Comparison of shoulder pain, physical activity adherence, and compliance in wheelchair users with spinal cord injury across levels of para sport systematization in rehabilitation hospitals

Individuals with spinal cord injury or disease (SCI/D) face significant barriers to physical activity, leading to high rates of sedentary behavior and related health complications. Structured Para sport programs in rehabilitation settings have emerged as a strategy to promote activity, improve outcomes, and support long-term health. To investigate the relationship between Para sport systematization levels (PSL) and adherence to physical activity guidelines, physical fitness, and shoulder pain among manual wheelchair users with SCI/D in a rehabilitation hospital. Cross-sectional study. Setting: Rehabilitation hospital. Participants: 114 SCI/D participants stratified by three PSL levels (1-3). Outcomes measures: Physical activity adherence, fitness status, and shoulder pain prevalence were compared across groups using guideline-based criteria and regression models. PSL3 demonstrated greater adherence to physical activity guidelines (84.6%) and higher physical fitness levels (50.0%) compared to PSL1 and PSL2. Adherence to activity recommendations was approximately seven times higher in PSL3 than in PSL1, and five times higher than in PSL2. Shoulder pain prevalence was lowest in PSL3 (15.4%), in contrast to higher rates observed in PSL1 (30.0%) and PSL2 (24.1%). Logistic regression analyses revealed significant associations between PSL and physical fitness (P < 0.01). No significant associations were identified between shoulder pain and adherence to physical activity. Structured Para sport programs within rehabilitation hospitals enhance physical activity participation may reduce shoulder pain prevalence. The PSL was a stronger predictor of adherence than demographic or clinical factors, supporting the integration of PSL programs as a cost-effective, health-promoting strategy in SCI/D rehabilitation.