Background A recent review in Orthopaedics (Goodwin et al, 2013) claims that ’Few guidelines are available to assist orthopaedic surgeons in advising patients about when to return to driving after orthopaedic surgery.’ A systematic review of interventions to evaluate fitness to drive in relation to chronic diseases (Marino et al, 2012) concludes similarly that ’ It seems necessary to develop tests with proven validity for identifying high-risk drivers so that physicians can provide guidance to their patients in chronic conditions, and also to medical advisory boards working with licensing offices’. The litterature on using car driving simulators is large from a basic research point of view, but at the application level for clinical use very little has been published. A major problem is the occurence of simulator driving sickness, which hinders clinical application.

Methods Phase 1: Based on existing driving simulator software (Oktal) a lengthy simulator sequence was applied in the laboratory setting. The virtual scenario included driving from one town to another via highways with obstructions and animals passing at random. The complete trip was about 10–15 minutes depending on speed. Phase 2: Development of short test passages for dedicated situations (disturbances, annoying other trafficants, right turn with bicycle passing, gps directional guidance).

Results Phase 1: Test persons and researchers developed simulator driving sickness due to poor frame rate in complicated situations (<20 khz). Phase 2: Short (3–5 minute) sequences are scheduled for development based on actual accident statistics and demands from driving tests. Results will be presented from these.

Conclusions Unfortunately the attempt to apply a pre-developed scenario from the software vendor has proven problematic to an extent that patient involvement is not feasible. Routine usage of driver simulators in the clinical setting demands further applicability testing and specific evaluation.