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

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 (beta = 0.11 [0.02-0.21] and age (beta = 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.