Feasibility and discriminatory properties of a simple fitness-to-drive assessment using a driving simulator placed in an orthopaedic outpatient department: a feasibility study

Introduction Safe return to driving after orthopaedic injury or surgery is important, but standardised and feasible in-hospital assessments are lacking. We evaluated the feasibility of a simple simulator-based fitness-to-drive assessment in an orthopaedic outpatient department and its ability to discriminate between orthopaedic patients and professional drivers. Methods In this prospective feasibility study (January 2024–January 2025), two identical driving simulators were installed in an orthopaedic outpatient department and a vocational training centre for professional drivers. Participants were ≥18 years, held a driving licence, and had no medical driving ban. All completed a 3-lap, 6-event scenario with predefined speed progression (50/60/70 km/h). Outcomes were completion, errors, speed progression, maximum reaction time and braking length (metres) at 50 km/h, simulator sickness, perceived realism, and subgroup test–retest reliability. Results We included 57 patients and 92 drivers. Overall completion was 96.6% (144/149); 31.2% achieved speed progression. Patients were older, more often female, and more functionally impaired than drivers. Drivers had a shorter braking distance (23.3 m; 95% CI 22.1–24.5) and faster reaction time (0.5 s; 95% CI 0.5–0.6) than patients (39.4 m; 95% CI 36.7–42.1 and 1.2 s; 95% CI 1.0–1.4). Simulator sickness leading to discontinuation occurred in 3.4%. Most patients (98.2%) and 64.0% of drivers perceived simulator driving as comparable to real driving. Repeat testing showed a shorter braking distance, particularly in patients. Conclusion The simulated assessment was feasible, well tolerated, and discriminated between patients and professional drivers. Variation indicates a need for individualised assessment. Validation against on-road driving is required before clinical implementation.