Research Papers

Evidence Based Review of Predictors of Driving Performance and Resumption of Driving in Persons with Traumatic Brain Injury

Version 1
Date added June 30, 2016
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Category 2016 CARSP XXVI Halifax
Tags Research and Evaluation, Session 3B
Author/Auteur Alexander Crizzle
Stream/Volet Research and Evaluation

Slidedeck Presentation Only (no paper submitted)

3B - Crizzle 


Background/Context: Driving requires the coordination of multiple systems (e.g. vision, motor and cognitive) which are impaired in persons with mild to severe traumatic brain injuries (TBI). Given the importance of driving in remaining independent and socially engaged, determining the best predictors for returning to drive following a TBI is important for health care professionals, families, and the driver. Determining the most critical factors for resumption of driving may lead to the development of tailored interventions in this driver population.

Aims/Objectives: The purpose of this study was to conduct an evidence-based review to assess predictors of fitness-to-drive and return to driving in persons with traumatic brain injury (TBI), to identify gaps and provide recommendations for future research.

Methods/Target Group: Relevant databases such as MEDLINE/PubMed, CINAHL, Cochrane Library, and SCOPUS were searched for primary articles published between January 2000 and September 2015. Articles were identified using MeSH search terms (in English only): traumatic brain injury, automobile driving, accidents, motor vehicle, screening. All retrieved abstracts were reviewed (n=1652), and full-texts printed if deemed relevant. Two independent reviewers extracted data from each article, with any differences resolved by collaborative discussion. The American Academy of Neurology’s classification criteria was used to provide evidence-based ratings and recommendations from the 19 primary studies that met the inclusion criteria. We rated the studies by class (1-IV), with I being the highest level of evidence. The studies were grouped into categories of driving assessment (on-road assessment, driving simulation, and self (and other report).

Results/Activities: Articles were classified according to TBI severity, as well as types of assessments (on-road, simulator, self-report, surveys, crash records). There were no Class I and only two Class II studies, 14 Class III and 3 Class IV studies. Only the following tests are potentially useful for predicting on-road performance in persons with TBI: Level B: Trail Making Test B. Level C: Spatial Reaction Time and Functional Independence Measure. There is limited evidence concerning predictors of driving resumption.

Discussion/Deliverables: The findings suggest limited evidence is available that predicts on-road driving performance in persons with TBI. Furthermore, 60-80% of all cases are persons with mild TBI, who often have deficits that go unrecognized and untested, yet pose a significant danger to road safety. Identifying how to best identify those with mild TBI is critical to ensuring road safety despite the limited number of studies available.

Conclusions: Class I studies reporting Level A recommendations for definitive predictors of driving performance in drivers with TBI are needed by policy makers and clinicians to develop evidence-based guidelines, both for identifying predictors of driving performance, as well as driving resumption.

Alexander Crizzle