Introduction-Dizziness is considered one of the most common symptoms in general medical practice. Patients can suffer from a wide range of symptoms that are highly relevant while driving and may affect driving ability. In most countries driving restrictions have been suggested for patients with dizziness or a vestibular disorder. However, these restrictions are not always evidence-based and differ significantly between European countries.Objective-The aim of this systematic review was to identify and evaluate studies dealing with driving performance of dizzy patients or patients with a vestibular disorder. Methods-A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. (1) Data sources: PubMed and the reference list of the included articles. (2) Study selection: articles about driving ability and reported driving difficulties in patients with dizziness, or a diagnosed vestibular disorder, were included.(3) Data extraction was performed by two independent authors using predefined data fields: patient's characteristics, diagnostic criteria, sample size, type of evaluation of driving ability and outcome of the study. The protocol (ID 178086) is available online at PROSPERO. Results-Eight out of 705 articles matched the inclusion criteria but varied widely regarding thestudy population, study design and outcome measures. The majority of studies reported a negative impact of dizziness and/or vestibular disorders on self-reported driving ability and car accidents. Yet several studies could not identify any impairment of driving ability.Conclusions Driving ability was negatively affected by dizziness or a vestibular disorder in the majority of included studies with low risk of bias. This systematic review revealed a significant heterogeneity in reporting driving performance and contradictory results. We were therefore unable to identify a causal relationship between dizziness and driving ability. There is a need for prospective studies in populations with different vestibular disorders using subjective and objective outcome measures that have been validated to evaluate driving performance.

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