Feasibility and discriminatory properties of a simple fitness-to-drive assessment using a driving simulator placed in an orthopaedic outpatient department: a feasibility study.

Abstract

Safe return to driving after orthopaedic injury or surgery is important, but standardised and feasible in-hospital assessments are lacking. We evaluated the feasibility of a simple simulator-based fitness-to-drive assessment in an orthopaedic outpatient department and its ability to discriminate between orthopaedic patients and professional drivers. In this prospective feasibility study (January 2024-January 2025), two identical driving simulators were installed in an orthopaedic outpatient department and a vocational training centre for professional drivers. Participants were ≥18 years, held a driving licence, and had no medical driving ban. All completed a 3-lap, 6-event scenario with predefined speed progression (50/60/70 km/h). Outcomes were completion, errors, speed progression, maximum reaction time and braking length (metres) at 50 km/h, simulator sickness, perceived realism, and subgroup test-retest reliability. We included 57 patients and 92 drivers. Overall completion was 96.6% (144/149); 31.2% achieved speed progression. Patients were older, more often female, and more functionally impaired than drivers. Drivers had a shorter braking distance (23.3 m; 95% CI 22.1-24.5) and faster reaction time (0.5 s; 95% CI 0.5-0.6) than patients (39.4 m; 95% CI 36.7-42.1 and 1.2 s; 95% CI 1.0-1.4). Simulator sickness leading to discontinuation occurred in 3.4%. Most patients (98.2%) and 64.0% of drivers perceived simulator driving as comparable to real driving. Repeat testing showed a shorter braking distance, particularly in patients. The simulated assessment was feasible, well tolerated, and discriminated between patients and professional drivers. Variation indicates a need for individualised assessment. Validation against on-road driving is required before clinical implementation.