A Systematic Review and Meta-Analysis on the Association Between Driving Ability and Neuropsychological Test Performances after Moderate to Severe Traumatic Brain Injury

Abstract

Objectives: Guidelines on return-to-driving after traumatic brain injury (TBI) are scarce. Since driving requires the coordination of multiple cognitive, perceptual, and psychomotor functions, neuropsychological testing may offer an estimate of driving ability. To examine this, a meta-analysis of the relationship between neuropsychological testing and driving ability after TBI was performed. Methods: Hedge’s g and 95% confidence intervals were calculated using a random effects model. Analyses were performed on cognitive domains and individual tests. Meta-regressions examined the influence of study design, demographic, and clinical factors on effect sizes. Results: Eleven studies were included in the meta-analysis. Executive functions had the largest effect size (g = 0.60 [0.39–0.80]), followed by verbal memory (g = 0.49 [0.27–0.71]), processing speed/attention (g = 0.48 [0.29–0.67]), and visual memory (g = 0.43 [0.14–0.71]). Of the individual tests, Useful Field of Vision (UFOV) divided attention (g = 1.12 [0.52–1.72]), Trail Making Test B (g = 0.75 [0.42–1.08]), and UFOV selective attention (g = 0.67 [0.22–1.12]) had the largest effects. The effect sizes for Choice Reaction Time test and Trail Making Test A were g = 0.63 (0.09–1.16) and g = 0.58 (0.10–1.06), respectively. Years post injury (β = 0.11 [0.02–0.21] and age (β = 0.05 [0.009–0.09]) emerged as significant predictors of effect sizes (both p < .05). Conclusions: These results provide preliminary evidence of associations between neuropsychological test performance and driving ability after moderate to severe TBI and highlight moderating effects of demographic and clinical factors.

Chronic subdural hematoma in patients over 65 years old: Results of using a postoperative cognitive evaluation to determine whether to permit return to driving

“…[ 25 ] Regarding cognitive assessment, TMT-B is widely used as a simple test to assess attention diversion and allocation, and executive function. [ 3 ] Our results also suggest that TMT-A and B can be useful tests similar to the previous report. [ 22 ]…”

Fitness to drive after acquired brain injury: Results from patient cognitive screening and on‐road assessment compared to age‐adjusted norm values

“…Due to the impact of age on different cognitive screening test results, age-adjusted norm values could be useful as a guide (Selander, Wressle & Samuelsson, 2020;Tombaugh, 2004). The Useful Field of View (UFOV) test (Marshall, Molnar, Man-Son-Hing, Blair, Brosseau & Finestone, 2007;Visual Awareness Research Group, 2009) and Trail Making Test (TMT) (Reitan, 1986) are examples of cognitive screening tests often used in a first stage to assess cognitive functions relevant to driving (Egeto, Badovinac, Hutchison, Ornstein & Schweizer, 2019). In the Nordic countries, the Nordic Stroke Driver Screening Assessment (NorSDSA) (Lundberg, 2003) is another assessment tool often used for a cognitive screening (Larsson, Lundberg, Falkmer & Johansson, 2007).…”

Performance validity testing via telehealth and failure rate in veterans with moderate-to-severe traumatic brain injury: A veterans affairs TBI model systems study1

“…The utility of neuropsychological evaluations rests on the assumption that examinees are performing to the best of their ability. For example, neuropsychological functioning during the early recovery from traumatic brain injury (TBI) predicts important rehabilitation outcomes such as employment (Sherer et al, 2002), productivity (Green et al, 2008), and driving fitness (Egeto et al, 2019). However, accurate prognostication by clinical providers requires credible performance by examines during neuropsychological testing.…”