Individual and contextual factors influencing children's effort in pediatric rehabilitation interventions

Rehabilitation clinicians strive to encourage children's sustained effort within challenging practice conditions. Effort influences intervention success, yet it is rarely defined or measured. Effort can be conflated with individual factors, such as motivation and engagement, that might influence it. Contextual factors that likely impact children's effort, such as practice conditions and therapeutic interactions, are generally under-described. Defining, describing, and measuring effort and its influencers is necessary to enhance understanding of differences in rehabilitation intervention outcomes across individuals and contexts and to support the development of personalized precision rehabilitation approaches. This narrative review describes effort conceptualization in rehabilitation, particularly in relation to intensity, engagement, and participation nomenclature. The review outlines individual and contextual factors that may influence children's effort in rehabilitation and describes potential next steps for effort description and measurement. Subsequent work should aim to identify factors that can be targeted in clinical practice to promote and sustain children's effort in the rehabilitation process, thereby individualizing interventions and potentially improving their effectiveness. WHAT THIS PAPER ADDS: Effort as it relates to rehabilitation is confusingly described and infrequently measured. Engagement, involvement, intensity, and participation are terms alluding to effort. Child-specific and therapy-specific factors, alone and in combination, may influence children's effort. Clearer conceptualization of effort and the factors that influence it will support personalization of interventions. Better measurement will enhance knowledge about relationships between effort and therapeutic outcomes.