College Athletes Expectations About Injury Rehabilitation With an Athletic Trainer

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1 ORIGINAL RESEARCH Joe Hart, PhD, ATC, Report Editor College Athletes Expectations About Injury Rehabilitation With an Athletic Trainer Damien Clement, PhD, ATC, CC-AASP West Virginia University; Jordan Hamson-Utley, PhD, LAT, ATC Weber State University; Monna Arvinen-Barrow, PhD, C. Psychol University of Northampton; Cindra Kamphoff, PhD, CC-AASP Minnesota State University, Mankato; Rebecca A. Zakrajsek, PhD, CC-AASP University of Tennessee; Scott B. Martin, PhD, CC-AASP, Fellow-AASP University of North Texas Context: Injured athletes begin the rehabilitation process with expectations about the nature of the working relationship with an athletic trainer. These expectations can influence the effectiveness of the assistance provided. Objective: To determine whether male and female athletes differed in terms of expectations about injury rehabilitation services with an athletic trainer. Design: A questionnaire was administered to student athletes that assessed expectations about injury rehabilitation. Setting: Five colleges and universities. Patients or Other Participants: Questionnaire responses were provided by 679 student athletes (443 males and 236 females). Main Outcome Measure: Responses to the Expectations about Athletic Training questionnaire were used to assess factors identified as Personal Commitment, Facilitative Conditions, Athletic Trainer Expertise, and Realism. Results: A statistically significant interaction between gender and prior experience was identified. Male athletes with no prior experience had lower expectations for a facilitative environment. Female athletes with prior experience were less likely to have realistic expectations. Conclusions: Gender and prior experience influence athletes expectations of injury rehabilitation with an athletic trainer. may be influenced by individuals expectations. Given the importance of patients expectations in the areas of counseling 3 and sport psychology, 4 the athletic trainer (AT) needs to consider athletes expectations about injury rehabilitation. An AT can use this information to individualize rehabilitation programs to meet athletes needs, with the goal of optimizing outcomes. The available literature pertaining to injured athletes expectations of injury rehabilitation is extremely limited. The purposes of this study were as follows: (a) to evaluate the psychometric properties of the Expec- I njured athletes typically begin the injury rehabilitation process with expectations of what the experience will be like, which can influence the outcome that is ultimately realized. 1 Individuals who possess a high level of selfefficacy tend to have positive expectations, and they will likely exhibit congruent behaviors. 2 Conversely, individuals who possess a low level of self-efficacy tend to have low expectations, and they may display negative behaviors. Attitudes and behaviors such as motivation, adherence, compliance, and pain tolerance 2012 Human Kinetics - IJATT 17(4), pp july 2012 international journal of Athletic Therapy & training

2 tations About Athletic Training (EAAT) survey, (b) to determine whether male and female athletes expectations of injury rehabilitation services with an AT differ, and (c) to assess whether or not an interaction exists between past experience, gender, and expectations about injury rehabilitation with an AT. Participants Methods The participants were college student athletes who were recruited from five universities located in the Midwest, Southeast, Southwest, and Western regions of the United States. Each participant was a member of an athletic team sponsored by a member institution of the National Collegiate Athletic Association. Instrumentation The questionnaire used in this study was a modified version of the Expectations About Counseling-Brief form (EAC-B) 5 and Expectations about Sport Psychology Consulting form (EASPC). 4 The EAC-B and EASPC consist of 66 items that are grouped into 18 scales that document the various expectations an individual might have about counseling 5 or sport psychology. 4 Of the 18 scales, 17 assess three factors that have been addressed by numerous studies: (a) personal commitment, (b) facilitative conditions, and (c) expertise. 4,5 The Expectations About Athletic Training (EAAT) questionnaire assessed these same expectations for injury rehabilitation with an AT (Table 1). Personal commitment includes motivation, openness, responsibility, attractiveness, concreteness, immediacy, and outcome factors. Facilitative conditions include acceptance, confrontation, genuineness, nurturance, self-disclosure, tolerance, and trustworthiness. Expertise includes authority, empathy, and expertise of the AT. Realism is assessed separately, because the specific situation may influence the meaningfulness of the results. 6 For example, student athletes routinely complete psychological and physiological tests, and many of them receive care from athletic training students. Thus, the realism of the student athletes expectations may need to be considered in the context of a specific situation. The wording of the EAAT questionnaire was evaluated for clarity by seven professionals in the areas of athletic training and sport psychology. In addition, 41 athletes (i.e., 18 to 23 years of age) reviewed the instrument and provided feedback. The final EAAT version included a number of demographic items (i.e., age, gender, race, education level, academic major, college sport type, number of years participating in athletics, and whether or not the respondent had previously been treated by an athletic trainer) and 18 scales that assessed four constructs relating to athletic injury rehabilitation (i.e., personal commitment, facilitative conditions, AT expertise, and realism). 7 The participants responded to each of 66 items by selecting a response on a Likert scale that ranged from 1 (strongly disagree) to 7 (strongly agree). Procedures Institutional review board approval and informed consent was obtained prior to administration of the EAAT questionnaire. The following instructions were provided to participants: As an athlete, imagine that you are injured and about to see an athletic trainer for your first visit. We would like to know just what you think about visiting an athletic trainer for sports injury rehabilitation. On the following pages you will find a number of statements about athletic training and mental training. In each instance, you are to indicate your level of agreement regarding what you expect the athletic training visit to be like. Expectations Personal Commitment Motivation Openness Responsibility Attractiveness Concreteness Immediacy Outcome Facilitative Conditions Acceptance Confrontation Genuineness Nurturance Self-disclosure Tolerance Trustworthiness Athletic Training Expertise Authority Empathy Expertise Realism Table 1. Explanation of Constructs Associated With the Expectations About Athletic Training Questionnaire Definition Being motivated to engage in injury rehabilitation Being open and willing to the rehabilitation process Being willing to take responsibility for statements and actions in rehabilitation Finding the athletic trainer likable and enjoying spending time and talking with the athletic trainer Expecting to identify problems and better understand rehabilitation Gaining new experiences to aid in solving new problems Gaining better understanding of the current situation and learning how to handle future situations Athletic trainer is accepting and facilitates positive regard. Athletic trainer requires the athlete to face up to the differences between personal statements and behaviors when necessary, and the rehabilitation experience is characterized by concreteness. Athletic trainer is honest and sincere. Athletic trainer is warm and interpersonally skilled. Athletic trainer is able to discuss attitudes and feelings related to the injury and rehabilitation. Athletic trainer is calm and easy going. Athletic trainer inspires confidence and trust. Athletic trainer explains what the problem is and gives advice on how to handle it. Athletic trainer listens empathetically and is able to express athlete s feelings. Athletic trainer is knowledgeable about injury and knows how to help facilitate recovery. Athletic trainer aims to assess how realistic the athlete s expectations are of the rehabilitation process. international journal of Athletic Therapy & training july

3 The wording of some portions of the questionnaire was changed from counselor to athletic trainer. Respondents were instructed to relate expectations for an initial session with an AT (e.g. I expect to like the Athletic Trainer or I expect the Athletic Trainer to tell me what to do ). Completion of the EAAT questionnaire required approximately 15 minutes. Data Analysis: Psychometric Properties of the EAAT The 66 items that contribute to the 18 scales derived from responses to the EAAT questionnaire (Motivation, Openness, Responsibility, Attractiveness, Concreteness, Immediacy, Outcome, Acceptance, Confrontation, Genuineness, Nurturance, Self-Disclosure, Tolerance, Trustworthiness, Authority, Empathy, Expertise, and Realism) were assessed by the same statistical procedures used by Tinsley et al. 5,8 Mean expectation scores for each of the 18 scales were calculated for each participant, 5,8 and Cronbach s alpha coefficient was calculated for each scale to assess internal consistency. Test-retest reliability was assessed by administering the survey to a different sample of athletes at one of the participating institutions. Confirmatory factor analysis (CFA) was performed to assess the hypothesized three-factor model (i.e., personal commitment, facilitative conditions, and expertise). 9 The root mean square error of approximation (RMSEA), standardized root mean square residual (SRMR), the goodness of fit index (GFI), and the adjusted goodness of fit index (AGFI) were evaluated to determine if the data fit the specified three-factor model. The participants expectations corresponding to the four individual scales derived the EAAT questionnaire responses (i.e., personal commitment, facilitative conditions, expertise, and realism) were evaluated using a 2 2 (Gender Past Experience) multivariate analysis of variance (MANOVA). To adjust for multiple comparisons, the alpha level was divided by the number of simple effect tests performed for a given factor (i.e., 0.05/2 = 0.025). 10(p. 527) Follow-up univariate ANOVAs and discriminant function analyses were conducted to identify differences between groups and to assess the relative importance of the multiple dependent variables. 11 Demographics Results Of the 759 questionnaires distributed, a total of 679 were returned and deemed usable for analysis (89% response rate). The sample consisted of 443 males (65.2%) and 236 females (34.8%), who ranged from 18 to 23 years of age (M = 20.4, SD = 1.8). Table 2 presents more detailed demographic information. Psychometric Properties of the EAAT Questionnaire Internal Consistency and Reliability. Internal consistency values for the various EAAT scales ranged from 0.63 to 0.80 (Table 3). The inter-scale consistency among the EAAT scales was 0.94, which did not improve if a scale was removed. To estimate test-retest reliability, the EAAT questionnaire was administered twice over a 2-week period to a sample of 41 athletes who were not members of the larger sample. The test-retest correlation coefficient for the entire EAAT questionnaire was The test-retest reliability of the EAAT scales ranged from 0.50 to 0.89 (Table 3). Confirmatory Factor Analysis (CFA). The CFA produced an RMSEA of Steiger 12 suggests that RMSEA values below 0.10 indicate a good fit to the data, values below 0.05 indicate a very good, and values below 0.01 indicate an outstanding fit. The analysis also produced an SRMR value of An SRMR value less than 0.05 is considered good fit and a value below 0.08 is considered adequate fit. 13 The GFI was 0.96, which is the ratio of the sum of the squared discrepancies to the observed variance. The AGFI was 0.95, which is an adjustment of the GFI for degrees of freedom in the model. 14 Values for both the GFI and AGFI range from 0 to 1, with values exceeding 0.9 indicating a good fit to the data. 13,14 The goodness of fit values were all within the acceptable range of model fit, thus the data fit the hypothesized model. 15 Table 2. Demographic Information Level of Education % (Number of Students) Freshman 29.5% (n = 183) Sport Sophomore 23.7% (n = 147) Junior 24.2% (n = 150) Senior 21.5% (n = 133) 5 th year Senior 1.2% (n=7) Bachelors Degree 0.04% (n = 24) Masters Degree 0.002% (n = 1) Football 30.4% (n = 206) Track and Field 18.8% (n = 127) Basketball 10.8% (n = 73) Soccer 10.6% (n = 72) Baseball 7.5% (n = 5) History of Injury M(SD) 0-72 Injuries 3.34 (4.06) Minor Injuries 2.27 (4.68) Moderate Injuries 1.38 (1.90) Severe Injuries 1.06 (1.61) Catastrophic 0.26 (0.82) Years/ Hours Spent Number of years involved in sport: 0-18 years Number of hours spent in training per week (0-20 hours) M (SD) 9.61 (4.96) (6.03) 20 july 2012 international journal of Athletic Therapy & training

4 Multivariate Group Comparisons Gender by Prior Injury Rehabilitation Experience With an AT. The MANOVA results (Table 4) demonstrated a significant multivariate interaction for gender and prior experience with an AT (Wilks Lambda = 0.97, F 4,23 = 3.83, p = 0.004, h 2 p = 0.028). Follow-up univariate ANOVA results demonstrated significant interactions (Figures 1 3) for Personal Commitment (F 1,526 = 11.90, p = 0.001, h 2 p = 0.022), Facilitative Conditions (F 1,526 = 6.13, p = 0.014, h 2 p = 0.012), and Realism (F 1,526 = 4.49, p = 0.035, h 2 p = 0.008). AT Expertise was non-significant (F 1,525 = 1.15, p = 0.29, h 2 p = 0.002). Factors contributing to discrimination between males and females and prior experience were personal commitment and AT expertise. Follow-up canonical discriminant analysis yielded correlations between the factors and the discriminant functions of 0.88 for personal commitment, 0.63 for facilitative conditions, 0.27 for AT expertise, and 0.54 for realism. Male athletes with no prior experience (M = 5.19, SD = 1.00) had lower personal commitment expectations of injury rehabilitation with an AT than the others (female athletes with prior experience M = 5.64, SD = 0.68; female athletes without prior experience M = 5.83, SD =.63; and male athletes with prior experience M = 5.52, SD = 0.78; Figure 1). Male athletes with no prior experience (M = 5.20, SD = 1.05) were less likely to believe that ATs would provide a facilitative environment than male athletes with prior experience (M = 5.44, SD = 0.79), female athletes with prior experience (M = 5.46, SD = 0.73), and female athletes without prior experience (M = 5.62, SD = 0.79; Figure 4). Female athletes with prior experience (M = 4.64, SD =.68) were less likely to have realistic expectations of athletic training than male athletes with prior experience (M = 4.87, SD = 0.71) and female and male athletes without prior experience (M = 4.87, SD = 0.62, M = 4.80, SD = 0.85, respectively; Figure 3). Gender. The MANOVA results demonstrated a significant main effect for gender (Wilks Lambda = 0.87, F 4,523 = 18.95, p <.001, h 2 p = 0.127; Table 4). Factors contributing to discrimination between males and females were realism, personal commitment, and facilitative conditions. The follow-up canonical discriminant analysis yielded correlations between the factors and the discriminant Table 3. Internal Consistency and Test-Retest Coefficients for the Expectations About Athletic Training Scales Expectations # of Items Alpha N = 679 Test-Retest N = 41 + Personal Commitment Motivation Openness Responsibility Attractiveness Concreteness Immediacy Outcome Facilitative Conditions Acceptance Confrontation Genuineness Nurturance Self-Disclosure Tolerance Trustworthiness Expertise Authority Empathy Expertise Realism Table 4. Descriptive Statistics: Prior Experience (Injury Rehabilitation With an AT) No Prior Experience Prior Experience Interaction Main Effects Females (n = 61) Males (n = 111) Females (n = 151) Males (n = 207) Gender Prior Experience Gender Prior Experience Expectations M SD M SD M SD M SD F r F r F r Personal a a Commitment Facilitative c b Conditions AT Expertise Realism c Note. a P <.001, b P <.01, c P <.05 international journal of Athletic Therapy & training july

5 Figure 1 Interaction between gender and prior experience (personal commitment). Figure 2 Interaction between gender and prior experience (facilitative conditions). Figure 3 Interaction between gender and prior experience (realism). Figure 4 Interaction between gender and prior experience (AT- expertise). functions of 0.58 for personal commitment, 0.32 for facilitative conditions, for athletic training expertise, and.12 for realism. The univariate ANOVA results demonstrated a significant effect for personal commitment (F 1,526 = 25.51, p = 0.000, h p 2 = 0.046) and facilitative conditions (F 1,526 = 7.67, p = 0.006, h p 2 = 0.014). Female athletes (M = 5.74, SD = 0.87) had higher personal commitment expectations of athletic training than male athletes (M = 5.35, SD = 0.82; Table 3). Likewise, female athletes (M = 5.54, SD = 0.92) were more likely than males (M = 5.32, SD = 0.87) to indicate that an AT would provide a facilitative environment. Prior Experience With an AT. Although the MANOVA result demonstrated a significant main effect for prior experience with an AT (Wilks Lambda = 0.98, F 4,523 = 3.02, p = 0.018, h 2 p = 0.023), neither the univariate F ratios nor the discriminant function correlations were statistically significant. Discussion Intercollegiate athletes are susceptible to injuries, which often prevent participation in practice sessions and competitive events. 16 Similar to athletes seeking counseling, athletes entering injury rehabilitation will have expectations about ATs and the rehabilitation process. The results of this study demonstrated an interaction between prior injury rehabilitation experience with an AT and gender, indicating that male athletes with no prior experience had lower expectations of personal commitment to injury rehabilitation than other participants; however, female athletes with prior experience were less likely to have realistic expectations when compared to males and females without prior experience and males with prior experience. The results also revealed that female student athletes had higher expectations of personal commitment to injury rehabilitation when compared to males. Additionally, female athletes had higher expectations for a facilitative injury rehabilitation environment. Although the results are consistent with those other studies that have documented a gender difference in expectations for services provided by different helping professions (e.g., counseling, 17 sport psychology, 18 and athletic training 19,20 ), the difference appears to be mediated by prior experience with injury rehabilitation with an AT. One would expect that a prior positive experience would cause an individual to have an optimistic approach toward an impending rehabilitation program. Conversely, a negative previous experience may produce a more listless and unmotivated approach. Research involving related professional disciplines, such as counseling 17 and sport psychology, 18 suggests that prior experience has an influence on whether or not a person returns for subsequent sessions and services. 18 A positive prior experience typically encourages an individual to seek the service in the future, whereas a negative experience usually creates the opposite effect. 18 The Wiese-Bjornstal et al. model 21 and Bandura s 2 work linking efficacy beliefs and outcome expectations offer some basis for understanding the relationship between expectations and injury rehabilitation outcomes. The Wiese-Bjornstal et al. model 21 accounts for the factors that influence athletes responses to injuries (cognitive, emotional, and behavioral). Prior 22 july 2012 international journal of Athletic Therapy & training

6 experiences are considered personal factors that influence the manner in which an athlete cognitively appraises a situation (i.e., estimation of one s abilities 2 ), which influences emotional response (e.g., fear, frustration, anger) and consequent behavioral responses (e.g., adherence, compliance). The cognitive appraisal model suggests that an athlete who had a negative injury rehabilitation experience with an AT will not view an impending rehabilitation positively, which may cause negative emotions that result in poor behavioral responses, such as lack of compliance. Conversely, an athlete with a previous injury rehabilitation experience that was positive will exhibit behaviors consistent with a positive outlook. Bandura 22 has suggested that a complex relationship exists between expectations, self-efficacy, selfmotivation, and outcome. Furthermore, the effects of outcome expectations on performance motivation are partly governed by self-beliefs of efficacy. 22(p.1180) Schwarzer and Fuchs 23 assert, however, that outcome expectations have a greater influence on the behaviors of individuals with no prior experience. Once an individual has attained experience with a particular behavior, self-efficacy plays a stronger role in influencing subsequent behaviors. Thus, it seems likely that athletes with no prior experience with injury rehabilitation with an AT, especially males, will have lower expectations of personal commitment to a process they have not previously experienced. Consequently, such individuals may be unmotivated and noncompliant. With prior experience, the individual s self-efficacy (i.e., belief in the ability to perform a behavior) can positively influence the upcoming injury rehabilitation experience. The results suggest that female athletes who have previously completed injury rehabilitation with an AT have lower expectations. Shaffer 24 found that participants who had previously completed injury rehabilitation had higher self-efficacy levels, but Bandura 2 asserted that environmental conditions (i.e., facilitative conditions) must also be taken into consideration. The female participants in our study had higher expectations for facilitative conditions than did males, which may have influenced self-efficacy and expectations for the injury rehabilitation process. Clinical Implications Given that both gender and a prior injury rehabilitation experience with an AT appear to influence expectations, ATs should recognize that psychosocial factors may need to be addressed to optimize injury rehabilitation outcomes. The EAAT Personal Commitment scale assesses the athlete s personal motivation, communication, personal growth and accomplishment, and willingness to partake in the rehabilitation process. Males with no prior experience had lower expectations of Personal Commitment and were less likely to believe that an AT would provide Facilitative Conditions in the rehabilitation environment. When an AT interacts with an injured male athlete who has not had a prior injury rehabilitation experience, it is important to recognize that the athlete may not understand the importance of the injury rehabilitation process, nor his role in the process. Furthermore, an injured athlete may not be aware that an AT is qualified to provide psychosocial support, 25 including motivation, social support, communication/active listening and relaxation, pain management, and imagery strategies. 26 Communication that identifies physical challenges and motivational difficulties can improve the athlete s injury rehabilitation experience. The AT should promote the athlete s personal commitment to the injury rehabilitation process by emphasizing the athlete s role as a responsible, accountable, motivated individual who is in control of the outcome that is ultimately realized. For example, setting rehabilitation goals with the athlete will promote a sense of control that is likely to increase selfefficacy. 22 Female athletes with prior injury rehabilitation experience with an AT were less likely than female athletes without such prior experience, or male athletes in either category, to have realistic expectations. The female athlete with prior experience may expect the AT to be highly responsive to needs and concerns 4 and to fulfill a strong social support role during the injury rehabilitation process. 19,20 Thus, the injured female athlete may need more and expect more from an AT than injured male athletes. Thus, the AT may need to discuss realistic goals for the extent of involvement with the injured female athlete during the injury rehabilitation process. Communicating with the athlete about her needs and expectations in relation to that which the AT is willing and able to provide may facilitate a positive outcome. 22 The results of this study clearly indicate that the female athlete s expectation for the AT to be accepting, nurturing, likeable, sincere, and warm is greater than that of male athletes. international journal of Athletic Therapy & training july

7 Because the clinician exerts a major influence on the rehabilitation environment, the personality of the AT is an important aspect of an athlete s injury rehabilitation experience. Responses related to the Personal Commitment scale indicated that athletes expect the AT to be likeable, easy to talk to, and an enjoyable person. Responses related to the Facilitative Conditions scale indicated that athletes expect the AT to be honest and sincere, warm and nurturing, skilled in interpersonal relations, calm and easy going, accepting, and facilitating positive regard. Males with no prior experience expected less from the AT in terms of a caring and honest personality, which could relate to a reluctance to discuss emotions associated with injury. Such a lack of communication could adversely affect self-efficacy and motivation. 22 The injured female athlete may require less prompting for engagement with the AT, which can promote self-efficacy and a positive injury rehabilitation outcome. 2,22 Development of communication skills may enhance an AT s ability to effectively receive and deliver messages to injured athletes, thereby providing a more facilitative injury rehabilitation environment. Incorporating psychosocial strategies, such as goal setting (e.g., setting specific, measurable, action-oriented, realistic, and time-based goals), may increase accountability and involvement in the injury rehabilitation process. Other strategies include establishment of a rehabilitation contract early in the process, varying rehabilitation activities, and creating rehabilitation partners. Although injured male athletes may not have such expectations, the use of strategies to improve communication could reduce reluctance to ask for AT guidance. Limitations The cross-sectional study design facilitated acquisition of a relatively large sample, but limited conclusions could be drawn about athletes expectations for injury rehabilitation with an AT. Although all of the researchers who were involved used the same protocol to administer the EAAT questionnaire, differing roles and relationships with the participants may have influenced their responses. The questionnaire items appeared to have moderate to high internal consistency and strong testretest reliability, but cross-validation of the findings in other samples is needed to further establish construct validity. Future research should also assess the extent to which expectations are associated with quantifiable outcome measures. Conclusions ATs should consider the influences of prior experience and gender on expectations for the injury rehabilitation process. Our results suggest that female athletes expect an AT to provide a rehabilitation environment that is accepting, nurturing, and based on trust that allows for self-disclosure and personal growth. Such a rehabilitation environment may facilitate compliance, faster recovery, and a more positive experience. Social support, communication/active listening, relaxation, and imagery strategies may enhance the self-efficacy of male athletes who expect less from an AT during the injury rehabilitation process. 22 An individualized approach that accounts for differences in expectations associated with gender and prior experience may improve the outcome that is realized. References 1. Hardin SI, Subich LM, Holvey JM. Expectancies for counseling in relation to premature termination. J Couns Psychol. 1988;35: Bandura A. Self-efficacy: The Exercise of Control. 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8 17. Addis ME, Mahalik JR. Men, masculinity, and the context of help seeking. Am Psychol. 2003;58: Martin SB. High school and college athletes attitudes toward sport psychology consulting. J Appl Sport Psychol. 2005;17: Gould D, Udry E, Bridges D, Beck L. Coping with season-ending injuries. Sport Psychol. 1997;11: Ermler KL, Thomas CE. Interventions for the alienating effect of injury. J Athl Train. 1990;25: Wiese-Bjornstal DM, Smith A, Shaffer S, Morrey M. An integrated model of response to sport injury: psychological and sociological dynamics. J Appl Sport Psychol. 1998;10: Bandura A. Self-efficacy mechanism in physiological activation and health-promoting behavior. In: Madden J, Matthysee S, Barchas J, eds. Adaptation, Learning and Affect. New York: Raven; 1989: Schwarzer R, Fuchs R. Self-efficacy and health behaviors. In: Conner M, Norman P, eds. Predicting Heath Behaviors: Research and Practice with Special Cognition Models. Buckingham, UK: Open University Press;1995: Shaffer SM. Attributions and Self-Efficacy as Predictors of Rehabilitative Success. Unpublished master s thesis. University of Illinois, Urbana- Champaign. 25. Hamson -Utley JJ, Martin S, Walters J. Athletic trainers and physical therapists perceptions of the effectiveness of psychological skills within sport injury rehabilitation programs. J Athl Train. 2008;43: National Athletic Trainers Association. Athletic Training Educational Competencies, 5 th ed. Dallas, TX: National Athletic Trainers Association; Hardin SI, Subich LM, Holvey JM. Expectancies for counseling in relation to premature termination. J Couns Psychol. 1988;35: Shaffer SM. Attributions and Self-Efficacy as Predictors of Rehabilitative Success. Unpublished master s thesis. University of Illinois, Urbana- Champaign; Damien Clement is an assistant professor with the College of Physical Activity and Sport Sciences at West Virginia University in Morgantown. He is also an athletic trainer and certified consultant with the Association for Applied Sport Psychology. Jordan Hamson-Utley is an assistant professor and Director of the Undergraduate Athletic Training Program at Weber State University, Ogden UT. She is also a licensed athletic trainer. Monna Arvinen-Barrow is a senior lecturer in Sport and Exercise Psychology at the University of Northampton, UK. Cindra Kamphoff is an associate professor and Coordinator of the Sport and Exercise Psychology Graduate Program at Minnesota State University, Mankato. She is also a certified consultant with the Association for Applied Sport Psychology. Rebecca Zakrajsek is with the Department of Kinesiology, Recreation, and Sport Studies at the University of Tennessee, Knoxville. She is also a certified consultant and fellow with the Association for Applied Sport Psychology. Scott B. Martin is a professor in the Department of Kinesiology, Health Promotion, & Recreation at the University of North Texas, Denton. He is also a consultant and fellow with the Association for Applied Sport Psychology. Frequency: Bimonthly (January, March, May, July, September, November) ISSN (print): ISSN (online): Don t miss a single issue! I already subscribe to IJATT. Please renew my subscription. Yes! Please start my one year subscription to IJATT. Print and online version ISBN: Individual Institution Student US $57.00 $ $42.00 International $72.00 $ $57.00 Canada $69.00 CDN $ CDN $51.00 CDN UK UK UK UK Europe EURO EURO EURO Australia $75.00 AUS $ AUS $55.00 AUS New Zealand $ NZ $ NZ $75.00 NZ International Journal of Athletic Therapy & Training (IJATT) is dedicated to the unique needs of athletic trainers and therapists. IJATT provides insights into professional practice issues, highlights sports health care techniques, shares experiential knowledge, and presents practical applications of current research. IJATT strives to present these subjects in a simple, streamlined format that focuses on clinical applications and athlete and patient care practices. IJATT is also available in an online format that offers the same great content available in the print edition with all the convenience of electronically formatted material. Human Kinetics Access your journal through the HK Journals app! Available from the Apple App Store. Subscription Total $ Please visit the website for additional pricing and information. Name Institution Advisor s Name Year In School (students only) (students only) Address City State Zip Phone (for journal online access) Personal Orders (Prepayment in U.S. funds is required) My check or money order is enclosed. (A fee of $25.00 will be charged for checks returned for insufficient funds) Charge my Visa American Express Mastercard Exp. Date Cardholder Name Account No. Signature (Required for credit card orders) Prices subject to change. 12/11 (800) US (217) INT (800) CDN 44 (0) UK (08) AUS NZ Human Kinetics P.O. Box 5076 Champaign, IL international journal of Athletic Therapy & training july