Predictors of Return to Driving in Patients With Acquired Brain Injury: A Systematic Review With Meta-Analysis

This review aimed to comprehensively synthesise evidence on the therapeutic efficacy of driving rehabilitation for patients with acquired brain injury (ABI) and identify and analyse key predictors of successful return-to-driving.

A comprehensive literature search was conducted using four databases: PubMed, Embase, Web of Science and ProQuest. Eleven studies (four randomised controlled trials and seven cross-sectional studies) were included in the final analysis. Reporting completeness and methodological quality were assessed using PRISMA checklists. A random-effects model was used to calculate the standardised mean differences (SMDs) and odds ratios (ORs).

A qualitative analysis of cross-sectional studies identified cognitive processing speed, reaction time and functional independence as frequently reported predictors of returning to driving, with a pooled meta-analysis further highlighting lower initial injury severity (higher GCS scores) as a significant predictor of returning to driving. The meta-analysis revealed that simulator- and VR-based training significantly reduced driving errors (SMD = -1.19, 95% confidence interval [CI]: -1.75 to -0.64; p < 0.0001). The intervention significantly increased the likelihood of passing the on-road driving test by approximately 3.37 times (OR = 3.37, 95% CI: 1.36-8.35).

The results of this review suggest that simulator-based interventions may positively impact driving performance and current cognitive and functional activities, as well as psychological self-efficacy, and facilitat a successful return to driving in patients with ABI. These findings provide a baseline for developing clinical guidelines for the safe resumption of driving.