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. 2014 Feb 25;2014(2):CD008357. doi: 10.1002/14651858.CD008357.pub2

Crotty 2009.

Methods RCT
Participants 4 rehabilitation centres in Adelaide, Australia
26 participants: 13 intervention, 13 control
Inclusion criteria: no visual field impairments, binocular vision of minimum 6/12, minimum 1 month post stroke, desire to return to driving, clearance from medical practitioner to perform driving assessment, holder of driver's licence and driving pre stroke
Exclusion criteria: visual field < 120 degrees; unable to provide informed consent; required the use of greater modifications than a spinner knob on the steering wheel, such as a left foot accelerator to complete on‐road assessment
Mean age (years): 65.6 (SD 13.1)
92.31% male
Side of lesion: 27% left, 58% right, 15% other
Median time post stroke (days): 83.5 (range 29 to 816)
Interventions Experimental intervention: training on the Dynavision device (developed to train visuomotor abilities) using a standardised programme of intervention of grading in complexity of tasks from self paced to apparatus paced, in which the time required to respond was reduced as skilled level increased
Control intervention: no intervention and wait‐listed for 6 weeks
Sessions were 3 times a week for 6 weeks, each session approximately 40 minutes (total of 12 hours)
Outcomes Outcomes recorded at baseline and post intervention
  • Primary outcome: on‐road driving test (pass that included lessons, or fail)

  • Secondary outcomes

    • vision tests: visual scanning

    • cognitive tests: response speed and driving self efficacy

Notes  
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Computerised number generation
Allocation concealment (selection bias) Low risk Allocation managed by an independent person
Incomplete outcome data (attrition bias) 
 All outcomes Low risk There were some missing data due to the number of participants who withdrew (12% withdrew from their allocated intervention, 16% of participants were lost to follow‐up)
Intention‐to‐treat analysis performed
Selective reporting (reporting bias) Low risk All outcomes and negative results reported
Other bias Unclear risk Participation bias as participants may have been reluctant to enter study, particularly those with more disability and poor driving skills as results were sent to licensing agency
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Participants not blinded to allocation
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk Outcome assessors blinded to allocation