Evaluating the effectiveness of on‐road driving remediation following acquired brain injury: A wait‐list feasibility study with follow‐up

Abstract

Introduction Return to driving is an important goal for people recovering from acquired brain injury. Occupational therapy driving assessments aim to determine the impact of acquired brain injury on a person’s capacity to drive and may include on‐road driving rehabilitation. The primary objective of this project was to conduct a feasibility randomised controlled trial (RCT) of an on‐road driving remediation program for adults with acquired brain injury. Secondary objectives were to measure the effectiveness of the on‐road driving program and determine sample size required for a randomised controlled trial. Methods A wait‐list randomised controlled trial with blinded assessment and 6‐month follow‐up aimed to recruit 10 participants with acquired brain injury. Concealed methods randomly allocated participants to receive the on‐road driving rehabilitation program immediately (intervention group) or after 6 weeks (wait‐list group). The primary outcome measure of functional fitness to drive, was assessed pre‐ and post‐intervention, and at 6‐month follow‐up. Driving performance was measured by percentage of correct manoeuvres and driving instructor intervention. Results Eight participants (seven male; average age 46 years; six traumatic brain injury and two stroke) were recruited. The protocol was feasible. Results of the RCT suggest intervention effectiveness initially with two of the three interventions, and no wait‐list, participants achieving fitness to drive. This increased to five out of eight participants after the wait‐list group completed the intervention. While three participants retained this outcome at 6‐month follow‐up, universal deterioration in on‐road driving performance was evident for all participants at 6‐month follow‐up. Conclusion The trial was feasible and findings suggest that on‐road driving remediation assists people with acquired brain injury to achieve functional fitness to drive but the skills may not be maintained 6 months later. A full RCT is warranted to further determine the effectiveness of on‐road driving remediation and capacity of participants to maintain the skills developed.