Addressing return to driving goals in the community after acquired brain injury: a scoping review.

Abstract

Neurological changes after acquired brain injury (ABI) can prevent or delay medical clearance for return to driving. Individuals attending community-based services often have goals to return to driving. This review aimed to explore approaches used in community-based services to support return to driving goals after ABI. The Arksey and O'Malley scoping review approach was followed, with additional quality appraisal. Inclusion criteria were: articles reporting on community-based services for people with moderate to severe ABI and who held a driver's licence at onset of ABI. Papers focused on driving assessments or predictors of driving performance were excluded. Thirty-three articles met inclusion criteria. Eight approaches were identified with variable levels of evidence: on-road remediation, simulator training, assistive technology and vehicle modifications, skill component training (e.g. pen and paper activities), community-based activities, education, support for emotional adjustment, and mobile applications. On-road remediation and simulator training have developing evidence but require specialised skills and are considered high-cost healthcare. Alternative approaches to support skill development by clinicians without specialised driving training are described but require further investigation. Developing a systematic approach within a service based on models of driving is suggested as a first step to building evidence-based practice.