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

OBJECTIVES: 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. METHODS: 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). MAIN FINDINGS: 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). CONCLUSION: 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.