Determining fitness to drive: A systematic review of the methods and assessments used after mild traumatic brain injury

Introduction: Limited evidence is available to support knowledge of the time-frame and capacity for fitness to drive after mild traumatic brain injury. The aim of this systematic review was to identify what methods and assessments are, or could be used to determine fitness to drive for this population. Method: We undertook a systematic search of six electronic databases. Two authors rated all studies for methodological content and quality, and standardised data were extracted. Narrative analysis was conducted to understand the content of eligible studies. Findings: A total of 2022 articles were retrieved; seven articles met the inclusion criteria. Self-reported questionnaires, nonstandardised assessments, questionnaires completed by next-of-kin, and simulator tests were the primary methods used to determine fitness to drive. Only one assessment has been used to aid recommendations about fitness to drive in the acute hospital setting. Six additional standardised assessments were identified that have the potential to predict fitness to drive in this population group; however, these assessments require further psychometric testing prior to use. Conclusion: While a variety of methods and assessments are currently used, there is little research evidence to suggest when individuals are able to return to driving after mild traumatic brain injury. Research is urgently required to determine a consistent and standardised approach to assessing fitness to drive following mild traumatic brain injury.