Exploring associations between self-reported executive functions, impulsive personality traits, driving self-efficacy, and functional abilities in driver behaviour after brain injury

•Executive functions and impulsive personality traits were associated with driving self-efficacy.•Driving self-efficacy was associated with driving characteristics.•Higher-level functions influence post-injury accident involvement mediated through proximal driving factors. The assessment of self-awareness and self-efficacy as they relate to driving after stroke and TBI is lacking in the literature where the focus has tended to be on neuropsychological testing of underlying component of cognition in predicting driving outcome. Therefore, this study aims to investigate the associations between self-rating of higher-level functions and post-injury driving behaviour. The present one-year follow-up study included twenty-four adults with stroke and ten adults with traumatic brain injury (TBI) deemed suitable for driving after a comprehensive driving evaluation according to Norwegian regulations. In addition, but not part of the decision making, baseline measurements included self-rating of executive functions (Behaviour Rating of Executive Function (BRIEF-A)), impulsive personality traits (UPPS Impulsive Behaviour Scale), driving self-efficacy (Adelaide Driving Self-Efficacy Scale (ADSES)), and functional abilities (Awareness Questionnaire (AQ)). Follow-up measurements twelve months after baseline were collected, the ADSES, AQ, and Swedish Driver Behaviour Questionnaire (Swedish DBQ). Perceived driving self-efficacy and functional abilities did not change from baseline to follow-up. Baseline perceived executive functions and impulsive personality traits were significantly associated with driving self-efficacy at follow-up. Lower self-efficacy and functional abilities were associated with lower driving mileage and increased use of compensatory driving strategies, whereas lower self-efficacy beliefs were associated with driver mistakes and inattention. Driver violations and inattention were associated with minor accidents. The present study demonstrates that higher-level functions such as executive functions, impulsive personality traits, driving self-efficacy and functional abilities, influence post-injury accident involvement mediated through proximal driving factors such as driver inattention. Further evidence is warranted to explore self-rating measures compared to performance-based methods as predictors of risky driver behaviour, crashes, and near misses.