Predictors of on-road driver performance following traumatic brain injury

Objective To examine assessment outcomes and factors associated with passing an occupational therapy (OT) on-road driver assessment after traumatic brain injury (TBI). Design Retrospective analysis of outcomes of on-road driver assessment completed by persons with TBI over an 8-year period. Setting Inpatient and outpatient rehabilitation hospital. Participants A consecutive sample of individuals (N=207) with mild to severe TBI who completed an on-road driver assessment and were assessed at least 3 months postinjury. Intervention Not applicable. Main Outcome Measure Outcome of on-road driver assessment. Results Of the drivers with TBI, 66 (n=137) passed the initial on-road driver assessment (pass group), whereas 34 (n=70) required on-road driver rehabilitation and/or =1 on-road assessment (rehabilitation group). After driver rehabilitation, only 3 participants of the group did not resume driving. Participants who were men, had shorter posttraumatic amnesia (PTA) duration, had no physical and/or visual impairment, and had faster reaction times were significantly more likely to be in the pass group. In combination, these variables correctly classified 87.6 of the pass group and 71.2 of the rehabilitation group. Conclusions PTA duration proved to be a better predictor of driver assessment outcome than Glasgow Coma Scale score. In combination with the presence of physical/visual impairment and slowed reaction times, PTA could assist clinicians to determine referral criteria for OT driver assessment. On-road driver rehabilitation followed by on-road reassessment were associated with a high probability of return to driving after TBI