Adaptive Sports Engagement for Spinal Cord Injury Survivors: Quality-of-Life Trajectories, and Determinants of Community Reintegration

Abstract

Spinal cord injury (SCI) produces life-altering consequences affecting mobility, self-care, work capacity, social participation, mental health, and overall quality of life. Adaptive sports — competitive and recreational physical activities modified for disability have emerged as substantial contributors to comprehensive SCI rehabilitation and community reintegration. Beyond direct physical fitness benefits, adaptive sports support psychological wellbeing, community participation, peer engagement, and self-efficacy. We undertook a 12-month prospective cohort study of 218 SCI survivors enrolled in structured adaptive sports programmes. SCI level distribution included tetraplegia (32%) and paraplegia (60%) with mixed conus/cauda equina presentations (9%). Adaptive sport engagement varied substantially across the cohort with median 124 hours of training over 12 months. Training hours were strongly correlated with SCI-QOL improvement (r = 0.54). Largest improvement effect sizes were observed in cardiorespiratory fitness (Cohen's d 1.62), upper-body strength (1.42), community participation (1.42), and physical/psychological wellbeing (1.32, 1.28). Strongest predictors of community participation improvement included high training engagement, group-based sport, earlier post-injury engagement, incomplete SCI, adaptive equipment provision, and family/peer support. Severe chronic pain, untreated depression, and transportation barriers were associated with worse outcomes.