Table 1.

Characteristics of the studies.

Author, Reference, Country	Aims	Participants	Modalities	Evaluation Techniques	Results	Quality Score
Aitchison et al. [59] United Kingdom	Explore the experiences of social support in elite British para-swimmers and the influence on their wellbeing and performance	N = 9 British para-swimmers (3 male, 5 female, mean age 24.9 years). Disabilities: physical, visual and intellectual disabilities	Swimming	Semistructured interviews with duration ranging from 48 to 88 min (mean ± SD length 61 ± 15.3 min)	Social support in British para-swimmers is important for performance and wellbeing, especially a strong coach–athlete relationship, motivational and supportive teammates.	Fair
Atkinson and Martin [60] U.S.A.	Understanding if grit, hardiness, resilience and the added variable of athlete social support would predict life satisfaction and sport engagement in wheelchair rugby athletes	N = 87 adult athletes (80 males and 7 females). 35 in-person and 52 online. M age = 35.94 years, SD = 9.26) Disabilities: amputation (n = 6), spinal cord injury (n = 60), cerebral palsy (n = 9), other (n = 2).	Wheelchair rugby	Connor–Davidson Resilience Scales revised Norwegian Hardiness scale Satisfaction with Life Scale. 16-item Athlete Engagement Questionnaire 22-item Athletes’ Received Social Support Questionnaire	The resilience predicted 32% of the variance in life satisfaction and was the only significant predictor of life satisfaction. Grit, social support, resilience and hardiness were all significant predictors.	Good
Cardoso and Sacomori [61] Brazil	Examine resilience in the specific subgroupof Brazilian competitive athletes with physical disabilities. Test the validity of the Wagnild and Young (1993) Resilience Scale in Brazil for this population	N = 136 athletes Aged 18 or over with Disabilities: physical	Track and field, table tennis, swimming, weightlifting, basketball, rowing and tennis.	Semistructured interviews The questionnaire consists of 25 items	Participants were observed to have achieved higher resilience scores, while those with cerebral palsy obtained the lowest and those with amputations or polio obtained intermediate scores. The participants in this research study displayed a significantly lower mean resilience than those reported in other studies with the general population.	Fair
Cardoso et al. [62] Brazil	Describe the importance of structural and human resources support for Brazilian Paralympic athletes	N = 10 Paralympic athletes Athletics (7 males and 3 females) M age 28 ± 7.95. Swimming N = 10 (8 male and 2 female) M age = 22.50 ± 4.54 Disabilities: physical	Athletics and swimming	Semistructured interview	The results show that structural support and human resources support are considered fundamental by the interviewed athletes.	Poor
Crawford, Burns and Fernie [63] United Kingdom	Investigate the relationship between psychological resilience and vulnerability factors and involvement in the SO compared to being involved in sport not through the SO, and no sports activity	N = 101 (44 female and 57 male) M age 35.1 (range 18–67) Disabilities: intellectual	Athletics, football, judo, swimming, bowling and multiple sports	Demographic questionnaire Wechsler Abbreviated Scale of Intelligence (WASI) Rosenberg Self-esteem Scale The Life Stress Inventory Social Support Self Report	The results indicate that there is an association between involvement in the SO and reduced stress, increased quality of life and higher self-esteem. The hypothesis of increased social networks was not demonstrated. The findings provide further evidence of a positive association between sport involvement and increased psychological wellbeing, especially for those involved in the SO.	Good
Downie and Koestner [64] Canada	Study 1 compared the relation between success in the Paralympics versus the Olympics and national subjective well-being and life expectancy. Study 2 conceptually replicated these results using the standings of national men’s and women’s soccer teams	Olympics and Paralympics athletes	Olympics and Paralympics modalities (not specified) Soccer	Olympic and Paralympic Performance. Happiness. Data were taken from the World Database of Happiness	Study 1—There were mean differences in happiness for those countries that had a Paralympics team compared to those that did not. This suggests that even though countries without a Paralympics team were no less wealthy, or happy, their physical well-being was reduced. Study 2—Countries with a female soccer team were happier.	Poor
Dursun et al. [65] Turkey	Assess the effects of ice skating on the psychological well-being, self-concept and sleep quality of children with hearing or visual impairments	N = 40 students (20 visually impaired and 20 hearing impaired) Aged 8–16 Disabilities: visual and deaf	Ice skating	A self-report form of the Strengths and Difficulties Questionnaire (SDQ) The Piers–Harris Children’s Self-Concept Scale (PHCSCS) Pittsburgh Sleep Quality Index (PSQI)	There was a significant improvement in self-concept, behavioural and emotional problems and sleep quality (p < 0.05 for each) in of the children with hearing impairment. Although the sleep quality (p = 0.019) and emotional problem scores (p ¼ 0.000) of the visually impaired children improved, self-concept, peer relations and hyperactivity scores of these children worsened (p50.05 for each).	Fair
Fiorilli et al. [66] Italia	To examine the perception of well-being, social integration and emotional problems of Down Syndrome (DS) subjects and to investigate whether parents and their children with Down Syndrome have the same opinion on the problems caused by DS	N = 93 participants with DS 58 swimmers (aged 16.31 ± 1.55), 35 DS sedentary subjects (aged 16.06 ± 1.39), and their parents (n = 93). Disabilities: Down Syndrome	Swimming	2 questionnaires (SDQ) were individually administered: self-reported version (SDQ-SR), completed by the DS participants, and the parental version (SDQ-P), completed by their parents	Results showed significant differences between sportive vs. non-sportive groups in the overall domain scores, with better results for the sportive group. Parents of DS non-sportive participants underestimated their children’s problems in 6 of the 8 domains. The results validate the hypothesis that foresees a positive relation between well-being perception and sport activity and competitions in individuals with MR, such as DS.	Good
Hamdani et al. [67] Canada	To understand the state of perceived wellness and wellness-promoting behaviours of children and youth with IDD from multi-stakeholder perspectives	N = 35 in-person surveys of athletes N = 352 online surveys of caregivers (n = 240) and coaches (n = 112) Disabilities: intellectual	Special Olympics	A cross-sectional Likert survey methodology	Athletes, caregivers and coaches generally agreed rather than disagreed with wellness statements, with the exception of coaches’ responses regarding healthy nutrition. Athletes agreed more than caregivers and coaches that they engaged in some wellness-promoting behaviours (i.e., calming oneself down, participating in their communities).	Fair
Haslett, Fitzpatrick and Breslin [68] Ireland	To interpret participation in wheelchair rugby through the conceptual lens of the SRM	N = 10 male athletes from three clubs (M age = 33.1 years, age range: 22–53 years).	Wheelchair Rugby	A semistructured interview guide was developed based on the components of the SRM	The results indicate that in disability sport participation, the experience of social oppression, inequality and cultural stereotypes of disability can be synonymous with the personal experience of physical impairment.	Poor
Kokun et al. [69] Ukraine	To determine the influence of sports on Paralympic athletes’ personal development	N = 106 Paralympic and Defilimnical (Age 16–53, 84 men and 22 women) N = 191 students (Age 17–25, 91 without health problems, 98 with disabilities not engaged in sports) Disabilities: physical and deaf	Paralympic sports	The Ryff Scales of Psychological Well-Being and S. Maddi’s Personal Hardiness test.	Paralympic athletes achieve an optimal level of psychological well-being and a significant increase in all psychological hardiness components.	Fair
Kokun, Serdiuk and Shamyco [70] Ukraine	To investigate the personal characteristics supporting Paralympic athletes’ self-realization in sports.	N = 106 Paralympic and Defilimnical in different sports (Age 16–53, 84 men and 22 women) Disabilities: physical and deaf	Paralympic sports (football, fencing, powerlifting, sitting volleyball, judo, canoeing in pairs, swimming)	Self-efficacy scale of R. Schwarzer and M. Yerusalem; Ryff’s Scales of Psychological Well-Being; S. Maddi’s Personal Hardiness test (adapted by D. Leont’ev); the modified techniques of scaled self-estimation; The Self-Organization Questionnaire	The most important personal characteristic supporting Paralympic athletes’ self-realization in sports is their psychological hardiness, since all four of its indicators have sufficiently close correlations with three of the four self-realization indicators—“Satisfaction with own sports career”, “Fastness of sportive goal setting after achievement of a previous one” and “Reaching of top-achievements in sports”. Paralympic athletes’ rapidity in sportive goal setting after achievement of a previous one is significantly related to all ten psychological well-being scales, and their clarity of perception of own future in sports correlates with five scales.	Fair
Macdougall et al. [71] Australia	Explore well-being in para-athletes in a way that is consistent with theoretical perspectives	N = 23 para-athletes (10 female and 13 male) M age = 28.5 years, age range = 16–53 years) Disabilities: physical	Athletics, boccia, canoe slalom, cycling, swimming, table tennis, triathlon, wheelchair basketball, wheelchair rugby	Semistructured interviews	The well-being needs and strengths of para-athletes differed across gender, sport, level of competition and nature of impairment. Well-being strengths were perceived to increase as athletes increased their level of competition, and included personal growth, optimism, strong social support networks and contributing to multiple communities.	Poor
Machida, Irwin and Fetz [47] U.S.A.	Examine the resilience process of sport participants with acquired spinal cord injury, and the role of sport participation in the resilience process	N = 12 men with aged 21 to 41 years Disabilities: physical	Wheelchair rugby	Semistructured interviews	The development of resilience is a multifactorial process involving pre-existing factors and pre-adversity experiences, disturbance/disturbing emotions, various types and sources of social support, special opportunities and experiences, various behavioural and cognitive coping strategies, motivation to adapt to changes and learned attributes or gains from the resilience process.	Poor
Martin et al. [72] U.S.A.	To predict both general and sport-specific quality of life using measures of grit, hardiness and resilience	N = 75 (74 males and 1 female) M age = 37.0 years, SD = 11.01 Disabilities: physical	Wheelchair basketball	8-question Short Grit Scale Connor–Davidson Resilience Scales revised Norwegian hardiness scale (Dispositional Resilience Scale Satisfaction with Life Scale 16-item Athlete Engagement Questionnaire	Hardiness and resilience combined to predict 26% of the variance in life satisfaction, whereas grit was not a significant predictor. Athletes higher in both resilience and hardiness expressed greater life satisfaction compared with athletes lower in hardiness and resilience.	Good
Martin et al. [73] U.S.A.	Determine if grit, hardiness and resilience predicted life satisfaction and sport engagement in parasport athletes	N = 40 (22 ice hockey athletes and 18 wheelchair rugby) (M age = 32.0; SD = 8.6) Disabilities: physical	Ice hockey, wheelchair rugby	Short Grit Scale (Grit-S)10-item Connor–Davidson Resilience Scale (10- item CD-RISC) Norwegian hardiness scale (Dispositional Resilience Scale 15 (DSR-15) Satisfaction with Life Scale (SWLS) 16 item Athlete Engagement Questionnaire (AEQ)	Hardiness and resilience are important predictors of life satisfaction, with grit being irrelevant, and resilience and grit are important predictors of sport engagement. Overall resilience appears to be the most critical predictor for both outcomes across the three studies.	Good
Mira et al. [74] Portugal	Characterizing subjective well-being, resilience and social influence	N = 31 of the 33 athletes of the Portuguese Paralympic team M age = 34.45 ± 11.7 years (21 men and 10 women) Disabilities: physical	Multiple sports	Social support perceived by athletes with disabilities, a scale based on the recommendations of Jago et al. Subjective well-being was assessed through Satisfaction with Life Scale Positive and negative affect were evaluated through PANAS—The Positive and Negative Affect Schedule Brief Resilience Scale (BRS)	Athletes perceive a positive affect superior to negative affect. Regarding social support, the perception of support by the coach is the one with the highest value. The bivariate correlation was observed between life satisfaction and positive affect (medium), between positive affect with social support from parents (high) and between positive affect with social support from friends (medium). Resilience displayed a negative and significant association with the negative affect (high).	Good
Monton et al. [75] Canada	Explores the role of sport–life balance and well-being on athletic performance.	N = 47 Olympic athletes N = 14 Paralympic athletes N = 11 not specified (2 male, 40 female and 10 athletes that did not specify) Disabilities: physical	Multiple sports	Mixed-methods research design consisting of an online survey and a series of semistructured, follow-up interviews.	Overwhelmingly, athletes felt they received the most support from family and friends. These results exemplify the importance of athletes’ external support systems.	Poor
Mudjianto, Widya and Ubad [76] Indonesia	Determine the quality of life of Paralympic athletes who are members in West Java Peparnas Pelatda 2016	Handicapped/disabled athletes from Pelatda West Java	Not specified	Questionnaire WHOQOL-BREF	From the results of the analysis and calculation of the data obtained, the four domains of physical health, psychological well-being, social relationships and the relationship with the environment showed a good average range.	Poor
Porto, Cardoso and Sacomori [77] Chile	To analyse the association of team sports practice and physical and psychological factors with sexual adjustment in men with paraplegia	N = 60 men (30 wheelchair basketball and/or handball athletes and 30 non-athletes) Disabilities: physical	Wheelchair basketball and/or handball athletes	The Resilience Scale	Resilience was correlated with and predictive of sexual adjustment.	Good
Powell and Myers [78] United Kingdom	Understand the lived experiences of mentally tough Paralympians, aiming to conceptualize MT in a Paralympic context and investigate its development	N = 10 Team Great Britain Paralympic athletes (9 male and 1 female M age = 27.9, SD = 7.1) Disabilities: physical	Multiple sports	Semistructured interview	The development of MT requires a series of formative experiences, combined with support and coping resources. Athletes in general would benefit from exposure to highly demanding situations in a supportive environment to develop mentally tough characteristics and behaviours and to develop personalized cognitive strategies.	Poor
Puce et al. [79] Italy	Investigate the role of competitive sport practice in enhancing the self-perceived psychophysical well-being of some select participants	N = 100 Paralympic athletes N = 100 affected by impairment who do not practice competitive sport Disabilities: physical	Swimming	Psychological General Well-Being Index and the Short Form indices	Possible positive psychophysical benefits of competitive sport practice for young people affected by physical or intellectual impairment.	Poor
Richardson et al. [80] United Kingdom	To assess the psychosocial impact of participating in sport at an individual level and the impact of participating in sport in challenging cultural perceptions of disability	N = 16 (14 males and 2 females) M age 29 years (age range 18–40) Disabilities: physical	Wheelchair tennis	Semistructured interview	Wheelchair tennis players perceived that their participation in sport enhanced their psychosocial well-being. Three broad themes emerged from analysis of the interviews: (1) developed transferrable skills, (2) perceived personal growth and (3) benefits of an athletic identity.	Good
Saphiro and Malone [81] U.S.A.	Examined the relationship between athlete and parent perceptions of health-related quality of life (HRQoL) and the relationship between the athletes’ perceived HRQoL and subjective exercise evaluations	N = 70 athletes (47 males and 23 females) (M age = 15, SD = 2.92) Disabilities: physical	Swimming (n 5 3), wheelchair basketball (n 5 23), wheelchair handball (n 5 32), and a weekend multisports program (n 5 12	Pediatric Quality of Life Inventory (PedsQL) Subjective Exercise Experiences Scale (SEES)	Athletes with disabilities reported higher perceptions of HRQoL than their parents reported for them on physical, emotional and social functioning subscales with moderate to high effect sizes. Positive well-being subscale from the SEES was significantly related to overall HRQoL and was a significant predictor of overall HRQoL.	Good
Shapiro and Martin [82] U.S.A.	Examine athletic identity, affect and peer relations of youth athletes with physical disabilities and selected relationships among these variables	N = 36 (27 males and 9 females) M age = 16 Disabilities: physical	Swimming, wheelchair basketball, wheelchair handball, multisport program	Private–Public Athletic Identity Scale The Positive and Negative Affect Schedule The Peer Relations Scale	Participants reported stronger private athletic identity individual item scores compared with public athletic identity and expressed high positive affect and low negative affect. They also expressed strong peer relations. A significant relationship between positive affect and peer relations was found.	Good
Sikorska and Gerc [7] Poland	To describe selected aspects of a good life in Polish Paralympic athletes in light of positive psychology	N =30 disabled athletes (M = 26.5 years of age) N control group = 30 healthy young adults (M = 25.9 years of age) Disabilities: physical	Skiing, cycling, swimming, fencing, basketball	The You and Your Life Questionnaire The Resilience Scale for Adults by Friborg et al. (RSA) The Satisfaction with Life Scale (SWLS) Personal Values List (LWO)	A statistically relevant difference between the two groups can be identified with regard to resilience, concerning the structured style factor and with regards to courage in the level of the endurance factor. Disabled athletes choose the following as highly assessed values: being useful, courage and firmness.	Fair
Swason, Colwell and Zhao [83] U.S.A.	This study explored relationships among four sources of motivation and six forms of social support	N = 19 wheelchair athletes, (33 male and 60 female) M age = 19.79, SD = 4.93 Disabilities: physical	Wheelchair basketball	Survey	Importance of social support types differed according to skill level, playing level, years played and future playing intentions.	Good