Discussion
This study compared the quality of life, health, and subjective well-being of individuals with T-SCI and NT-SCI. The results revealed significant differences in QoL and health between the two groups, particularly in the overall health domain as indicated by the WHOQOL-BREF scores. While self-reported SWB as measured by the SWLS was similar across both SCI groups, notable disparities emerged in the QoL and health domains, with the NT-SCI group reporting lower scores.

These findings align with previous research indicating that individuals with NT-SCI experience higher levels of physical, psychological, and environmental health ( Migliorini, New & Tonge, 2011 ), while also reflecting lower scores in social relationships compared to their T-SCI counterparts ( Barclay et al., 2019 ). The observed differences in QoL domains may be attributed to variations in the profiles of individuals with T-SCI and NT-SCI commonly referred to as a cohort effect. The overall health domain was significantly lower in the NT-SCI group compared to the T-SCI group. Notably, patients in the NT-SCI group were older at the time of onset, which may make them more susceptible to age-related comorbidities. Additionally, the strong relationship between health and QoL contributed to the lower overall QoL scores observed in the NT-SCI group compared to the T-SCI group.

The physical health domain of the WHOQOL-BREF assesses specific physical abilities. In this study, over half of the T-SCI patients (54.5%) had cervical injuries, compared to only 23.5% of those in the NT-SCI group. The T-SCI group had eight lumbar or sacral injuries, while the NT-SCI group had ten. Notably, the NT-SCI group had no complete injuries, whereas 22 patients in the T-SCI group did. This suggests that physical abilities are likely more restricted in individuals with T-SCI than in those with NT-SCI. Furthermore, the time since injury was shorter in the T-SCI group compared to the NT-SCI group. Ganesh & Mishra (2016) identified a strong relationship between post-injury duration and physical health-related quality of life, attributing this to a gradual reduction in pain and improved neurological function over time.

In the psychological domain, the current study found that the T-SCI group reported a mean score of 54.85 ± 10.78, while the NT-SCI group reported a mean score of 54.96 ± 9.24, indicating the presence of mood problems, anxiety, and depression. Some patients experienced difficulties with concentration, while others expressed dissatisfaction with their daily activities. These findings align with the study by Ganesh & Mishra (2016) , which indicated a significant connection between psychological well-being and injury severity. Researchers attribute this connection to low self-esteem and negative feelings stemming from a perceived lack of control over their environment. Furthermore, self-efficacy and self-esteem are highly correlated with participation, contributing to a greater understanding of functioning, disability, and health ( Geyh et al., 2012 ; Altahla et al., 2024 ; Altahla, Alshorman & Tao, 2024 ).

The social relationships domain scored higher in the T-SCI group compared to the NT-SCI group. Specifically, the T-SCI group’s score in the overall health domain was 2.98 ± 0.90, while the NT-SCI group’s score was 2.46 ± 0.87. This finding is consistent with previous research that indicated a strong relationship between social relationships and overall health ( Hampton, 2004 ). Patients in the T-SCI group reported feeling more companionship, love, and support in their intimate relationships compared to those in the NT-SCI group. Qualitative studies have highlighted that individuals with NT-SCI often report feelings of being unsupported in managing their impairments ( Guilcher et al., 2013 ; Barclay et al., 2017 ). These individuals tend to experience social isolation and rely heavily on family members for assistance in the absence of paid support ( Barclay et al., 2017 ).

Conversely, the environmental domain scored higher in the NT-SCI group than in the T-SCI group. This is largely attributable to the fact that individuals with NT-SCI typically have incomplete injuries and lower injury levels. In this study, 100% of the NT-SCI group had incomplete injuries, and 61.9% had injuries at the T1–T12 level. As a result, the NT-SCI group demonstrated better physical health than the T-SCI group, which may explain their greater ability to navigate environmental barriers.

Hu et al. (2008) found significant differences in environmental factors between complete and incomplete SCI. Additionally, Boakye, Leigh & Skelly (2012) identified that environmental accessibility is related to neurological improvements, with higher accessibility in individuals with mild impairments compared to those with severe impairments.

Regarding the SWLS, life satisfaction levels were not significantly different between the SCI groups. This supports the findings of Barclay et al. (2019) , which suggest that the etiology of the injury influences QoL outcomes following spinal cord injury. According to SWLS recommendations, an “average” score is between 20–24 and 15–19 is recommended as “below average” score ( Pavot & Diener, 2008 ). It is common for SCI people to have low score with significant issues in many areas or to be doing well in many areas, but have one substantial problem.

A literature review examining mental health, life satisfaction, psychological factors, and social support has highlighted that individuals with SCI generally report lower life satisfaction compared to the healthy population. Previous studies often failed to differentiate between individuals with T-SCI and NT-SCI, with samples frequently being either mixed or composed solely of individuals with T-SCI ( Post & van Leeuwen, 2012 ).

The current research found a positive correlation between SWB and QoL. This finding aligns with the study by Migliorini & Tonge (2009) , which identified that the coping subscale of acceptance and the objective QoL domains were positively associated with normative SWB. Furthermore, a slight to medium positive relationship was observed between the physical, psychological, environmental health, and social relationships domains. This is consistent with findings from Ganesh & Mishra (2016) . Additionally, the moderately significant association between SWB and physical health corroborates prior research ( Fuhrer, 1994 ; Martin Ginis et al., 2010 ). However, only one study has specifically examined the relationship between physical activity and SWB in individuals with SCI ( Ginis et al., 2003 ). Ginis et al. (2003) concluded that exercise can enhance life satisfaction and alleviate depressive symptoms, potentially through mechanisms related to pain reduction. In this study, the relationship between SWB and psychological health was found to be (r = 0.110, p = 0.133).

Evidence suggests that exercise can increase the production of neurotransmitters such as serotonin, norepinephrine, and dopamine, which play crucial roles in regulating emotions and preventing depression. While the relationship between SWB and the social domain was weak, this finding aligns with the study by Hampton & Qin-Hilliard (2004) . In contrast, Fuhrer’s research strongly associated SWB with social relationships ( Fuhrer, 1994 ). Additionally, SWB was significantly correlated with environmental health, suggesting that SWB is linked to the client’s social environment. Since SCI impacts the health of clients’ families, supportive family and community networks are vital for promoting SWB ( Hampton, 2004 ).

This study has several limitations. Firstly, the sample size was relatively small and was obtained through convenience sampling, which may limit the generalizability of the findings. Secondly, the cross-sectional design restricted participation to individuals undergoing rehabilitation following SCI, potentially overlooking the experiences of those outside this specific context. As a result, the findings may not be applicable to broader populations due to the limited sample size, specific demographics, and controlled conditions of the study.

To address these limitations, future research should aim to include a larger cohort of individuals with NT-SCI to enhance the robustness of the findings. Additionally, longitudinal studies conducted in the early stages following NT-SCI are needed to better evaluate QoL outcomes post-injury.