Investigating feasibility and preliminary efficacy of a simulator-based driving intervention for people with acquired brain injury: A randomised controlled pilot study.

Objective: To investigate the feasibility and preliminary efficacy of a driving simulator intervention on driving outcomes following acquired brain injury.

Design: Pilot randomised controlled trial.

Setting: Occupational therapy driver assessment and rehabilitation service.

Subjects: Individuals post-acquired brain injury aiming to return to driving.

Intervention: Eight sessions of simulated driver training over four weeks, in addition to usual care. Control: Usual care only.

Main Measures: Feasibility outcomes: Participant recruitment and retention; data completeness; therapy attendance and fidelity; adverse events. Performance outcomes: on-road driving performance; Simulator Sickness Questionnaire; Brain Injury Driving Self-Awareness Measure and Driving Comfort Scale - Daytime, assessed at baseline and five weeks post-randomisation.

Results: Out of 523 individuals screened, 22 (4%) were recruited and randomised, with 20 completing their allocated group ( = 12 Simulator,  = 8 Usual Care). For those who completed training, session attendance was 100% with simulator sickness rated, on average, as mild. Six individuals (50%) in the Simulator group failed the on-road assessment, versus two (25%) in the Usual Care group ( = 0.373). On average, the Simulator group reported a positive change in confidence ratings ( = 5.77, SD = 13.96) compared to the Usual Care group, who reported a negative change ( = -6.97, SD = 8.47),  = 0.034. The Simulator group ( = 0.67, SD = 3.34) demonstrated no significant change in self-awareness relative to the Usual Care group ( = -0.83, SD = 1.83,  = 0.325).

Conclusions: With adjustments to inclusion criteria and recruitment strategies, it may be feasible to deliver the intervention and conduct a larger trial. There is potential benefit of simulator training for improving driver confidence after acquired brain injury.