title: The efficacy of resilience training programs: a systematic review protocol.
abstract: BACKGROUND
  Resilience has been defined as the ability of individuals to manage and adapt to stress and life challenges. Training programs that develop and/or enhance resilience may have efficacy in improving health, well-being, and quality of life. Because patients with chronic conditions must reliably self-manage their health, strategies to bolster resilience in this population may be of particular value. The objectives of this systematic review are to synthesize the evidence of resilience training program efficacy in improving outcomes related to quality of life, self-efficacy and activation, and resilience and coping ability in: 1) diverse adult populations; and 2) patients with chronic conditions.
  
  
  METHODS
  We will conduct a systematic review of randomized controlled trials assessing the efficacy of any program designed to enhance resilience in adults that measure any outcome against any comparator. We will search multiple electronic databases, trial registries, bibliographies, and will contact authors and experts to identify studies. We will use systematic review software to independently and in duplicate screen reports and extract data. We will extract characteristics of the study populations, interventions, comparators, outcomes, and quality/risk of bias. Primary, patient reported outcomes will be categorized into domains of quality of life, self-efficacy, and resilience. Secondary outcomes will be considered based on findings of the review. We will attempt meta-analysis by pooling standardized mean differences and minimally important differences (MIDs), when possible. Planned trial subgroup analyses are: 1) studies of patients with chronic conditions; 2) studies with placebo controls; 3) studies with similar intervention characteristics; and 4) studies with common lengths of follow-up.
  
  
  CONCLUSIONS
  This study is intended to accumulate the evidence for resilience training programs in improving quality of life, resilience, and self-efficacy for care management, particularly among adult patients with chronic conditions. Its findings will be valuable to policy-makers, funding agencies, clinicians, and patients seeking innovative and effective ways to achieve patient-centered care.
  
  
  BACKGROUND
  PROSPERO registration number: CRD42014007185.
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Leppin.aaron@mayo.edu.
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Leppin
authors.forename: Michael R
authors.initials: MR
authors.lastname: Gionfriddo
authors.forename: Amit
authors.initials: A
authors.lastname: Sood
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Erwin
authors.forename: Claudia
authors.initials: C
authors.lastname: Zeballos-Palacios
authors.forename: Pavithra R
authors.initials: PR
authors.lastname: Bora
authors.forename: Megan M
authors.initials: MM
authors.lastname: Dulohery
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Brito
authors.forename: Kasey R
authors.initials: KR
authors.lastname: Boehmer
authors.forename: Jon C
authors.initials: JC
authors.lastname: Tilburt
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D006801:Humans; D011613:Psychotherapy / Q000379:methods*; D055500:Resilience, Psychological; D020377:Self Efficacy; D013315:Stress, Psychological / Q000517:prevention & control / Q000628:therapy; D000078202:Systematic Reviews as Topic; D016896:Treatment Outcome