title: Older driver retraining: a systematic review of evidence of effectiveness.
abstract: OBJECTIVE
  The safety of older drivers is of growing concern as fatal crashes in this group increase annually. The objective was to systematically and critically appraise the evidence on effectiveness of older driver retraining.
  
  
  METHODS
  Articles were grouped according to the intervention studied: physical retraining, visual perception, or education. Randomized trials were appraised using the Physiotherapy Evidence Database (PEDro) Scale and interpreted following Foley's quality assessment. Each intervention was then rated for effectiveness based on Sackett's levels of evidence.
  
  
  RESULTS
  Six RCTs, one pre-post-study design, and one descriptive study met the inclusion criteria, one investigating physical retraining, one a visual perception intervention, five using an educational intervention, and one examining a combination of all three, in addition to traffic engineering improvements. There is limited evidence that physical retraining (Level 2a) and visual perception retraining (Level 2a) improve driving related skills in older drivers. There is moderate evidence that educational interventions improve driving awareness and driving behavior (Level 1a), but do not reduce crashes (Level 1b) in older drivers.
  
  
  CONCLUSIONS
  The current evidence on the effectiveness of retraining aimed at older drivers is limited but sufficiently encouraging to merit further research.
  
  
  CONCLUSIONS
  Given the potential cost savings to the insurance and health care industries, as well as the safety impact to the general population, the research agenda in this area requires much greater attention.
authors.affiliation: McGill University, Faculty of Medicine, School of Physical and Occupational Therapy, Montreal, Quebec, Canada. ailene.kua@mcgill.ca
authors.forename: Ailene
authors.initials: A
authors.lastname: Kua
authors.forename: Nicol
authors.initials: N
authors.lastname: Korner-Bitensky
authors.forename: Johanne
authors.initials: J
authors.lastname: Desrosiers
authors.forename: Malcolm
authors.initials: M
authors.lastname: Man-Son-Hing
authors.forename: Shawn
authors.initials: S
authors.lastname: Marshall
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology / Q000523:psychology; D001334:Automobile Driving / Q000193:education* / Q000523:psychology; D004496:Education, Continuing; D006801:Humans; D015397:Program Evaluation; D014792:Visual Acuity