The Return-to-Play Incentive and the Effect of Motivation on Neuropsychological Test-Performance: Implications for Baseline Concussion Testing

Abstract

Athletes may be less engaged in baseline cognitive testing in the absence of a powerful return-to-play incentive. The present study sought to evaluate whether athletes' level of motivation (1) influences baseline test performance and (2) changes across pre- and post-injury assessments. We found a significant relationship between examiners' ratings of athletes motivation toward testing and baseline cognitive test performance. Athletes, but not controls, demonstrated increased motivation between tests. These findings suggest that baseline test performance may underestimate true premorbid abilities for a subset of athletes.

A pilot investigation of the Motivation Behaviors Checklist (MBC): An observational rating scale of effort towards testing for baseline sports-concussion assessment

“…Research has demonstrated that baseline performance can be influenced by poor effort (Bailey, Echemendia, & Arnett, 2006;Hunt, Ferrara, Miller, & Macciocchi, 2007;Rabinowitz, Merritt, & Arnett, 2015;Schatz, 2010;Solomon & Haase, 2008). Furthermore, emerging evidence from the field of positive psychology suggests that individual differences in motivation influence cognitive performance in other contexts.…”

Exploring sandbagging behaviors, effort, and perceived utility of the ImPACT Baseline Assessment in college athletes.

“…However, the deleterious effects of suboptimal effort on neurocognitive performance are recognized in consensus statements as well as empirical studies (Broglio, Ferrara, Macciocchi, Baumgartner, & Elliott, 2007; Bush et al, 2005; Green, Rohling, Lees-Haley, & Allen, 2001; Heilbronner et al, 2009). The American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology discuss the measurement and investigation of suboptimal effort (Broglio et al, 2007; Bush et al, 2005; Green et al, 2001; Heilbronner et al, 2009), and the confounding effect that suboptimal effort has on baseline CNT performance is also a concern within the field of sports neuropsychology (Bailey et al, 2006; Rabinowitz, Merritt, & Arnett, 2015; Solomon & Haase, 2008). Despite these concerns, the incidence of suboptimal or poor effort is not widely documented.…”

Assessment of effort in sports concussion evaluations.

“…Another study by our group demonstrated that recently concussed athletes were judged by experimenters as putting forth significantly more effort on cognitive tests, as compared to the same athletes tested at baseline. Furthermore, those rated as putting forth poor effort at baseline exhibited the poorest baseline test performance (Rabinowitz et al, 2015). In this study examiners rated their impression of athletes' effort on a single-item Likert scale ranging from not trying at all to optimal effort.…”