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

Abstract

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 (n\u2009=\u200912 Simulator, n\u2009=\u20098 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 (P\u2009=\u20090.373). On average, the Simulator group reported a positive change in confidence ratings (M\u2009=\u20095.77, SD\u2009=\u200913.96) compared to the Usual Care group, who reported a negative change (M\u2009=\u2009−6.97, SD\u2009=\u20098.47), P\u2009=\u20090.034. The Simulator group (M\u2009=\u20090.67, SD\u2009=\u20093.34) demonstrated no significant change in self-awareness relative to the Usual Care group (M\u2009=\u2009−0.83, SD\u2009=\u20091.83, P\u2009=\u20090.325). 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.