participants), with a large pooled effect (SMD = −1.19, 95% CI: −1.75 to −0.64, p < 0.0001) and no heterogeneity (I² = 0%).
02In a single RCT, driving remediation increased the odds of passing the on-road driving test compared with usual care (OR = 3.37, 95% CI: 1.36–8.35, p = 0.009).
03Higher Glasgow Coma Scale scores (indicating less severe initial injury) were associated with return to driving across four observational studies (633 participants; MD = 1.90, 95% CI: 1.05–2.76, p < 0.0001).
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Only four RCTs were available, with 83 participants in total (individual study samples ranged from 11 to 35), so the pooled estimates rest on very small numbers. All four RCTs had high risk of performance bias because participants and therapists could not be blinded to the driving training they received. The on-road test result comes from a single RCT, so it cannot be pooled and is vulnerable to small-study effects. Outcome measures and definitions varied considerably across studies (driving performance, self-efficacy, cognitive function, return-to-driving status), limiting direct comparability. Only English-language studies were included, which may exclude relevant evidence. Publication bias and small-study effects could not be fully assessed given the small number of studies. The observational studies are cross-sectional or retrospective, so the GCS–driving association cannot be read as causal.
Declared interests
Funded by Chosun University (2024). The authors declare no conflict of interest.
The easy way to misread this
Do not read the 3.4-fold increase in passing the on-road test as settled evidence that driving remediation works. It comes from a single RCT with 35 participants, and all four RCTs in this review had high risk of performance bias because participants could not be blinded to the driving training they received. The driving-errors result, while larger in effect, is also based on only three RCTs totalling 62 participants.