Akinwuntan 2005

Methods	RCT
Participants	Recruited from 1 rehabilitation unit in Belgium 83 participants: 42 intervention, 41 control Inclusion criteria: within 3 months of first stroke, actively driving before stroke, in possession of an active driver's licence Exclusion criteria: ≥ 75 years old, history of epilepsy within previous 6 months, severe motor or sensory aphasia Mean (SD) age: intervention group 54 (12) years, control group 54 (11) years 81% male Stroke details: 77% ischaemic, 44% right hemiparesis Timing post stroke: intervention group mean (SD) 53 (6) days, control group 54 (6) days
Interventions	Virtual reality intervention: driving simulator in full sized automatic gear transmission Ford Fiesta; a variety of 5 km driving scenarios were used including positioning on straight and curvy roads, stopping at crossings and avoiding pedestrians, overtaking and road sign recognition Control intervention: driving‐related cognitive tasks: these included route finding on a paper map, recognition of road signs, commercially available games including 'rush hour' and 'tantrix' Sessions were 60 minutes, 3 times a week for 5 weeks (15 hours total)
Outcomes	Outcomes recorded at baseline, post‐intervention and at 6 months with some participants followed up at 5 years Cognitive outcome measures: Useful Field of View Test Activity limitation outcome measures: on‐road driving test (using Test Ride for Investigating Practical Fitness to Drive checklist), decision of fitness to drive, Barthel Index (assessed at baseline and 5 years only) Other outcome measures: binocular acuity, kinetic vision, components of the Stroke Driver Screening Assessment Other outcome measures assessed at baseline and 5 years only: Hospital Anxiety and Depression Scale, number of kilometres driven per year, number of self reported traffic tickets and accidents and driving status (actively driving or stopped driving)
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
Blinding of outcome assessment (detection bias) All outcomes	Low risk
Incomplete outcome data (attrition bias) All outcomes	Low risk	A large amount of missing data due to the number of participants who withdrew (14% withdrew from their allocated intervention, 29% of participants were lost at 6‐month follow‐up); however, the authors completed an intention‐to‐treat analysis and found that drop out was random and balanced evenly across groups
Selective reporting (reporting bias)	Low risk	No other outcomes were collected