How do occupational therapy and occupational science researchers conceptualize resilience? A scoping review

Como pesquisadores em terapia ocupacional e ciência ocupacional conceituam resiliência? Uma revisão de escopo

Abstract

The concept of resilience can be theorized at individual and/or collective levels—all indicating adaptation to disruption or stress. Within occupational science and occupational therapy, some researchers have asserted an important relationship between occupation and resilience. However, there has not yet been a published review of resilience in occupation-focused literature, despite calls for such research and the existence of resilience reviews in other disciplines. Using the Joanna Briggs Institute scoping review methodological guidelines, we aimed to summarize the characteristics of resilience research in occupational science and occupational therapy. Our inclusion criteria encompassed occupation- and resilience-focused empirical research articles published from 1990-2023. Our review question was: How is resilience conceptualized and operationalized in occupational therapy and occupational science research literature? We identified 222 articles that met our inclusion criteria. Results demonstrate inconsistent engagement with resilience definitions, theories, and outcome measures—though a predominantly psychological perspective on the concept was noted. Over half of included articles were published since 2020, illustrating an increasing interest in resilience among researchers. We highlight conceptualizations of resilience originating from occupational science and occupational therapy, including different uses of the term “occupational resilience”. We hope our study can be a starting point for further occupation-focused resilience research and, to that end, we include several recommendations for researchers and clinicians who are interested in resilience. Resilience is a highly relevant concept in occupational therapy, and we believe that the worldwide focus on how to become more resilient could benefit from the occupational perspective.

Keywords:
Resilience; Psychological; Review Literature as Topic; Occupational Therapy; Disasters

Resumo

O conceito ‘resiliência’ pode ser compreendido de uma perspectiva individual e/ou coletiva – todas indicando algum nível de adaptação frente a perturbações ou estresse. Na ciência ocupacional e na terapia ocupacional, alguns pesquisadores têm afirmado haver uma relação importante entre ocupação e resiliência. No entanto, ainda não há uma revisão publicada sobre resiliência na literatura focada em ocupação, apesar das justificativas para tal e da existência de revisões sobre resiliência em outras disciplinas. Utilizando as diretrizes metodológicas de revisões de escopo do Instituto Joanna Briggs, resumimos as características gerais da pesquisa sobre resiliência em ciência ocupacional e terapia ocupacional. Critérios de inclusão abrangeram artigos focados em ocupação e resiliência publicados de 1990 a 2023. A pergunta de pesquisa foi: Como a resiliência é conceituada e operacionalizada na literatura em ciência ocupacional e terapia ocupacional? Foram identificados 222 artigos atendendo nosso critério de inclusão. Resultados demonstram um engajamento inconsistente com definições, teorias e medidas de resiliência — embora tenhamos notado uma perspectiva predominantemente psicológica sobre o conceito. Mais da metade dos artigos incluídos foram publicados desde 2020, ilustrando um foco crescente sobre resiliência entre pesquisadores. Destacamos conceituações de resiliência originadas na ciência ocupacional e na terapia ocupacional, incluindo diferentes usos do termo “resiliência ocupacional”. Este estudo é um ponto de partida para futuras pesquisas focadas em resiliência na ocupação e, para esse fim, incluímos recomendações para pesquisadores e clínicos interessados. Resiliência é um conceito altamente relevante em terapia ocupacional e o foco mundial em como se tornar mais resiliente pode se beneficiar da perspectiva ocupacional.

Palavras-chave:
Resiliência Psicológica; Literatura de Revisão como Assunto; Terapia Ocupacional; Desastres

Introduction

In the aftermath of both the COVID-19 pandemic and the increasing effects of climate change worldwide, the word “resilience” is at the forefront of many people’s minds (Brown, 2021; Sima et al., 2017). In a general sense, resilience describes the ability or action of managing, coping with, and/or adapting to events of disruption and stress. However, the precise meaning of the concept varies between disciplines, has evolved over time, and can be studied at an individual or collective level (Ryff & Singer, 2008). To offer three examples, psychological resilience often refers to a set of (acquired and/or ingrained) traits that enable a person to cope (Werner & Smith, 2001), disaster resilience encompasses a community/society’s capacity to manage through the effects of a disaster (Cox & Hamlen, 2015), and some definitions of social ecological resilience describe it as “[…] an interactive process between broad social environments and individual adaptive mechanisms” (Salsi et al., 2017, p. 237). This article outlines how resilience has been conceptualized within the domain of occupation-focused research and practice (i.e., occupational science and occupational therapy). Although we understand that occupational science and occupational therapy can be considered as two distinct disciplines, we decided in this study to converse with both due to their shared occupation-focused perspectives and interconnected histories/bodies of literature (Wilcock, 1998; Yerxa et al., 1990).

In occupational therapy, the word “resilience” appears within some of the discipline’s important texts. For example, in Chapter 6 of A Model of Human Occupation (Fisher et al., 2024, p. 82), the authors assert that people’s experiences of their occupational performance “[…] give meaning to concepts of distance, direction, temporality, clarity, resistance, resilience, and obscurity”. In the article that first put forward the Ecology of Human Performance framework (Dunn et al., 1994, p. 605), a concluding suggestion for further research is to answer the question, “Are there particular contextual features [in the framework] that contribute to a person's resilience?”. Resilience has also been asserted to be “[…] among the innermost and distinct features of occupational therapy” (Peloquin, 2007, p. 477).

Some occupation-focused researchers have espoused the notion of resilience as an interactive process. For example, in Charles Christiansen’s published lecture to the Society for Human Occupation (Christiansen, 2007), as well as in some of his subsequent works (e.g., Matuska & Christiansen, 2008), Christiansen linked resilience with occupation. In an editorial article about occupational disruption during the COVID-19 pandemic (Brown, 2021, p. 104), occupational therapist Ted Brown suggested the concept of occupational resilience to describe “[…] a person's ability to successfully and creatively navigate and negotiate life stressors, challenging environments and difficult events, whereby changes and modifications to daily occupations and occupational participation are required”.

Meanwhile, some occupation-focused researchers have proposed multifaceted models of resilience. The Meaning of Life Experiences model (King, 2004)—developed from a literature review, with a goal of informing rehabilitation researchers and clinicians—proposes three processes of acquiring resilience: belonging, self-understanding, and doing. The Traumatic Brain Injury (TBI) Resiliency model (Nalder et al., 2019)—developed through a narrative literature review—suggests four components of resilience to TBI: self-efficacy, emotional functioning, self-awareness, and cognitive factors. Among youth transitioning from school to work, DeLuca et al. (2012) created the Person-in-Context Model for Enabling Resilience through Work-based Education (WBE), which purports WBE to foster resilience among at-risk youth as influenced by individual, social, and policy-related factors.

Importantly, some occupational authors (e.g., Wachspress et al., 2019) have critiqued the notion of resilience as perpetuating neoliberalist and ableist paradigms by demarking people and societies as either resilient or not resilient. Other researchers (e.g., Rushford & Thomas, 2016) contend that the threat of climate change is so great that people will no longer be able to demonstrate resilience to its effects. It is beyond the scope of this paper to delve into all the critiques of resilience, but we recognize the necessity of engaging critically with terms and concepts that are so popularly used in research—including in occupational science and occupational therapy.

Although resilience appears in many pieces of occupation-focused writing, its conceptualization does not have a consistently clear pattern. There are also calls to further explore resilience from an occupation-focused perspective (Gómez-Trinidad et al., 2021; Vaughan-Horrocks et al., 2021). Although resilience reviews have been conducted in other disciplines (e.g., Barrett et al., 2021), to our knowledge, there has not yet been a published review article investigating how resilience appears in occupational science and/or occupational therapy literature. Questions remain about which resilience paradigms are being drawn upon, which participant populations and outcome measures are represented, which methodologies are being applied, and many others. To address these gaps in the literature, we undertook a scoping review—for which we previously published a protocol paper (Turner et al., 2022c).

Study Aim and Review Questions

We aimed to identify how researchers in occupational therapy and occupational science theorize, discuss, and measure the concept of resilience. Our selected research method, scoping review, is a focused and structured literature review that captures the broad characteristics of a topic (Peters et al., 2020). This method can be particularly useful in instances where no published review exists on a given topic, as the scoping review approach can be a starting point for more in-depth or critical future inquiries (Tricco et al., 2018).

Quoted from our study protocol, our primary review question was, “How is resilience conceptualized and operationalized in occupational therapy and occupational science research literature?” (Turner et al., 2022c, p. 5). Underpinning this were the following subquestions:

1. What are the methodological, study participant-related, geographical, and temporal characteristics of occupation-focused resilience research?

2. What theories, frameworks, and/or definitions of resilience are used in occupation-focused research?

3. How is resilience measured in the occupational science and occupational therapy research literature?

Methods

Our methods followed the Joanna Briggs Institute methodological guidelines (JBI) for conducting scoping reviews (Peters et al., 2020), as well as the PRISMA extension for scoping reviews (Tricco et al., 2018). The overarching steps of a JBI scoping review include searching for potentially relevant records (e.g., research articles), reviewing each of the retrieved records based on a set of inclusion criteria, and extracting relevant information from each included record. The JBI scoping review guidelines have been widely used by researchers across various disciplines—including for other resilience scoping reviews (e.g., Barrett et al., 2021).

Positionality of authors

The first author (Turner) initially conceptualized and led all steps of this study, with their interest on the subject stemming from their positionality as an occupational therapist completing graduate-level research about resilience. Other study team members encompassed a skilled group of individuals, most of whom had previously participated in a scoping review and many of whom were current or former clinicians, including five occupational therapists (Turner, Miller, Blanco, Reid, and Towle), two physiotherapists (Moecke and Camp), and one rehabilitation assistant (Winter); having this strong contingent of rehabilitation clinicians was helpful in reviewing and interpreting the occupation-focused literature. Meanwhile, the diversity of backgrounds represented within our research team was a strength for this review, given the fact that both occupational science as a discipline and resilience as a concept draw from interdisciplinary perspectives.

Search strategy

A research librarian (coauthor Crosbie) with previous experience conducting scoping reviews was consulted during the search strategy development, with four academic databases selected: CINAHL, MEDLINE, PsycInfo, and Web of Science. Beyond these databases, we also identified 22 title and abstract records from article reference lists and Google search engine results. As indicated in our study protocol (Turner et al., 2022c), we originally intended to search for additional literature (e.g., thesis databases); however, we were constrained by resource limitations, so we focused on four databases that collectively index a large number of health and social science journals, including all the occupational therapy and occupational science periodicals that are also indexed on the OTDBase.

Search terms were adapted according to each database, but the general strategy incorporated terms for resilience plus terms for occupational science/occupational therapy (see Appendix A for our search of MEDLINE).

Eligibility criteria

To be included, articles needed to meet the following five criteria:

1. Published in the English language.

2. Published between 1990—the year of the first occupational science article (Yerxa et al., 1990)—and May 1, 2023 (date of final library database search).

3. Empirical research published in a peer-reviewed academic journal.

4. Include an occupational therapist or occupational scientist in the list of coauthors (verification method described in “Study Selection” below).

5. Include the root word “resilien*” in the title, abstract, and/or keywords—including resilience(s), resilient(ly), and resiliency/resiliencies.

As outlined in our protocol paper (Turner et al., 2022c), we originally employed a broader set of inclusion criteria to encompass non-research literature (e.g., editorials), as well as articles that included “resilien*” anywhere in the full text. We presented a preliminary analysis of this broader dataset at the World Federation of Occupational Therapists 2022 Annual Conference (Turner et al., 2022b). After team discussion about the large number of articles and the extensive representation of non-research literature, we refined our criteria to the list above.

Study selection

Database search results were uploaded to Covidence (Veritas Health Innovation, Melbourne, Australia). We then engaged in two sequential steps of screening records at the levels of 1) title and abstracts and 2) full texts. Our screening process at each step adhered to our inclusion and exclusion criteria.

Each title and abstract record was independently screened by two team members, with a third person offering a tie-breaking vote for any vote discrepancies between the initial screeners. To ensure including as many relevant articles as possible, we advanced a large portion of records to the full text screening stage for further review, including any with incomplete or missing information (e.g., abstract not included).

Next, we sought the full text files of all records which passed the title and abstract screening stage. Full text files not available as part of the research team’s institutional library subscriptions were sought by requesting interlibrary loans, reviewing publicly available search engine results, and directly contacting journals and authors. We then undertook a two-team-member screening process for each full text file—with vote discrepancies decided through team discussion. Our screening process entailed manually examining each article to verify whether it was an empirical, original research article that had “resilien*” in its title, abstract, and/or keywords. To verify occupational therapist or occupational scientist authorship, we first looked at the authors’ affiliations and biographical information in their respective articles, then—if we were still uncertain—searched online for public profiles (e.g., university webpages) and other published articles.

Data charting and extraction

We developed a data-charting form to extract relevant details from included articles (see Appendix B for completed data extraction form). We initially used the built-in data extraction software on Covidence, with two team members independently extracting data from each included article, and a third team member providing the consensus decision for any discrepancies; we later used Microsoft Excel (Microsoft Corporation, Redmond, WA) to organize the data into the data-charting form.

With respect to the data items extracted from each article, we noted: research methods used; population(s) of focus; geographic location(s); conceptualizations of resilience described; and (if applicable) how resilience was measured. We also recorded article frequency counts for individual authors and journals. In addition, we provided a summarized classification of how resilience was used within each article, with our classification decisions based upon a process of reviewing: 1) the resilience literature cited by the authors, 2) the mention of any resilience theories, models, frameworks, and/or definitions, 3) the use of any resilience assessment tools, and 4) the presence of any words to characterize resilience (e.g., psychological, family, or socio-ecological).

While analyzing the included articles, we noted instances where authors used the term “occupational resilience” or developed new theories, models, and/or frameworks of resilience. In grouping theories, models, and frameworks together, we recognize variability between scholars in answering the question of what constitutes a theory vs. a model vs. a framework. For the purposes of this review, we focused on instances wherein resilience was one of the central components of a visualized or described research finding that was 1) named by the authors as a theory, model, or framework and 2) aimed to summarize a phenomenon about resilience that could apply beyond the study context.

Results

Our screening of all retrieved records yielded 222 articles that met our full inclusion criteria (see Figure 1).

Figure 1
PRISMA Flow Diagram. ¹Note. The list of all 3266 records excluded during full text screening is available by the authors upon request.

Synthesis of results

Appendix B includes the extracted data from each of the 222 articles, while Appendix C is a numbered reference list of all included articles. We present summarized results in the following sections preceded by italicized headings related to our review questions. For sake of word count, in-text reference to included articles are denoted by square-bracketed numbers corresponding to their numerical position on the Appendix C reference list.

Which methodological approaches appear in the literature?

The 222 included articles encompassed 23 review articles and 199 non-review articles (see Appendix B, column H). Among the review articles, there were 7 systematic reviews, 11 scoping reviews, and 5 other types of structured literature reviews; none of these articles used the same criteria as our scoping review.

Among the non-review articles, 72 were quantitative studies, 101 were qualitative studies, and 26 used mixed-method approaches. Although not every article explicitly named their research designs, we found the three most common to be cross-sectional designs, phenomenological designs, and case study/series designs. Common sources of study data included interviews, surveys/questionnaires, and demographical information.

Which study populations are reported in the literature?

A wide range of participant populations were represented across the included articles (see Appendix B, column I). Studies focusing on healthcare professionals/students (including occupational therapy practitioners/students) encompassed the 68 included articles. Meanwhile, among studies investigating people with health conditions, the two most common participant categories were acquired brain injury (n=16) and spinal cord injury (n=11). Many studies also examined participants with multiple intersecting health conditions and social positionalities (e.g., military service members experiencing physical and/or mental health challenges [7]).

From an age breakdown perspective, studies employed a range of criteria and descriptions (e.g., exact meaning of “young adult” could be 15-25 years, 18-30 years, etc.) and sometimes included more than one age-related participant category. Children or youth were at least part of the focus of approximately 40 included articles, while adult (including older adult) study populations appeared most frequently.

As an outlier to the rest of the included literature, one article focused on a non-human population—specifically, the prosimian primate species [219]. Though we did not deliberately seek to encompass non-human research literature in our review, this article technically matched our inclusion criteria, so we list it among our results.

Where were the resilience studies conducted and published?

Study participants from nearly 40 countries were represented across the non-review articles (n=199). Perhaps unsurprisingly given our English language-based exclusion criterion, the top five countries by number of included articles all use English as an official or majority language: United States (n=39), Australia (n=37), Canada (n=36), South Africa (n=14), and United Kingdom (n=11). Five articles encompassed participants from multiple countries [21,111,157,176,180].

Just over one third of included articles were published in journals that primarily focus on occupational therapy and/or occupational science, while the majority appeared in journals that have a different or wider editorial scope. The three most represented journals were Disability & Rehabilitation (n=17), the Australian Occupational Therapy Journal (n=10), and the South African Journal of Occupational Therapy (n=10).

When Have the Occupation-Focused Resilience Research Articles Been Published?

There was an increasing volume of research literature published over time, with the majority of included articles (n=130) published since 2020 and very few (n=23) before 2013. The recency of this literature was further noted in the fact that 29 included articles focused on the impacts of COVID-19. Despite our inclusion criterion of time encompassing 1990-2023, the earliest article that met all our inclusion criteria was published in 1999 [82]. Figure 2 charts the number of articles per year.

Figure 2
Number of Included Articles per Year. Note. The number of resilience-focused occupational science and occupational therapy research articles indicated for 2022 and 2023 are likely underestimates due to the date of our library database search (May 2023), changes in article publication dates (e.g., articles available ahead-of-print online), and delays in database indexing of articles. †We identified no articles published in 2001 and 2006 that met our inclusion criteria.

How are occupation-focused researchers defining and/or conceptualizing resilience?

Full descriptions of how resilience was used in each article can be found in Appendix B, column J. Most commonly (n=71), we found resilience to be positioned primarily as a psychological construct. Sometimes, authors’ psychological conceptualizations of resilience were clear, such as using the term “psychological resilience” or discussing psychological resilience frameworks. In many other instances, the psychological perspectives about resilience were implicit, e.g., providing no resilience definition but using psychological resilience outcome measures.

We classified 28 articles as having unclear conceptualizations of resilience. These typically featured no engagement with other resilience literature, no resilience definitions, and/or vague/minimal use of the word “resilience”. In other words, these works were indexed with “resil*” by nature of the term appearing in their title, abstract, and/or keywords, but they did not appear to explicitly be in conversation with other resilience literature.

We noted over 50 studies wherein “resilience” appeared in the name or description of a qualitative finding (e.g., theme). Some of these studies also positioned their understanding of resilience within one or more existing resilience definitions or conceptualizations; for example, one article [134] integrated psychology and gerontology research to contextualize a resilience theme. In other instances, the word “resilience” appeared in the name of a qualitative result (e.g., theme or sub-theme), and a study participant said the word within a quoted data extract; for example, under their “Resiliency” qualitative finding, O’Brien et al. (2021, p. 235) [144] offered this participant quote: “I think cause I’ve always had knocks since I was young, I’ve just become resilient”. In many cases, however, “resilience” appeared in the name of a theme, but the authors did not integrate other resilience research literature, and if the word was used by participants, that evidence was not provided [e.g., 77].

Occupation-Focused Conceptualizations of Resilience. Approximately 20 articles primarily drew upon occupation-focused conceptualizations of resilience. In some instances, this entailed researchers building upon their own work, such as a literature review [38] wherein the authors refined a resilience model they had previously developed in a study of youth transitioning from school to work (DeLuca et al., 2012). For a few occupation-focused resilience models, we noted their influence within a wider body of literature, such as the Meaning of Life Experiences model (King, 2004), which formed some authors’ positionings of resilience [e.g., 48,102,103].

The term “occupational resilience” appeared in five included articles, with varying definitions and usages. One study [47] used an outcome measure called the Occupational Balance in Informal Caregivers questionnaire that includes an “occupational resilience” subscale, with the term meaning “the ability to perpetuate and to find new meaningful activities accompanying changed life circumstances” (Dür et al., 2021, p. 7). Another study [207] interpreted qualitative research findings using Muriithi & Muriithi’s (2020) occupational resilience definition, which the authors had put forward in a conference paper: “Occupational resilience enables one to continue performance of an occupation in circumstances in which great effort or even undertaking of risk is necessary to continue performance of the occupation” (Muriithi & Muriithi, 2020). Two qualitative studies [57,216] used the term “occupational resilience” as a way to summarize research findings, including Friedman (2022, p. 3), who stated, “Occupational resilience is built upon the concept of utilizing adaptable solutions to maintain participation in daily occupations”, and Wegner et al. (2022, p. 333), who wrote, “Young adults develop occupational resilience by being able to adapt to adverse circumstances to continue engaging in meaningful occupations such as leisure”. Meanwhile, Jacobs-Nzuzi Khuabi et al. (2022, p. 476) published a manuscript version [88] of the first author’s doctoral research, which entailed the development of a novel theory of occupational resilience, defined as, “The transactional relationship between personal, environmental and occupational resources that increases a person’s capacity to adapt positively to occupational challenges in the midst of adversity and facilitates his/her participation in valued occupations”.

Resilience Theories, Models, and Frameworks Originating From the Included Literature. We identified nine articles that—like Jacobs-Nzuzi Khuabi et al. (2022) [88]—put forward novel resilience theories, models, or frameworks [5,19,31,88,92,152,154,164,178]. Although it could be argued that each study included in this review represents an occupational perspective regarding resilience, we highlight in Appendix D the named theories, frameworks, and models of resilience that originated within our review’s included articles.

How is resilience measured by occupational researchers?

A total of 51 non-review articles quantified resilience using an outcome measure, with 40 of them selecting tools based on psychological resilience. Meanwhile, the majority of included non-review articles did not directly measure resilience—though some authors positioned this as a study limitation. Appendix E lists and describes the 23 assessment tools of resilience that were used across included articles.

The most commonly used tools were the Connor Davidson Resilience Scale (CD-RISC) (n=19) (Connor & Davidson, 2003), the Resilience at University Scale (n=4) (Turner et al., 2017), and the Brief Resilience Scale (n=4) (Smith et al., 2008). Most of the resilience measures were designed with psychological perspectives, but we identified some which were developed by occupational therapists and/or oriented toward a rehabilitation setting. These included: the Assessment Tool of Perceived Agency (Lautamo et al., 2021), the Occupational Balance in Informal Caregivers questionnaire (Dür et al., 2021), the Work Disability Functional Assessment Battery (Marfeo et al., 2018), the Physical Resilience Instrument for Older Adults (Hu et al., 2022), and the Resilience Scale for Parents of Children with Cancer (Onal et al., 2023).

Three included articles [48,53,103] drew upon a multicomponent model of resilience, then selected different assessment tools for each component of that model; in other words, although resilience was not directly assessed by any single tool, the combination of various measures was purported to provide a picture of resilience. These included one study [53] that drew upon the TBI Resiliency model (Nalder et al., 2019) and two studies [48,103] that used the Meaning of Life Experiences model (King, 2004).

Some authors reported that one or more of their selected assessment tools measured “resilience factors” (defined at varying levels of specificity) [e.g., 43,97,200]. In other instances, authors interpreted questionnaire findings to denote resilience—even when the tool was not designed as a resilience measure, e.g., one study [214] using the Autism Parenting Questionnaire (Wachspress et al., 2019) as a proxy for parental resilience.

Five articles quantified resilience in a manner that differed from the rest of the included literature. In one cross-sectional study [111], the authors examined among stroke survivors the concept of structural brain resilience, defined as “[…] maintenance of structural whole brain integrity, measured as younger brain age, despite matched lesion damage” (Liew et al., 2023); their method of quantifying resilience relied on interpretation of neural imaging. In three other studies, “resilience” as a category or name was applied by the authors to results of different statistical analyses—specifically cluster analysis [93], latent class analysis [221], and exploratory class analysis [23]. Another study [219] denoted mixed-methods results with the term “behavioral resilience” (Wood et al., 2000, p. 13).

Discussion

In this scoping review, we aimed to identify how researchers in occupational therapy and occupational science theorize, discuss, and measure the concept of resilience. Our findings demonstrate a large and increasing interest in resilience among occupation-focused researchers, a mixed level of engagement with other resilience literature, and a prominent trend of implicitly conceptualizing resilience from a psychological perspective.

Predominant conceptualizations of resilience

Our findings with respect to the predominant resilience conceptualizations align with a review paper of health system resilience (Biddle et al., 2020, p. 1106), which found that “[…] few empirical studies make use of an explicit conceptual framework for collection or analysis of data, thus not linking research objectives to the rich theoretical body of work on how resilience can be understood in a health system context”. Other than its focus on health system resilience, this review’s finding resonates with ours; the majority of articles included in our review implicitly drew upon a psychological understanding of resilience, but only some were explicitly in conversation with psychology “theoretical body of work” (Biddle et al., 2020, p. 1106).

Looking at the qualitative articles included in our review, resilience was frequently reported as a thematic finding. Some authors related their work to other resilience literature, but a larger proportion included the word “resilience” in a theme name without explicitly linking it to resilience research. This pattern echoes a scoping review of resilience in the humanitarian field (Barrett et al., 2021, p. 11), which found: “The majority of qualitative studies do not present clear or replicable methods to address the concept of resilience... [being] quite limited in scope, content, or external validity”.

Researchers enrich their work when they position it within wider conversations of their respective fields. Although psychological perspectives of resilience implicitly predominate occupational science and occupational therapy, it is beneficial when researchers in our field make their perspectives evident. There is also complexity in the operationalization of psychological resilience, as found in an integrative review of human resilience literature that identified six categories of resilience definitions (Métais et al., 2022). In other words, even if psychological perspectives guide a researcher’s resilience work, it may strengthen their research to articulate which theories/definitions they are using.

Our review’s finding regarding the prevalence of psychological resilience perspectives is perhaps unsurprising, given the clinical focus of occupational therapy. Understanding resilience as a set of individual traits—especially those that can be measurably improved within a therapeutic setting—aligns with the rehabilitative goals of occupational therapy. Where occupational therapy differs from other helping professions, however, is its focus on occupation.

Resilience with an occupational lens

A common message across much of our included literature was the centrality of occupation to resilience. Wilcock (1998, p. 257) defines occupation as “[…] all ‘doing’ that has intrinsic or extrinsic meaning”. Our review’s findings position resilience as directly related to this ‘doing’—with many authors asserting resilience to be affected by engaging in occupations.

Resilience was also positioned in some included studies as an outcome of the relationship between person, environment, and occupation—aligning with socioecological resilience researchers like Ungar (2016). Craig et al. (2017, p. 714), for instance, echoed Ungar’s conceptualization of resilience by stating, “Resilience can be understood not as an exclusively internal individual characteristic, but also in ecological terms encompassing person, occupation and environmental factors”. Situating resilience as not solely an individual trait addresses some of the critiques levied against neoliberal understandings of the concept, with ample room available for considering social and environmental factors like marginalization (Rushford & Thomas, 2016).

Highly-cited non-empirical articles in occupational science and occupational therapy have asserted that resilience and occupation are intertwined (e.g., Fine, 1991; Peloquin, 2007). Occupational scholars may wish to further investigate the resilience-occupation interrelationship. For quantitative researchers, a potential area for further study could be comparing data between outcome measures of resilience with those measuring occupational constructs, such as Cruyt et al. (2021) using both the CD-RISC (Connor & Davidson, 2003) and the Engagement in Meaningful Activities Scale (Eakman, 2012) in their study. For qualitative researchers, delving into questions of how people experience and describe resilience in relation to occupation may prove fruitful.

Another area that could be fruitful for growth in occupation-focused resilience research is engagement with theories, frameworks, and definitions originating from our own scholarly community. To that end, we offer readers Appendix D as a list of nine novel resilience conceptualizations originating from included literature. Rather than creating disconnected islands of resilience, we would humbly encourage occupation-focused researchers studying resilience to build bridges towards one another. By doing so, there may become greater consistency and clarity in how resilience is conceptualized by occupational scientists and occupational therapists—and perhaps even conceptual refinement of terms like “occupational resilience”.

Occupational resilience

The term “occupational resilience” appeared in five of our review’s included studies (Dür et al., 2022; Friedman, 2022; Jacobs-Nzuzi Khuabi et al., 2022; Turner et al., 2022a; Wegner et al., 2022). We had noted some usage of the term before commencing the review (e.g., Brown, 2021; Muriithi & Muriithi, 2020; Shaw, 2016)—though with variable conceptualizations that did not necessarily exemplify an occupational worldview. For example, Shaw’s (2016) published lecture used an economics definition of occupational resilience, which describes an employment sector’s adaptability to market disruption. The fact an occupational therapist would use a non-occupational science/occupational therapy theory of occupational resilience poses the question of whether the term already has a robust body of literature in economics, and so perhaps occupation-focused researchers should develop differently named resilience terms. At the same time, several identically-named terms are conceptualized distinctly and separately within occupational science/occupational therapy and other research fields, with little apparent cross-discipline conflict or confusion (e.g., occupational adaptation). From this perspective, using the term “occupational resilience” with an occupation-focused lens could be an approach for helping to focus resilience conversations for occupational therapists, occupational scientists, and other researchers interested in the occupational worldview.

In Appendix F, we list all iterations of “occupational resilience” we encountered while conducting this review. Beyond this list, we note the continued research into Muriithi & Muriithi’s (2020) definition, including the creation of an assessment tool called the Occupational Resilience Measure (ORM 1.0), which measures “[…] one’s capacity for persistence in an occupation… [i.e.,] the degree to which one is likely to continue a specified occupation when faced with adversity” (Muriithi & Gore, 2023, para. 1).

Assessing resilience

In highlighting the ORM 1.0, one fundamental question to ask is whether it is truly possible to quantify resilience through an outcome measure. If the definition of resilience is based solely on the items of the measure (e.g., CD-RISC), then yes. But when resilience has a more expanded conceptualization, then perhaps we can measure constructs that contribute to resilience, but not the full phenomenon itself. For example, in a study of people living with chronic pain, Park & Sonty (2010, p. 1272) examined correlations between participants’ scores on measures of self-reported pain intensity, perceptions of self-efficacy, and emotional affect, reporting that their findings “[…] may be explained by a framework within which the mediating role of positive emotions is related to a broader construct of psychological resilience”.

For occupational therapists looking for a clinical outcome measure of resilience, something that integrates an occupational perspective may be particularly desirable. The Physical Resilience Instrument for Older Adults (Hu et al., 2022, p. 3)—designed for older adults and based upon the gerontological notion of physical resilience—has some items that seem to target occupation, including: “I believe I can handle my daily activities” and “I believe I can recover to do my daily activities after illness or injury”. Meanwhile, the Assessment Tool for Perceived Agency (Lautamo et al., 2021, p. 100) does not focus specifically on resilience, but it does assess the construct of perceived agency as influenced by resilience; in the measure, some self-rated occupational items include: “I can solve daily challenges in a reasonable way”, and “I feel that I have enough skills to manage the challenges of daily life”.

With Ungar’s (2016) social-ecological notions of resilience somewhat aligning with an occupational worldview, assessment tools developed by Ungar may be relevant to occupational scientists and occupational therapists. Our review identified one study (Armstrong-Heimsoth et al., 2021) that used the Child and Youth Resilience Measure (CYRM-R), but none using the adult version of the tool, the Adult Resilience Measure (ARM-R). Though they are not explicitly occupation-focused, these resilience measures contain items that could be interpreted occupationally, for example: “I have opportunities to develop skills that will be useful later in life (like job skills and skills to care for others)” (CYRM-R) and “I have opportunities to apply my abilities in life (like skills, a job, caring for others)” (ARM-R) (Resilience Research Centre, 2018, p. 31-32).

Strengths and limitations

During our screening process, there is a chance we erroneously excluded some occupation-focused resilience articles at the title and abstract level. We endeavoured to mitigate this potential error by being very inclusive during the first screening stage, such that records with missing information or that we reasoned could be potentially relevant were forwarded to the full text review stage. An alternative strategy could have been to focus only on occupational journals, but this would have limited many relevant texts published elsewhere, as nearly two thirds of our included literature was published in non-occupation-focused periodicals.

Our inclusion criteria meant excluding some papers which extensively discussed resilience in their full text but did not use the term in their title, abstract, or keywords (e.g., Cameron et al., 2016). Despite this, we reasoned that if we had employed broader inclusion criteria to capture literature that is not indexed with the term “resilience”, then our results likely would have demonstrated a higher representation of articles that do not explicitly draw upon resilience research (e.g., colloquial use of the adjective “resilient”). We would encourage authors researching resilience to consider indexing their articles such that other resilience researchers could easily find them—i.e., include “resilien*” in the title, abstract, and/or keywords.

Our review did not incorporate the optional step of critical appraisal of included articles (Tricco et al., 2018). We acknowledge our review likely includes some articles with robust strategies of rigour, while others were conducted in a less rigorous manner. Similarly, our review reports but does not evaluate certain demographical/representational characteristics of the included literature, such as study participant populations and geographic locations of research—though we recognize the value of critically engaging with questions of over- and under-representation (and we encourage readers of this article to do so). We hope that future researchers can build upon our work as a starting point. Step one is often to identify the work that has been done—which is what we have aimed to do. Other researchers may wish to conduct more focused and/or evaluative types of reviews, such as systematic review, where the quality of the work can be investigated. We also recommend an updated review of resilience literature in occupational science and occupational therapy in a few years’ time, as the interest regarding the subject appears to be ever-increasing among occupation-focused researchers.

Only original research studies were included in our review, so highly-cited non-empirical articles (e.g., Fine, 1991) are not encompassed in our results. Previously we considered including more literature (e.g., dissertations, conference abstracts, editorials), but this proved too massive of an endeavour for our team to feasibility synthesize. Nonetheless, we have identified a large body of resilience research literature.

Conclusion

Across the occupational science and occupational therapy studies included in our review, resilience was conceptualized in a variety of ways and with ranging levels of engagement with other resilience research. We noted an increasing interest in resilience over time and the presence of several occupation-focused resilience theories, models, and frameworks—including varying definitions to date of the term “occupational resilience”. In the further development of occupation-focused conceptualizations of resilience, we would encourage occupational researchers who want to discuss this concept to consider whether their work builds upon previously completed occupation-focused resilience work. Of particular interest for occupational therapists wishing to measure change in a client’s resilience, our review also identified 23 resilience assessment tools used with various populations and study contexts. One area for future research is the further development and validation of resilience assessment measures incorporating occupational perspectives. Resilience is a topic of immense interest and importance for communities both within and beyond occupational science and therapy. We believe that the worldwide focus on how to become more resilient in the face of disruptive factors like climate change and COVID-19 could benefit from the occupational perspective. Occupation, from our understanding, represents the “how” of fostering resilience, and we can and should be proud of asserting this fact.

Appendix A Search Strategy.

Table A1 Search Terms Used in MEDLINE (Search Date: May 4, 2023)

#	Search Terms
1	exp Resilience, Psychological/
2	exp Adaptation, Psychological/
3	(resilien* or hardiness or transformation* or (occupation* adj2 adaptation*) or psychological adaptation*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]
4	1 or 2 or 3
5	exp Occupational Therapists/
6	exp Occupational Therapy/
7	(occupational therap* or occupational scien* or occupation*).mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]
8	(occupational therap* or occupational scien* or OT or BScOT or MOT or MScOT or DOT or DipOT or OTD or OTR* or allied health* or physiotherap* or physical therap*).in.
9	5 or 6 or 7 or 8
10	4 and 9
11	limit 10 to English language

Note. The exact iterations of these search terms varied between databases.

Appendix B Data Extracted From Included Studies.

Note. Appendix B is available as a supplemental file in Microsoft Excel (.xslx) format.

Appendix C Numbered Reference List of All Included Articles.

1. Ahum, Y., Aikat, R., & Kumar, P. (2016). Resilience in subjects with spinal cord injury. Indian Journal of Physiotherapy & Occupational Therapy, 10(4), 195–198. https://doi.org/10.5958/0973-5674.2016.00145.3

2. Allin, S., Shepherd, J., Thorson, T., Tomasone, J., Munce, S., Linassi, G., McBride, C. B., Jiancaro, T., & Jaglal, S. (2020). Web-based health coaching for spinal cord injury: Results from a mixed methods feasibility evaluation. JMIR Rehabilitation & Assistive Technologies, 7(2), 1–15. https://doi.org/10.2196/16351

3. Apostol, C., Cranwell, K., & Hitch, D. (2021). Evaluating a multidimensional strategy to improve the professional self-care of occupational therapists working with people with life limiting illness. BMC Palliative Care, 20(2), 1–12. https://doi.org/10.1186/s12904-020-00695-x

4. Armstrong-Heimsoth, A., Hahn-Floyd, M., Williamson, H. J., Kurka, J. M., Yoo, W., & Rodríguez De Jesús, S. A. (2021). Former foster system youth: Perspectives on transitional supports and programs. Journal of Behavioral Health Services & Research, 48, 287–305. https://doi.org/10.1007/s11414-020-09693-6

5. Ashby, S. E., Ryan, S., Gray, M., & James, C. (2013). Factors that influence the professional resilience of occupational therapists in mental health practice. Australian Occupational Therapy Journal, 60(2), 110–119. https://doi.org/10.1111/1440-1630.12012

6. Avrech Bar, M., Katz Leurer, M., Warshawski, S., & Itzhaki, M. (2018). The role of personal resilience and personality traits of healthcare students on their attitudes towards interprofessional collaboration. Nurse Education Today, 61, 36–42. https://doi.org/10.1016/j.nedt.2017.11.005

7. Beck, C. E., Gonzales, F., Sells, C. H., Jones, C., Reer, T., & Zhu, Y. Y. (2012). The effects of animal-assisted therapy on wounded warriors in an Occupational Therapy Life Skills program. U.S. Army Medical Department Journal, 38–45.

8. Ben-Avraham, R., Afek, A., Berezin Cohen, N., Davidov, A., Van Vleet, T., Jordan, J., Ben Yehudah, A., Gilboa, Y., & Nahum, M. (2022). Feasibility and preliminary effectiveness of mobile cognitive control training during basic combat training in the military. Military Psychology, 34(1), 55–67. https://doi.org/10.1080/08995605.2021.1969162

9. Boniface, G., Humpage, S., Awatar, S., & Reagon, C. (2015). Developing an occupation- and recovery-based outcome measure for people with mental health conditions: An action research study. British Journal of Occupational Therapy, 78(4), 222–231. https://doi.org/10.1177/0308022614562788

10. Boshoff, K., Gibbs, D., Phillips, R. L., Wiles, L., & Porter, L. (2019). A meta‐synthesis of how parents of children with autism describe their experience of advocating for their children during the process of diagnosis. Health & Social Care in the Community, 27(4), 143–157. https://doi.org/10.1111/hsc.12691

11. Bowden, L., Reed, K., & Nicholson, E. (2018). The contribution of occupation to children’s experience of resilience: A qualitative descriptive study. Australian Occupational Therapy Journal, 65(4), 268–275. https://doi.org/10.1111/1440-1630.12462

12. Boyes, M. E., Leitao, S., Claessen, M., Dzidic, P., Badcock, N. A., & Nayton, M. (2021). Piloting “Clever Kids”: A randomized-controlled trial assessing feasibility, efficacy, and acceptability of a socioemotional well-being programme for children with dyslexia. British Journal of Educational Psychology, 91(3), 950–971. https://doi.org/10.1111/bjep.12401

13. Brack, P., Bramley, A., Downie, S., Gardner, M., Leo, J., Sturt, R., & Markham, D. (2021). Riding the waves: Lessons learnt from Victoria’s COVID-19 pandemic response for maintaining effective allied health student education and clinical placements. Australian Health Review, 45(6), 683–689. https://doi.org/10.1071/AH21145

14. Breitkreuz, R., Wunderli, L., Savage, A., & McConnell, D. (2014). Rethinking resilience in families of children with disabilities: A socioecological approach. Community, Work & Family, 17(3), 346–365. https://doi.org/10.1080/13668803.2014.893228

15. Brown, T., Yu, M., & Etherington, J. (2021). Listening and interpersonal communication skills as predictors of resilience in occupational therapy students: A cross-sectional study. British Journal of Occupational Therapy, 84(1), 42–53. https://doi.org/10.1177/0308022620908503

16. Brown, T., Yu, M., Hewitt, A., Cousland, R., & Etherington, J. (2022). Professionalism, resilience and reflective thinking: How do these influence occupational therapy student fieldwork outcomes? Occupational Therapy in Health Care, 36(4), 327–352. https://doi.org/10.1080/07380577.2021.1978606

17. Brown, T., Yu, M., Hewitt, A. E., Isbel, S. T., Bevitt, T., & Etherington, J. (2020). Exploring the relationship between resilience and practice education placement success in occupational therapy students. Australian Occupational Therapy Journal, 67(1), 49–61. https://doi.org/10.1111/1440-1630.12622

18. Bundy, A. C., Luckett, T., Naughton, G. A., Tranter, P. J., Wyver, S. R., Ragen, J., Singleton, E., & Spies, G. (2008). Playful interaction: Occupational therapy for all children on the school playground. American Journal of Occupational Therapy, 62(5), 522–527. https://doi.org/10.5014/ajot.62.5.522

19. Cameranesi, M., Ripat, J. D., & Piotrowski, C. C. (2021). “I wouldn’t be here without them”: Resilience in youth exposed to intimate partner violence. Adversity and Resilience Science, 2, 19–35. https://doi.org/10.1007/s42844-020-00023-5

20. Carra, K., Curtin, M., Fortune, T., & Gordon, B. (2021). Participation in occupations, health and adjustment during the transition from military service: A cross-sectional study. Military Psychology, 33(5), 320–331. https://doi.org/10.1080/08995605.2021.1962180

21. Ceramidas, D., de Zita, C. F., Eklund, M., & Kirsh, B. (2009). The 2009 world team of mental health occupational therapists: A resilient and dedicated workforce. World Federation of Occupational Therapists Bulletin, 60(1), 9–17. https://doi.org/10.1179/otb.2009.60.1.003

22. Cerny, S., Reishus, J., Robinson, W., Beckman, S., Buse, E., Sebastian, R., & Smith, J. (2022). Promoting social-emotional development in children experiencing economic hardship using TBRI® Nurture Group©. Journal of Occupational Therapy, Schools, & Early Intervention, 15(1), 31-48. https://doi.org/10.1080/19411243.2021.1884633

23. Challita, J., Chapparo, C., & Hinitt, J. (2019). Patterns of social skill difficulties in young children with reduced social competence: Parent and teacher perceptions. Journal of Occupational Therapy, Schools, & Early Intervention, 12(3), 298–310. https://doi.org/10.1080/19411243.2019.1590752

24. Cheung, L., Chan, K., Heffernan, M. G., Pakosh, M., Hitzig, S. L., Marzolini, S., Kalsi-Ryan, S., & Musselman, K. E. (2022). The impact of sport participation for individuals with spinal cord injury: A scoping review. NeuroRehabilitation, 51(3), 353–395. https://doi.org/10.3233/NRE-220037

25. Cho, E., Osenga, S., Forwell, S. J., & Lee Bunting, K. (2023). Understanding occupation in Canada: Recent graduates’ perspectives. Scandinavian Journal of Occupational Therapy, 30(4), 488–496. https://doi.org/10.1080/11038128.2023.2173646

26. Christopher, C., Joubert, R. W., & Pillay, M. (2021). “Walking with a smile but her shoulders are hanging down” Exploring “Coloured” women’s occupational resistance in the face of personal, historied and societal suffocation. South African Journal of Occupational Therapy, 51(2), 4–12. https://doi.org/10.17159/2310-3833/2021/vol51n4a2

27. Chui, A., Dainty, K. N., Kirsh, B., Dawson, D. R., & Colquhoun, H. (2022). Hope for “continued vitality”: Qualitative study of adults with traumatic brain injury and low mood on their rehabilitation. Frontiers in Rehabilitation Sciences, 3, 1–11. https://doi.org/10.3389/fresc.2022.848575

28. Clouston, T. J. (2019). Pearls of wisdom: Using the single case study or “gem” to identify strategies for mediating stress and work-life imbalance in healthcare staff. Journal of Research in Nursing, 24(1-2), 61–72. https://doi.org/10.1177/1744987118809506

29. Colloby, S., Whiting, S., & Warren, A. (2022). Supporting the couple relationship following dementia diagnosis: A scoping review. Health & Social Care in the Community, 30(6), 3643–3655. https://doi.org/10.1111/hsc.14006

30. Craig, L., Cameron, J., & Longden, E. (2017). Work-related experiences of people who hear voices: An occupational perspective. British Journal of Occupational Therapy, 80(12), 707–716. https://doi.org/10.1177/0308022617714749

31. Crawford, E., Turpin, M., Nayar, S., Steel, E., & Durand, J.-L. (2016). The structural-personal interaction: Occupational deprivation and asylum seekers in Australia. Journal of Occupational Science, 23(3), 321–338. https://doi.org/10.1080/14427591.2016.1153510

32. Cruyt, E., De Vriendt, P., De Letter, M., Vlerick, P., Calders, P., De Pauw, R., Oostra, K., Rodriguez-Bailon, M., Szmalec, A., Merchan-Baeza, J. A., Fernandez-Solano, A. J., Vidana-Moya, L., & Van de Velde, D. (2021). Meaningful activities during COVID-19 lockdown and association with mental health in Belgian adults. BMC Public Health, 21, 1–15. https://doi.org/10.1186/s12889-021-10673-4

33. Davies, K., Curtin, M., & Robson, K. (2017). Impact of an international workplace learning placement on personal and professional development. Australian Occupational Therapy Journal, 64(2), 121–128. https://doi.org/10.1111/1440-1630.12338

34. Davy, C., Magalhães, L. V., Mandich, A., & Galheigo, S. M. (2014). Aspects of the resilience and settlement of refugee youth: A narrative study using body maps. Cadernos de Terapia Ocupacional da UFSCar, 22(2), 231–241. https://doi.org/10.4322/cto.2014.045

35. de Vries, A., Mthembu, T. G., & Wegner, L. (2023). Older adults’ adaptiveness to disruptions during South Africa’s COVID-19 lockdown: Keep your head up and continue breathing. South African Journal of Occupational Therapy, 53(1), 54–66.

36. de Witt, P. A., Monareng, L., Abraham, A. A., Koor, S., & Saber, R. (2019). Resilience in occupational therapy students. South African Journal of Occupational Therapy, 49(2), 33–41.

37. Dean, E. E., Little, L., Tomchek, S., & Dunn, W. (2018). Sensory processing in the general population: Adaptability, resiliency, and challenging behavior. American Journal of Occupational Therapy, 72(1), 1–8. https://doi.org/10.5014/ajot.2018.019919

38. DeLuca, C., Godden, L., Hutchinson, N. L., & Versnel, J. (2015). Preparing at-risk youth for a changing world: Revisiting a person-in-context model for transition to employment. Educational Research, 57(2), 182–200. https://doi.org/10.1080/00131881.2015.1030854

39. DeLuca, C., Hutchinson, N. L., deLugt, J. S., Beyer, W., Thornton, A., Versnel, J., Chin, P., & Munby, H. (2010). Learning in the workplace: Fostering resilience in disengaged youth. WORK, 36(3), 305–319. https://doi.org/10.3233/WOR-2010-1032

40. Derakhshan, P., Miller, W. C., Borisoff, J., Esfandiari, E., Forwell, S., Jarus, T., Mohammadi, S., Rash, I., Sakakibara, B., Schmidt, J., Tao, G., Tregobov, N., & Mortenson, W. B. (2022). Describing the function, disability, and health of adults and older adults during the early coronavirus restrictions in 2019: An online survey. Disabilities, 2(4), 575–587. https://doi.org/10.3390/disabilities2040041

41. Derakhshanrad, S. A., Piven, E. F., & Ghoochani, B. Z. (2017a). Adaption to stroke: A nonlinear thinking approach in occupational therapy. Occupational Therapy in Health Care, 31(3), 255–269. https://doi.org/10.1080/07380577.2017.1335922

42. Derakhshanrad, S. A., Piven, E. F., & Ghoochani, B. Z. (2017b). Comparing the cognitive process of circular causality in two patients with strokes through qualitative analysis. Nonlinear Dynamics, Psychology, and Life Sciences, 21(4), 555–567.

43. Dumont, C., Gervais, M., Fougeyrollas, P., & Bertrand, R. (2004). Toward an explanatory model of social participation for adults with traumatic brain injury. Journal of Head Trauma Rehabilitation, 19(6), 431–444. https://doi.org/10.1097/00001199-200411000-00002

44. Duncan, A., & Batliwalla, Z. (2018). Growing older with post-polio syndrome: Social and quality-of-life implications. SAGE Open Medicine, 6, 1–7. https://doi.org/10.1177/2050312118793563

45. Duncan, M., Swartz, L., & Kathard, H. (2011a). The burden of psychiatric disability on chronically poor households: Part 1 (costs). South African Journal of Occupational Therapy, 41(3), 55–63.

46. Duncan, M., Swartz, L., & Kathard, H. (2011b). The burden of psychiatric disability on chronically poor households: Part 2 (coping). South African Journal of Occupational Therapy, 41(3), 64–70.

47. Dür, M., Röschel, A., Oberleitner-Leeb, C., Herrmanns, V., Pichler-Stachl, E., Mattner, B., Pernter, S.-D., Wald, M., Urlesberger, B., Kurz, H., Frischer, T., Zwiauer, K., Matter, I. S., & Berger, A. (2022). Associations between parental occupational balance, subjective health, and clinical characteristics of VLBW infants. Frontiers in Pediatrics, 10, 1–10. https://doi.org/10.3389/fped.2022.816221

48. Eakman, A. M., Schelly, C., & Henry, K. L. (2016). Protective and vulnerability factors contributing to resilience in post-9/11 veterans with service-related injuries in postsecondary education. American Journal of Occupational Therapy, 70(1), 1–10. https://doi.org/10.5014/ajot.2016.016519

49. Easton, C., Oudshoorn, A., Smith‐Carrier, T., Forchuk, C., & Marshall, C. A. (2022). The experience of food insecurity during and following homelessness in high‐income countries: A systematic review and meta‐aggregation. Health & Social Care in the Community, 30(6), 3384–3405. https://doi.org/10.1111/hsc.13939

50. Einerson, J., Lundstrom, L. K., Allen, B. K., Sefandonakis, A., & Terrill, A. L. (2023). Learning to flourish in a new reality: A thematic analysis of couples’ experience of participation in a positive psychology intervention post-stroke. Disability & Rehabilitation, 45(16), 2612–2619. https://doi.org/10.1080/09638288.2022.2102256

51. Engel-Yeger, B. (2022). Emotional status and quality of life in women with ADHD during COVID-19. Occupational Therapy Journal of Research, 42(3), 219–227. https://doi.org/10.1177/15394492221076516

52. Erez, A. B.-H., Katz, N., & Waldman-Levi, A. (2016). Protective personality variables and their effect on well-being and participation in the elderly: A pilot study. Healthy Aging Research, 5, 1–9. https://doi.org/10.1097/01.HXR.0000508388.87759.42

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54. Falk-Kessler, J., Kalina, J. T., & Miller, P. (2012). Influence of occupational therapy on resilience in individuals with multiple sclerosis. International Journal of MS Care, 14(3), 160–168. https://doi.org/10.7224/1537-2073-14.3.160

55. Fang, C.-J., Tong, N., Villa, R. J., Flores, A. M., Lim, E., & Tu, A. (2022). Adult attachment, stress-coping, and resilience in first-generation immigrants in the United States. British Journal of Occupational Therapy, 85(5), 332–340. https://doi.org/10.1177/03080226211022962

56. Fisher, R., Parmar, J., Duggleby, W., Tian, P. G. J., Janzen, W., Anderson, S., & Brémault-Phillips, S. (2020). Health-care workforce training to effectively support family caregivers of seniors in care. Canadian Geriatrics Journal, 23(2), 160–171. https://doi.org/10.5770/cgj.23.384

57. Friedman, Z. L. (2022). Breakfast club lessons: Staff perspectives on a yearlong collaborative teletherapy initiative during COVID-19. Journal of Research on Technology in Education, 56(2), 1–22. https://doi.org/10.1080/15391523.2022.2119447

58. Gahlot, A., Chiaravalloti, N., & Goverover, Y. (2023). The impact of personal protective factors on quality of life after traumatic brain injury. Brain Injury, 37(7), 621–627. https://doi.org/10.1080/02699052.2023.2187090

59. Gardiner, S.-A., & Martin, P. (2022). Bringing organisations together during a pandemic: The case of an intersectoral community support group. Australian Health Review, 46(1), 121–125. https://doi.org/10.1071/AH21230

60. Gcaza, S., & Lorenzo, T. (2008). Discovering the barriers that stop children with disabilities from being children: The impact of lack of access to mobility devices—A human rights perspective. South African Journal of Occupational Therapy, 38(1), 16–21.

61. George, M., Brown, T., & Yu, M.-L. (2022). The relationship between resilience, reflective thinking and professionalism in Australian undergraduate occupational therapy students. Scandinavian Journal of Occupational Therapy, 29(3), 229–241. https://doi.org/10.1080/11038128.2021.1908421

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64. Ghoochani, B. Z., Derakhshanrad, S. A., & Ahmadpour, M. (2022). Investigating the relationship between locus of control, emotional intelligence, and resilience among young male opium abusers in Shiraz. Journal of Rehabilitation Sciences & Research, 9(4), 162–166. https://doi.org/10.30476/jrsr.2022.91888.1191

65. Gibbs, D. P., Boshoff, K., & Stanley, M. J. (2016). The acquisition of parenting occupations in neonatal intensive care: A preliminary perspective. Canadian Journal of Occupational Therapy, 83(2), 91–102. https://doi.org/10.1177/0008417415625421

66. Giri, S., Mir, N., Al-Obaidi, M., Clark, D., Kenzik, K. M., McDonald, A., Young-Smith, C., Paluri, R., Nandagopal, L., Gbolahan, O., Nyrop, K. A., Muss, H. B., Pergolotti, M., Bhatia, S., & Williams, G. R. (2022). Use of single-item self-rated health measure to identify frailty and geriatric assessment-identified impairments among older adults with cancer. The Oncologist, 27(1), 45–52. https://doi.org/10.1093/oncolo/oyab020

67. Gomez-Trinidad, M. N., Chimpen-Lopez, C. A., Rodriguez-Santos, L., Moral, M. A., & Rodriguez-Mansilla, J. (2021). Resilience, emotional intelligence, and occupational performance in family members who are the caretakers of patients with dementia in Spain: A cross-sectional, analytical, and descriptive study. Journal of Clinical Medicine, 10(18), 1–18. https://doi.org/10.3390/jcm10184262

68. Gustafsdottir, S. S., Sigurdardottir, A. K., Mårtensson, L., & Arnadottir, S. A. (2022). Making Europe health literate: Including older adults in sparsely populated Arctic areas. BMC Public Health, 22(511), 1–12. https://doi.org/10.1186/s12889-022-12935-1

69. Gustafsson, P. E., Nilsson, I., & San Sebastian, M. (2022). Venerable vulnerability or remarkable resilience? A prospective study of the impact of the first wave of the COVID-19 pandemic and quarantine measures on loneliness in Swedish older adults with home care. BMJ Open, 12(5), 1–8. https://doi.org/10.1136/bmjopen-2021-060209

70. Gustafsson, P. E., Schröders, J., Nilsson, I., & Sebastián, M. S. (2022). Surviving through solitude: A prospective national study of the impact of the early COVID-19 pandemic and a visiting ban on loneliness among nursing home residents in Sweden. Journals of Gerontology Series B: Psychological Sciences & Social Sciences, 77(12), 2286–2295. https://doi.org/10.1093/geronb/gbac126

71. Hall, S., McKinstry, C., & Hyett, N. (2016). Youth perceptions of positive mental health. British Journal of Occupational Therapy, 79(8), 475–483. https://doi.org/10.1177/0308022616632775

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158. Price, P., Kinghorn, J., Patrick, R., & Cardell, B. (2012). “Still there is beauty”: One man’s resilient adaptation to stroke. Scandinavian Journal of Occupational Therapy, 19(2), 111–117. https://doi.org/10.3109/11038128.2010.519402

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189. Sinvani, R.-T., Fogel-Grinvald, H., Afek, A., Ben-Avraham, R., Davidov, A., Cohen, N. B., Ben Yehuda, A., Nahum, M., & Gilboa, Y. (2021). Ecological momentary mood, resilience, and mental health status as predictors of quality of life among young adults under stress: A structural equation modeling analysis. Frontiers in Psychiatry, 12, 1–13. https://doi.org/10.3389/fpsyt.2021.672397

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191. Smith, J., Whittington, F., Ackermann, C., Clarke, R., Hoten-Walker, G., Kubba, Y., Low, C., Partridge, K., Wang, C., Dockerty, J. D., Robertson, L., Hale, L., & Waters, D. L. (2022). Impact of the 2020 New Zealand COVID-19 lockdown on participants in a community-based, peer-led fall prevention program. Australasian Journal on Ageing, 41(3), 240–248. https://doi.org/10.1111/ajag.13040

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198. Sy, M. P., Yao, D. P., Panotes, A., Kaw, J., & Mendoza, T. (2023). Contemporary history: Progress and resilience of occupational therapy in the Philippines (2004-2020). World Federation of Occupational Therapists Bulletin, 79(1), 80–93. https://doi.org/10.1080/14473828.2021.1995226

199. Szigeti, Z., Nalder, E., King, G., Farthing, J., & Gauvin-Lepage, J. (2021). The road to family resiliency: A case report of a family’s experiences following adolescent stroke. Rehabilitation Nursing, 46(2), 87–94. https://doi.org/10.1097/RNJ.0000000000000293

200. Tal-Saban, M., & Zaguri-Vittenberg, S. (2022). Adolescents and resilience: Factors contributing to health-related quality of life during the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 19(6), 1–10. https://doi.org/10.3390/ijerph19063157

201. Tan, B.-L., Zhen Lim, M. W., Xie, H., Li, Z., & Lee, J. (2020). Defining occupational competence and occupational identity in the context of recovery in schizophrenia. American Journal of Occupational Therapy, 74(4), 1–11. https://doi.org/10.5014/ajot.2020.034843

202. Taylor, M. F., Coall, D., Marquis, R., & Batten, R. (2016). Drug addiction is a scourge on the earth and my grandchildren are its victims: The tough love and resilient growth exhibited by grandparents raising the children of drug-dependent mothers. International Journal of Mental Health and Addiction, 14, 937–951. https://doi.org/10.1007/s11469-016-9645-7

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205. Thomas, Y., & Judd, J. (2015). Establishing a community of practice for occupational therapy curriculum development: The value of a two-way process. Australian Occupational Therapy Journal, 62(4), 238–245. https://doi.org/10.1111/1440-1630.12196

206. Trimboli, C., Parsons, L., Fleay, C., Parsons, D., & Buchanan, A. (2021). A systematic review and meta-analysis of psychosocial interventions for 6–12-year-old children who have been forcibly displaced. SSM Mental Health, 1, 1–16. https://doi.org/10.1016/j.ssmmh.2021.100028

207. Turner, J., Maiwald, K., Winter, A., Simms, A., Bendall, C., & Camp, P. G. (2022). Photovoice exploration of physical activity norms and values among rural and remote pulmonary rehabilitation participants in British Columbia, Canada. Disability & Rehabilitation, 44(26), 8400–8411. https://doi.org/10.1080/09638288.2021.2018052

208. van der Merwe, T. R., Basson, L., Buschow, R., Crous, T., Gillmer, A., Muller, M., & Niemann, J.-M. (2021). Human praxis as possible innovation for occupational therapy practice: An interpretivist description from people who enact praxis. South African Journal of Occupational Therapy, 51(2), 13–21. https://doi.org/10.17159/2310-3833/2021/vol51n4a3

209. Vargas Rivas, M. M., Olivares Aising, D., & Fernández Droguett, R. (2016). Autoethnography: Theater as a therapeutic tool for hospital School Children. Cadernos de Terapia Ocupacional da UFSCar, 24(3), 639–650. https://doi.org/10.4322/0104-4931.ctoEN0678

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211. Vigen, C. L. P., Carandang, K., Blanchard, J., Sequeira, P. A., Wood, J. R., Spruijt-Metz, D., Whittemore, R., Peters, A. L., & Pyatak, E. A. (2018). Psychosocial and behavioral correlates of A1C and quality of life among young adults with diabetes. Diabetes Educator, 44(6), 489–500. https://doi.org/10.1177/0145721718804170

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Appendix D Novel Theories, Frameworks, and Models of Resilience.

Table D1 Theories, Frameworks, and Models of Resilience Originating from Our Review’s Included Literature

Name* of Model, Theory, or Framework	Authors & Number on Appendix C Ref. List	Description
*listed alphabetically
The Caregiver-Centred Care Competency Framework	(Parmar et al., 2021) [152]	Based upon a qualitative study that aimed to develop a competency framework for the healthcare workforce to support family caregivers. Six domains of caregiver-centered competencies were identified, with “Fostering Resilience in Family Caregivers” comprising one of them (p. 1330). This domain comprises indicators that healthcare workers can measure to determine whether their work is adequately fostering family caregivers' resilience.
Conceptual Framework of Developmental Coordination Disorder in Adolescence	(Payne & Ward, 2020) [154]	Framework developed from an interpretive phenomenological design study that used interviews conducted over the span of two years to explore the lived experiences of teenagers with developmental coordination disorder. Resilience is linked with coping in the conceptual model as being one of the factors influencing their lived experience.
The Model of Resilience in Daily Occupations	(Santoso et al., 2015) [178]	The authors developed this model from an analysis of focus group data, in which Indonesian mothers of children with autism spectrum disorder were asked to explore their experiences of engaging in daily occupations. The model encompasses four categories of how mothers enact resilience in their daily occupations related to parenting: “(1) creating and re-creating accepting conditions, (2) finding solutions to problems, (3) striving for balance among daily occupations, and (4) thinking about the child’s future” (p. 6).
The Occupational Resilience Model	(Jacobs-Nzuzi Khuabi et al., 2022) [88]	Developed from a qualitative study of youth who had experienced a TBI and were transitioning back to high school. Proposes a definition of occupational resilience as: “The transactional relationship between personal, environmental and occupational resources that increases a person’s capacity to adapt positively to occupational challenges in the midst of adversity and facilitates his/her participation in valued occupations” (p. 476).
The PRIOrity (Professional Resilience, Identity, Occupation) Model	(Ashby et al., 2013) [5]	Model put forward based on the findings of a qualitative study that used narrative inquiry methodology to explore the processes involved in developing and maintaining professional resilience among occupational therapists working in mental health practice. Six professional resilience strategies are suggested, one of them being, “The use of discipline-based theories and concepts” (p. 113).
The PREparedness, REsponse and SySTemic Transformation (PRE-RE-SyST) Model	(Jesus et al., 2021) [92]	Based on a scoping review that employed thematic analysis to develop a model for disability-inclusive pandemic responses that can “address ongoing and structural strains toward building ‘everyday resilience’” (p. 12). There are four overarching components in the PRE-RE-SyST model, including: “1) Respond to prevent or reduce disability disparities during a pandemic crisis; 2) Prepare ahead for pandemic and other crises responses; 3) Design systems and policies for a structural disability inclusiveness; and 4) Transform society’s cultural assumptions about disability” (p. 2). The authors state their model aligns with other research/models which articulate disasters as opening opportunities to create more resilient systems.
The Process of Non-Resilience in Spinal Cord Injury	(Rasa et al., 2018) [164]	Based on an analysis of interview data, with interview participants including people who had a spinal cord injury and scored in the low resilience range of the Connor Davidson Resilience Scale (Connor & Davidson, 2003). As a grounded theory study, the authors propose a novel theory of resilience based on their analysis, termed, “The process of non-resilience in spinal cord injury” (p. 329). Their theory encompasses several factors leading to non-resilience among some people with SCI that can be affected via treatment, including “lack of essential knowledge about SCI”, “lack of accommodation”, “inappropriate feedback”, and other factors (p. 329).
The Resilience Model for Young Person Exposed to Intimate Partner Violence	(Cameranesi et al., 2021) [19]	Model of resilience created as outcome of grounded theory study that used interviews, photovoice, and ecomap methods to explore how young people cope with exposure to intimate partner violence. The model considers individual, occupational, family, school-based, and community-based contributors to participants' resilience. The authors argue their model “closely reflects the multisystemic social ecological conceptualization...proposed by [Michael] Ungar” (p. 6).
The Structural-Personal Interaction	(Crawford et al., 2016) [31]	The Structural-Personal Interaction (SPI) is “a substantive theory” (p. 321) created as an output of a grounded theory study that incorporated interviews, participant observations, surveys, and policy document analyses—all related to the context of asylum seekers in Australia and their lives in asylum detention centres and/or the community. Resilience is embedded within the study finding that asylum seekers' personal characteristics interact with structural factors to affect their life experiences. Resilience is described as “abilities to cope with adversity” (p. 331).

Appendix E Resilience Measurement Tools

Table E1 Resilience Measurement Tools Used in Included Non-Review Articles (n=199)

Name of Tool	Description & Cited Literature
Note 1: Tools in table listed in order of number of included articles that used the tool (and alphabetically in cases of a tie) Note 2: Numbers in square brackets under “Included Articles Using the Tool” indicate citation’s position on numbered reference list of Appendix C
Connor Davidson Resilience Scale (CD-RISC)	Description of Tool
	Self-rated psychological resilience assessment tool available in multiple languages and researched in numerous populations (Connor & Davidson, 2003). Participants numerically score the extent to which they personally display resilient characteristics. Originally created with 25-items; shortened 10- and 2-item versions subsequently developed and validated.
	Included Articles Using the Tool* (n=19)
	[1,6,7,8,12,32,40,41,42,64,67,68,110,164,165,173,182,192,201] *Note: Multiple versions of CD-RISC used across included articles
Brief Resilience Scale (BRS)	Description of Tool
	Self-rated 6-item scale that measures “the ability to bounce back or recover from stress” (Smith et al., 2008, p. 194). Developed for use among participants facing health-related challenges.
	Included Articles Using the Tool (n=4)
	[86,155,156,171]
Resilience at University Scale	Description of Tool
	Self-rated 20-item scale designed for university students, which situates resilience within the university environment and conceptualizes it as a skill that can be fostered (Turner et al., 2017). Adapted from the Resilience at Work Scale (Winwood et al., 2013).
	Included Articles Using the Tool (n=4)
	[15,16,17,61]
Resilience Scale (RS)	Description of Tool
	Self-rated Likert scale—originally developed with 25 items—which purports to measure individual psychological resilience (Wagnild & Young, 1993). Resilience in the scale is comprised of five components, which correspond to qualitative findings from a grounded theory study of “24 older women who had adapted successfully following a major life event” (Cajada et al., 2023, p. 247; Wagnild & Young, 1990).
	Included Articles Using the Tool* (n=3)
	[36,54,55] *Note: Multiple versions of RS used across included studies
Brief Resilient Coping Scale	Description of Tool
	Four-item measure, using a self-administered Likert scale to assess an individual’s resilient coping behavior, defined as “a tendency to effectively use cognitive appraisal skills in a flexible, committed approach to active problem solving despite stressful circumstances” (Sinclair & Wallston, 2004, p. 95)
	Included Articles Using the Tool (n=2)
	[102,103]
Physical Resilience Instrument for Older Adults (PRIFOR)	Description of Tool
	Self-administered 16-item scale, measuring the construct of physical resilience among older adults—with the conceptualization based upon gerontological research, and the items on the scale based upon findings of a qualitative study of hospitalized older adults (Hu et al., 2022). The 16 items in the PRIFOR are categorized within three “dimensions” of physical resilience: “positive thinking”, “cope and adjust lifestyle”, and “belief and hopeful mindset” (p. 3).
	Included Articles Using the Tool (n=2)
	[80,81]
Resilience Scale for Adults	Description of Tool
	Self-report 33-item scale, encompassing five constructs of resilience related to both personal and social/family characteristics (Hjemdal et al., 2001). Designed to be “an assessment tool of protective factors important to prevent maladjustment and psychological disorders” (Friborg et al., 2003, p. 74).
	Included Articles Using the Tool (n=2)
	[15,16]
Self-assessed resilience scale	Description of Tool
	Comprised of five items—self-rated with a Likert scale—that focus on psychological resilience among soldiers in the United States Armed Forces facing deployment-related stressors (Campbell‐Sills et al., 2018). This scale is embedded within a longer mental health-focused survey for Armed Forces members. Includes one item about drawing upon one’s sense of humour
	Included Articles Using the Tool (n=2)
	[8,189]
Spinal Cord Injury-Quality of Life (SCI-QOL)-Resilience measure	Description of Tool
	Self-rated, 21-item (8 items in the short version) questionnaire that was designed specifically for patients with spinal cord injury to measure their psychological resilience (Victorson et al., 2015). It is one of several tools comprising the SCI-QOL measurement system—with four domains of QOL covered across over 20 measures (e.g., SCI-QOL-Anxiety, SCI-QOL-Pain Interference, etc.).
	Included Articles Using the Tool (n=2)
	[2,72]
Work Disability Functional Assessment Battery (WD-FAB), Resilience & Sociability scale	Description of Tool
	The WD-FAB is a self-rated measurement tool with eight scales that assess an individual’s work-related functional abilities with respect to their physical and mental health—with one of its scales being ‘Resilience & Sociability’, defined as, “capacity to adapt and respond to pressure of daily life demands” (Marfeo et al., 2018, p. 191).
	Included Articles Using the Tool (n=2)
	[122,123]
Assessment Tool for Perceived Agency (ATPA)	Description of Tool
	Designed for use in adult rehabilitation practice settings, the ATPA is a self-rated measure of people’s perceived agency, defined as “the capacity of individuals to act independently and to make their own free choices”—as influenced by the interaction between one’s competence, resilience, and balance (Lautamo et al., 2021, p. 98). Originally included 25 items, with the most recent version comprising 19 items (Juntunen et al., 2023); the authors do not clearly delineate which items (if any) specifically target resilience. With respect to their conceptualization of resilience, they suggest an occupationally-oriented understanding: “Resilience is viewed not only as the result of successful adaptation to difficulties during the life course but also as the ability to adapt one’s performance and routines and have an active impact one’s environmental features” (Lautamo et al., 2021, p. 99).
	Included Articles Using the Tool (n=1)
	[96]
Behavior Assessment System for Children (2nd ed.) (BASC–2), Resiliency scale	Description of Tool
	The BASC encompasses a set of scales that collectively assess emotions and behaviour among children and adolescents, with the assessment system’s various scales completed by caregivers, educators, and via self-report (Reynolds & Kamphaus, 2004). The Resiliency scale in the BASC measures “a child’s ability to use supports to overcome obstacles” (Dean et al., 2018, p. 4), with resiliency conceptualized as a “personal trait” (p. 6).
	Included Articles Using the Tool (n=1)
	[37]
Child and Youth Resilience Measure (CYRM-R)	Description of Tool
	Self-report 17-item measure of social-ecological resilience, with versions available for children (aged 5-9 years) and youth (aged 10-23 years) (Ungar, 2016). A similar measure for adults also exists called the Adult Resilience Measure (ARM-R). Each item in the CYRM-R can be placed into one of two subscales, which (respectively) measure personal resilience and caregiver/relational resilience.
	Included Articles Using the Tool (n=1)
	[4]
Dispositional Resilience Scale (DRS)	Description of Tool
	The DRS is a self-report, Likert-scale measure of psychological hardiness (Bartone et al., 2008), which is defined as, “a personality style associated with resilience, good health, and performance under stressful conditions” (Bartone, 2007, p. 943). Versions of the DRS with 15, 30, and 45 items exist.
	Included Articles Using the Tool (n=1)
	[95]
Global Resilience Question	Description of Tool
	Consists of a single prompt—“When things go wrong in my life it generally takes me a long time to get back to normal”—to which participants self-rate on a scale of one to five to indicate their level of agreement (Smith-MacDonald et al., 2022, p. 119).
	Included Articles Using the Tool (n=1)
	[192]
Multidimensional Individual and Interpersonal Resilience Measure (MIIRM)	Description of Tool
	Self- and/or family member-administered, Likert-rated measure of individual and interpersonal resilience among older adults (Martin et al., 2015). Encompasses eight resilience factors that range from individual personality traits to family structure—with the tool’s conceptualization based upon research in psychology, gerontology, family studies, and other domains.
	Included Articles Using the Tool (n=1)
	[151]
National Survey of American Life (NSAL) (selected questions)	Description of Tool
	The NSAL was a United States-based survey of mental health among over 3,000 Americans of African descent, conducted in a structured interview format at the beginning of the 21st century (Jackson et al., 2004). Eight Likert-rated items in the NSAL were interpreted by Parnell et al. (2022, p. 4) to encompass participants’ psychological resilience, though the authors do not indicate their rationale for selecting those items.
	Included Articles Using the Tool (n=1)
	[153]
Occupational Balance in Informal Caregivers (OBI-Care) questionnaire, occupational resilience subscale	Description of Tool
	The OBI-Care is a self-report, Likert-scale rated questionnaire that measures the construct of occupational balance—i.e., “a satisfying amount and variety of meaningful activities” (Dür et al., 2021, p. 2)—among unpaid caregivers (e.g., parents). One of the tool’s three subscales purports to measure occupational resilience, which the authors define as “the ability to perpetuate and to find new meaningful activities accompanying changed life circumstances” (p. 7).
	Included Articles Using the Tool (n=1)
	[47]
Parental Disability Adaptation Scale - Escala Parental de Adaptação à Deficiência (EPAD), Resilience dimension	Description of Tool
	The EPAD is a Portuguese-language self-rated Likert-scale questionnaire (Franco, 2016), which measures—among parents of children with disabilities—“aspects of the parents' resumption of their development path and, consequently, the process of adapting to the disability” (Roiz & Figueiredo, 2023, p. 5). Resilience is measured within the EPAD as a “personal resource” (p. 10) that parents can possess in adapting to the experiences associating with having a child with a disability.
	Included Articles Using the Tool (n=1)
	[174]
Resilience Inventory	Description of Tool
	A self-rated Likert-scale measure of psychological resilience, comprised of 28 items that encompass three aspects of resilience—related to external supports, intrinsic abilities, and social factors. The Resilience Inventory is described within one article included in our review [105] (Kumkun et al., 2022), but we were unable to find the tool itself online—perhaps because it was developed and used in Thailand with a different non-English name.
	Included Articles Using the Tool (n=1)
	[105]
Resilience Scale for Parents of Children with Cancer (RSP‐CC)	Description of Tool
	The RSP-CC was created to measure psychological resilience within the specific population of parents whose children have an oncological diagnosis (Onal et al., 2023). The tool is based upon a previously developed theoretical framework of resilience among parents of children with cancer (Ye et al., 2017). There are 24 items in the RSP-CC, which are self-rated by participants on a Likert scale, and which are classified into four factors of resilience: coping, emotional stress, social support, and caregiver burden.
	Included Articles Using the Tool (n=1)
	[147]
Strong Souls Index, resilience subscale	Description of Tool
	The Strong Souls Index was developed as a culturally-relevant tool for measuring social and emotional well-being (SEWB) among Aboriginal and Torres Strait Islander youth in Australia (Thomas et al., 2010). The tool comprises 25 items that participants self-rate using a Likert scale—with the items classified into four subscales that correspond to four SEWB factors: resilience, depression, anxiety, and suicidality. Items in the Resilience subscale relate to interpersonal relationships and personality traits.
	Included Articles Using the Tool (n=1)
	[117]
Unnamed four-item scale measuring trait resilience	Description of Tool
	This unnamed measure of resilience comprises four Likert scale self-rated questions, developed to assess among frontline workers during the COVID-19 pandemic “trait resilience… defined as a personal trait, which benefits individuals in coping with traumatic events” (Huang et al., 2022, p. 3070). The questions ask participants about their physical and mental health in the context of the COVID-19 pandemic.
	Included Articles Using the Tool (n=1)
	[112]

Note. Not included in this table are assessment tools that were mentioned within our included articles but not actually used, e.g., a literature review paper [183] that identified and critiqued 25 different resiliency measures that can be used in pediatric rehabilitation.

Reference List of Works Cited in “Description of Tool” Section of 1

Bartone, P. T. (2007). Test-retest reliability of the Dispositional Resilience Scale-15, a brief hardiness scale. Psychological Reports, 101(3), 943–944. https://doi.org/10.2466/pr0.101.3.943-944

Bartone, P. T., Roland, R. R., Picano, J. J., & Williams, T. J. (2008). Psychological hardiness predicts success in US Army Special Forces candidates. International Journal of Selection & Assessment, 16(1), 78–81. https://doi.org/10.1111/j.1468-2389.2008.00412.x

Cajada, L., Stephenson, Z., & Bishopp, D. (2023). Exploring the psychometric properties of the Resilience Scale. Adversity and Resilience Science, 4, 245–257. https://doi.org/10.1007/s42844-023-00102-3

Campbell‐Sills, L., Kessler, R. C., Ursano, R. J., Sun, X., Taylor, C. T., Heeringa, S. G., Nock, M. K., Sampson, N. A., Jain, S., & Stein, M. B. (2018). Predictive validity and correlates of self‐assessed resilience among U.S. Army soldiers. Depression and Anxiety, 35(2), 122–131. https://doi.org/10.1002/da.22694

Connor, K. M., & Davidson, J. R. T. (2003). Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18(2), 76–82. https://doi.org/10.1002/da.10113

Dean, E. E., Little, L., Tomchek, S., & Dunn, W. (2018). Sensory processing in the general population: Adaptability, resiliency, and challenging behavior. American Journal of Occupational Therapy, 72(1), 1–8. https://doi.org/10.5014/ajot.2018.019919

Dür, M., Röschel, A., Oberleitner-Leeb, C., Herrmanns, V., Pichler-Stachl, E., Mattner, B., Pernter, S.-D., Wald, M., Urlesberger, B., Kurz, H., Frischer, T., Zwiauer, K., & Berger, A. (2021). Development and validation of a self-reported questionnaire to assess occupational balance in parents of preterm infants. PloS One, 16(11), 1-15. https://doi.org/10.1371/journal.pone.0259648

Franco, V. (2016). Escala Parental de Adaptação à Deficiência – EPAD (Vol. 1). Évora: Universidade de Évora.

Friborg, O., Hjemdal, O., Rosenvinge, J. H., & Martinussen, M. (2003). A new rating scale for adult resilience: What are the central protective resources behind healthy adjustment? International Journal of Methods in Psychiatric Research, 12(2), 65–76. https://doi.org/10.1002/mpr.143

Hjemdal, O., Friborg, O., Martinussen, M., & Rosenvinge, J. H. (2001). Preliminary results from the development and validation of a Norwegian scale for measuring adult resilience. Journal of the Norwegian Psychological Association, 38, 310–317.

Hu, F.-W., Lin, C.-H., Yueh, F.-R., Lo, Y.-T., & Lin, C.-Y. (2022). Development and psychometric evaluation of the Physical Resilience Instrument for Older Adults (PRIFOR). BMC Geriatrics, 22(1), 1–10. https://doi.org/10.1186/s12877-022-02918-7

Huang, P.-C., Hung, C.-H., Chen, G.-W., Cashin, C., Griffiths, M. D., Yang, W.-C., Wang, H.-W., Lin, C.-Y., & Ko, N.-Y. (2022). COVID-19-related self-stigma, post-traumatic stress disorder, insomnia, and smartphone addiction among frontline government workers with COVID-19 pandemic control duties. Psychology Research and Behavior Management, 15, 3069–3080. https://doi.org/10.2147/PRBM.S383842

Jackson, J. S., Neighbors, H. W., Nesse, R. M., Trierweiler, S. J., & Torres, M. (2004). Methodological innovations in the National Survey of American Life. International Journal of Methods in Psychiatric Research, 13(4), 289–298. https://doi.org/10.1002/mpr.182

Juntunen, K., Lautamo, T., Pikkarainen, A., & Lällä, K. (2023). Detecting changes in human agency of older adults in rehabilitation. Activities, Adaptation & Aging, 47(3), 329–347. https://doi.org/10.1080/01924788.2022.2116531

Kumkun, C., Sirisatayawong, P., & Chupradit, S. (2022). Effect of a resilience programme through group dynamics on the academic problems of grade 7 students, Chiang Mai University Demonstration School. Open Psychology Journal, 15, 1–10. https://doi.org/10.2174/18743501-v15-e2206100

Lautamo, T., Paltamaa, J., Moilanen, J., & Malinen, K. (2021). Psychometric properties of the Assessment Tool for Perceived Agency (ATPA-22)—Utility for the rehabilitation of young adults not in education, employment or training (NEETs). Scandinavian Journal of Occupational Therapy, 28(2), 97–109. https://doi.org/10.1080/11038128.2020.1782983

Marfeo, E. E., Ni, P., McDonough, C., Peterik, K., Marino, M., Meterko, M., Rasch, E. K., Chan, L., Brandt, D., & Jette, A. M. (2018). Improving assessment of work related mental health function using the Work Disability Functional Assessment Battery (WD-FAB). Journal of Occupational Rehabilitation, 28, 190–199. https://doi.org/10.1007/s10926-017-9710-5

Martin, A. S., Distelberg, B., Palmer, B. W., & Jeste, D. V. (2015). Development of a new multidimensional individual and interpersonal resilience measure for older adults. Aging & Mental Health, 19(1), 32–45. https://doi.org/10.1080/13607863.2014.909383

Onal, G., Huri, M., Karakukcu, M., & Demir, H. A. (2023). The Resilience Scale for Parents of Children with Cancer: Scale development and psychometric evaluation. Psycho-Oncology, 32(6), 951–960. https://doi.org/10.1002/pon.6137

Parnell, R. N., Lacey, K. K., & Wood, M. (2022). Coping and protective factors of mental health: An examination of African American and US Caribbean Black women exposed to IPV from a nationally representative sample. International Journal of Environmental Research and Public Health, 19(22), 1–17. https://doi.org/10.3390/ijerph192215343

Reynolds, C. R., & Kamphaus, R. W. (2004). Behavior Assessment System for Children (2nd ed.). London: Pearson Assessments.

Roiz, G. R., & Figueiredo, M. de O. (2023). Adaptation process and occupational performance of mothers of children with autism spectrum disorders. Brazilian Journal of Occupational Therapy, 31, 1–17. https://doi.org/10.1590/2526-8910.ctoAO252633042

Sinclair, V. G., & Wallston, K. A. (2004). The development and psychometric evaluation of the Brief Resilient Coping Scale. Assessment, 11(1), 94–101. https://doi.org/10.1177/1073191103258144

Smith, B. W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J. (2008). The Brief Resilience Scale: Assessing the ability to bounce back. International Journal of Behavioral Medicine, 15, 194–200. https://doi.org/10.1080/10705500802222972

Smith-MacDonald, L., Pike, A., Jones, C., & Brémault-Phillips, S. (2022). Exploration of trauma-oriented retreats: Quantitative changes in mental health measures for Canadian military members, veterans and Royal Canadian Mounted Police with posttraumatic stress disorder and moral injury. Trauma Care, 2(2), 114–130. https://doi.org/10.3390/traumacare2020010

Thomas, A., Cairney, S., Gunthorpe, W., Paradies, Y., & Sayers, S. (2010). Strong Souls: Development and validation of a culturally appropriate tool for assessment of social and emotional well-being in Indigenous youth. Australian & New Zealand Journal of Psychiatry, 44(1), 40–48. https://doi.org/10.3109/00048670903393589

Turner, M., Holdsworth, S., & Scott-Young, C. M. (2017). Resilience at University: The development and testing of a new measure. Higher Education Research & Development, 36(2), 386–400. https://doi.org/10.1080/07294360.2016.1185398

Ungar, M. (2016). Child and Youth Resilience Measure: Youth version. Dalhousie University Resilience Research Centre.

Victorson, D., Tulsky, D. S., Kisala, P. A., Kalpakjian, C. Z., Weiland, B., & Choi, S. W. (2015). Measuring resilience after spinal cord injury: Development, validation and psychometric characteristics of the SCI-QOL Resilience item bank and short form. Journal of Spinal Cord Medicine, 38(3), 366–376. https://doi.org/10.1179/2045772315Y.0000000016

Wagnild, G. M., & Young, H. M. (1990). Resilience among older women. Image: The Journal of Nursing Scholarship, 22(4), 252–255. https://doi.org/10.1111/j.1547-5069.1990.tb00224.x

Wagnild, G. M., & Young, H. M. (1993). Development and psychometric evaluation of the Resilience Scale. Journal of Nursing Measurement, 1(2), 165–178.

Winwood, P. C., Colon, R., & McEwen, K. (2013). A practical measure of workplace resilience: Developing the Resilience at Work scale. Journal of Occupational and Environmental Medicine, 55(10), 1205–1212. https://doi.org/10.1097/JOM.0b013e3182a2a60a

Ye, Z. J., Qiu, H. Z., Li, P. F., Liang, M. Z., Wang, S. N., & Quan, X. M. (2017). Resilience model for parents of children with cancer in mainland China-An exploratory study. European Journal of Oncology Nursing, 27, 9–16. https://doi.org/10.1016/j.ejon.2017.01.002

Appendix F Occupational Resilience Definitions.

We offer six definitions of occupational resilience in 1 below. Three of these articles did not meet our full list of inclusion criteria—one was an editorial article (Brown, 2021), another was a conference paper (Muriithi & Muriithi, 2020), and the third was not indexed with “resil*” (Dür et al., 2021).

Table F1 Definitions of Occupational Resilience

Article Name *indicates if included in our review	Quoted Definition from Article
The response to COVID‐19: Occupational resilience and the resilience of daily occupations in action (Brown, 2021)	“Occupational resilience refers to a person's ability to successfully and creatively navigate and negotiate life stressors, challenging environments and difficult events, whereby changes and modifications to daily occupations and occupational participation are required” (p. 104).
Development and validation of a self-reported questionnaire to assess occupational balance in parents of preterm infants (Dür et al., 2021)	“The ability to perpetuate and to find new meaningful activities accompanying changed life circumstances” (p. 7).
*Breakfast club lessons: staff perspectives on a yearlong collaborative teletherapy initiative during COVID-19 (Friedman, 2022)	“Occupational resilience is built upon the concept of utilizing adaptable solutions to maintain participation in daily occupations” (p. 3).
*Towards occupational resilience: A model to facilitate high school participation post traumatic brain injury (Jacobs-Nzuzi Khuabi et al., 2022)	“Occupational resilience is the transactional relationship between personal, environmental and occupational resources that increases a person’s capacity to adapt positively to occupational challenges in the midst of adversity and facilitates his/her participation in valued occupations” (p. 476).
Occupational resilience: A new concept in occupational science (Muriithi & Muriithi, 2020)	“Occupational resilience enables one to continue performance of an occupation in circumstances in which great effort or even undertaking of risk is necessary to continue performance of the occupation” (para. 4).
*”This pandemic has changed our daily living”: Young adults' leisure experiences during the COVID-19 pandemic in South Africa (Wegner et al., 2022)	“Clearly, the study highlighted how meaningful leisure was used as a way to cope in the face of occupational injustices and enabled the young adults to display occupational resilience. The meaning derived from leisure engagement enabled young adults to continue to do, be, become, and belong, despite the confinement. Young adults develop occupational resilience by being able to adapt to adverse circumstances to continue engaging in meaningful occupations such as leisure” (p. 333)

Supplementary Material

Supplementary material accompanies this paper.

Appendix B.

Data Extracted From Included Studies.

This material is available as part of the online article from https://doi.org/10.1590/2526-8910.ctoAR406839742.

Acknowledgements

This research was conducted in Vancouver, Canada—which is situated on the unceded traditional territories of the xʷməθkʷəy̓əm (Musqueam), Sḵwx̱wú7mesh (Squamish), and səlilwətaɬ (Tsleil-Waututh) Nations; the authors acknowledge with gratitude the longstanding land stewardship and sovereign rights of these Indigenous Nations within their territories. The authors also acknowledge Dr. Briony Gray and Sunaina Chopra for their assistance with preparing this manuscript based on APA formatting requirements.

• How to cite:
  Turner, J., Miller, W. C., Petlitsyna, P., Moecke, D. P., Blanco, M. A., Reid, H., Kamurasi, I., Friesen, M., Crosbie, S., Towle, J., McDonald, I., Winter, A., Girt, M., Knox, A., Peter, M., & Camp, P. (2025). How do occupational therapy and occupational science researchers conceptualize resilience? A scoping review. Cadernos Brasileiros de Terapia Ocupacional, 33, e3974. https://doi.org/10.1590/2526-8910.ctoAR406839742
• Funding Source
  Turner’s PhD studies have been funded by the following organizations (listed alphabetically): Brain Canada Foundation; British Columbia Lung Foundation; Canadian Lung Association; Canadian Institutes of Health Research; Heart & Stroke Foundation of Canada; and Social Sciences & Humanities Research Council of Canada.

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Edited by

• Section editor
  Profa. Dra. Ana Paula Serrata Malfitano

Publication Dates

• Publication in this collection
  15 Aug 2025
• Date of issue
  2025

History

• Received
  25 Oct 2024
• Reviewed
  12 Mar 2025
• Accepted
  22 May 2025
• Corrected
  25 Aug 2025