Two studies [125,126] developed and evaluated an online game to train drivers with simulator sickness (SS). The evidence in one study  used the Simulator Sickness Rating Scale (SSRS) to demonstrate the relationship between gameplay experience and SS. The evidence obtained in the other study  was from an online game with SSRS, which showed that SS in the online game can be rated using the SSRS. To evaluate learning effect for SS during the game period, one study  used SSRS and other measures to compare the performance of drivers who spent one week playing a certain driving game with the performance of drivers who spent less time playing the same game. The evidence is low-quality evidence since it simply reports change in score during a certain period of time.
Five studies [88,89,90,91,92] evaluated functional performance on a driving simulator using the real car (n=5) and the Cyton Abs Supportive Airbag Driving Simulator (n=4). In comparison with normal controls without functional impairments, there was a significant and substantial improvement in driving performance in patients with Parkinson’s disease or post-polio syndrome (P=0.003 and P=0.0006, respectively). The evidence was strengthened by the fact that correlation was found between the Cyton and other variables as a source of validity evidence. In other words, performance on the Cyton was not as good as that on the real car. This finding indicates that the Cyton can be used to assess performance in real cars rather than in a simulator.
Four studies evaluated the assessment of driving skills before and after cognitive training (near transfer), reaching the OCEBM level of 2b for near transfer. Another study  evaluated the assessment of driving skills before and after an online training program (far transfer). As a source of validity evidence, All were found to have an Effect of two different variables on the simulator between pre- and post-training (n=4). No serious adverse effects or complaints were reported in any of those studies. 7211a4ac4a