A systematic review 1 including 35 studies (106 separate driver improvement programmes) with a total of more than 1 300 000 subjects in the intervention groups was abstracted in DARE. Studies of drivers selected because of poor driving ability (repeated crashes) were eligible for inclusion. Studies involving only driving-under-the-influence offenders were excluded. Driver improvement programmes were associated with a small but statistically significant reduction in crashes (d=0.030, 95% CI 0.027 to 0.034, P<0.05) and violations (d=0.061, (95% CI 0.057 to 0.064, P<0.05). Licence suspension or revocation was the most effective intervention for reducing crashes (d=0.113, 95% CI: 0.101 to 0.126, P<0.05) and violations (d=0.190, 95% CI: 0.177, 0.202, P<0.05). Reductions in crashes and violations were also reported for warning letters, group meetings and individual hearings. Educational and informational material interventions were not associated with a reduction in either outcome.
Comment: The quality of evidence is downgraded by heterogeneity.
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