This study showed that there was a positive relationship between participation in wheelchair sports and improved QoL. All participants from the sports group that filled out the questionnaire responded positively to the QoL questions and reported that as a direct result of participation in sports, they felt happier, stronger, and more confident. This suggested that wheelchair sports may be beneficial at improving perceptions of happiness and confidence in individuals with physical disabilities. The findings of this study were consistent with other research that concluded that regular physical activity has a positive influence on an individual’s QoL [3, 5, 14].
Kljajic et al., found that people with spinal cord injury engaged in sports activities, either individually or as a group, and had a significantly higher quality of life when compared to people not involved in any sports . Results from this current study are important as increasing opportunities to participate in wheelchair sports may allow more individuals with disabilities to reap the physical and mental health benefits [5, 15]. The main difference in this current study is that it was focused on a wider scope of disabilities and determined the impact that sports may have on any individual with any physical disability, rather than just one clinical population, such as spinal cord injuries. Salvador-De La Barrera et al. 18 reported that normative values for overall QoL in traumatic spinal cord injury was 66.2 ± 20.7, which is slightly higher that the overall QoL reported by sports participants (61.1 ± 16.9) in this study.
This study found that there were differences between the sports and non-sports groups in the overall score of the WHOQOL-BREF, such that scores were higher in people with physical disabilities who participated in sports mirroring the positive correlation between high quality of life and participation in adaptive sports in people with disabilities found in other studies . Notably, participation in adaptive sports has been shown to have similar benefits in quality of life that are comparable to people without any physical limitations .
The physical domain of QoL in people with physical disabilities is an important component to consider, as the QoL of people with injuries and disabilities has been found to be lower in comparison to the general healthy population . Improvements in the physical domain are important as they can have a positive impact in function, such as wheelchair transfers and bed mobility, can also increase strength and cardiovascular fitness and can have a greater influence on independence  such as in improved ability to complete activities of daily living (ADLs), such as dressing, personal cares and feeding . This study has demonstrated that those who participated in sports had a higher average score within the physical domain (64%) than those who did not (56%), which may be translated in the previously mentioned improvements in physical function. This may be related to the satisfaction of completing an activity or by the positive impact of physical activity on self-efficacy perception, feelings of control and ultimate satisfaction  that someone participating in sports may experience. Previous disability research has established that participation in physical activity improved psychological well-being , though this was not wheelchair specific.
This study’s results in the physical domain were also consistent with a previous study conducted by Yazicioglu et al, (2012) , who found that the physical domain scores of the WHOQOL-BREF was significantly higher in the group who participated in adapted sports when compared to the control group who did not participate. However, our study did not find any statistically significant difference in the psychological and social domains. This may have been related to the small sample size and due to the study recruiting a larger sample of participants with physical disabilities from a disability specific outpatient therapy clinic in Turkey, whilst our study relied on online responses limited to organisations in Australia.
This study has demonstrated that those who play sports have a higher psychological domain score (37% vs. 55%). The psychological normative score in traumatic spinal cord injury was 67.76% , which means that the group that played sports were closer to the average psychological normative score than those who did not participate in sports. Therefore, this study determined that those who play sports were above the cut-off standards for low QoL in the psychological domain and those who do not play sports are below the cut off standards, which was consistent with findings from previous literature, in which people with spinal cord injuries involved in wheelchair sports was associated with better psychological status irrespective of the level of lesion [6, 20].
Environmental domain of QoL in this study was found to be equal in both people participating and not participating in sports. People with physical disabilities who played sports had a relatively equal environmental domain average score at 67.5/100 when compared with those who do not at 68/100. The normative data scores for the environmental normative for traumatic spinal cord injury are 69.09/100 , showing that both sports and non-sports groups within this study scored above the cut-off standards for QoL (at least in one subset of people with physical disabilities, such as people with spinal cord injury) in the environmental domain regardless of their participation in wheelchair sports. These results may be related to similar perceived environmental barriers to participate for both sports and non-sports participants . Environmental factors that were perceived as barriers to participation in wheelchair sports were costs, no fitting sport, lack of sports buddy and lack of transport and sports facilities in the neighbourhood .Other environmental factors that can affect QoL, but not related to participation in sports specifically, include financial resources, access to healthcare, funding, home environment, physical safety and security . Considering the multiple environmental factors that can influence QoL in people with disabilities, it is reasonable to consider that participation in sports may not solely positively improve the environmental domain of QoL, as environmental factors seem to be an ongoing challenge in people with physical disabilities .
Social participation is an influencing factor strongly linked to an individual’s QoL, and as such, being able to consider oneself part of a group or family increases the sense of belonging, which increases sense of well-being . Social benefits can arise from social support and personal relationships , and as such, social interaction is an essential dimension of health . A study by Côté-Leclerc et al. 33, found that being involved in adapted sports had a positive impact on quality of life based on the increased number of meaningful relationships with teammates . This is somewhat reflected in the current study as those who participate in sports have a higher social domain average score at 50.5/100 than those who do not at 44/100. However, the sports group scored below and those who do not play sports scored significantly below the cut-off standards for QoL in the social domain in people with traumatic spinal cord injury, which is 65.43/100 . This can be explained by other not included in this study and stronger factors influencing the social participation domain of QoL. One of them maybe related to self-perceived efficacy, which means not being reliant on others and may be one of the possible factors influencing the social aspect of QoL related to participating in community activities . Therefore, future studies should include investigating other specific factors, such as self-perceived efficacy that can strongly influence the social participation domain of QoL in people with physical disabilities.
People with physical disabilities often experience a reduction in physical function and health compromising their quality of life 21 that can be addressed by participating in leisure activities that would promote their physical health, social integration, and quality of life. However, there are many barriers that wheelchair users encounter every day which prevent them accessing and participating in activities for leisure 9. A study by Rimmer et al, (2004) 22 found multiple barriers to physical activity participation among persons with physical disabilities. These included, but were not limited to a lack of transportation, accessible facilities/equipment, and lack of adaptive equipment 22. Our study identified similar barriers to participation in wheelchair sports, with the main barriers being lack of access to facilities and/or equipment and a lack of income and/or funding.
In terms of facilitators to participate in adaptive sports, our study found an increase in funding and/or income as the main one. A previous study  also identified similar facilitators as our study, which were increased financial income, specifically from government funding. Other facilitators were also identified by Rimmer et al, (2004) 22 which include: decreasing or waiving fees associated with joining facilities and transportation, as well as pooling resources from neighbouring communities with limited funds to provide accessible facilities and programs to benefit persons with disabilities in these communities 22. These results highlight the increasing need to allocate funding into community organisation that work towards building an adaptive sports ecosystem in local communities. Similarly, strategies to improve different sources of income, such as promoting employability can also facilitate participation in adaptive sports and an improvement of QoL as a probable outcome. In this manner, people with disabilities can start to overcome their main barriers and access the great physical and mental health benefits that participating in adaptive sports can bring.
A limitation of this study was the small sample size (n = 54) in comparison to a previous study by Anneken et al., (2010) with a sample size of (n = 277) . The electronic mode of distributing the survey may have decreased the sample size due to the known factor of low rates of participation with electronic questionnaires . Smaller sample sizes decrease the statistical significance of any changes found in the results .