title: Driver rehabilitation: a systematic review of the types and effectiveness of interventions used by occupational therapists to improve on-road fitness-to-drive.
abstract: OBJECTIVE
  Driver rehabilitation has the potential to improve on-road safety and is commonly recommended to clients. The aim of this systematic review was to identify what intervention approaches are used by occupational therapists as part of driver rehabilitation programmes, and to determine the effectiveness of these interventions.
  
  
  METHODS
  Six electronic databases (MEDLINE, CINAHL, PsycInfo, Embase, The Cochrane Library, and OTDBase) were searched. Two authors independently reviewed studies reporting all types of research designs and for all patient populations, provided the interventions could be administered by occupational therapists. The methodological quality of studies was assessed using the 'Downs and Black Instrument', and the level of evidence for each intervention approach was established using 'Centre for Evidence Based Medicine' criteria.
  
  
  RESULTS
  Sixteen studies were included in the review. The most common type of intervention approach used was computer-based driving simulator training (n=8), followed by off-road skill-specific training (n=4), and off-road education programmes (n=3). Car adaptations/modifications were used in one of the included studies. There was significant variability between studies with regards to frequency, duration, and total number of intervention sessions, and the diagnoses of the participants. Of the four intervention approaches, there is evidence to support the effectiveness of off-road skill-specific training (with older clients), and computer-based driving simulator training (with both older clients and participants with acquired brain injury).
  
  
  CONCLUSIONS
  Three types of intervention approaches are commonly reported, however, there is limited evidence to determine to effectiveness of these in improving fitness-to-drive. Further research is required, with clients from a range of diagnostic groups to establish evidence-based interventions and determine their effectiveness in improving these clients' on-road fitness-to-drive.
authors.affiliation: Faculty of Health Sciences, La Trobe University, Melbourne 3086, VIC, Australia; Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden. Electronic address: c.unsworth@latrobe.edu.au.
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Unsworth
authors.affiliation: Faculty of Health Sciences, La Trobe University, Melbourne 3086, VIC, Australia.
authors.forename: Anne
authors.initials: A
authors.lastname: Baker
mesh_terms: D001334:Automobile Driving; D001930:Brain Injuries / Q000534:rehabilitation*; D003198:Computer Simulation; D006801:Humans; D008607:Intellectual Disability / Q000534:rehabilitation*; D009788:Occupational Therapy / Q000379:methods*; D010243:Paralysis / Q000534:rehabilitation*; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D000071939:Stroke Rehabilitation
keywords: Driver intervention; Driver rehabilitation; Fitness-to-drive; On-road; Systematic review