Relationship between Sleep Quality and Functional Ability in Patients with Chronic Spinal Cord Injury: A Cross-Sectional Study
Authors: Imtiaz Sidra , Ali Muhammad Qousain , Sikander Tanveer , Anwar Mamoona , Ayub Zulqarnain , Khurshid Azfar , Hashim Adnan 
Published: February 2025

Background: Sleep quality plays a crucial role in maintaining overall health and functional ability, particularly in individuals with chronic spinal cord injury (SCI). Sleep disturbances are highly prevalent in this population due to neuropathic pain, muscle spasticity, autonomic dysfunction, and psychological distress. Poor sleep can negatively impact rehabilitation outcomes, cognitive function, and daily activities, ultimately reducing independence. Despite its significance, the relationship between sleep quality and functional ability in SCI patients remains underexplored. This study aims to examine the association between sleep disturbances and functional dependence in individuals with chronic SCI.
Objective: To investigate the relationship between sleep quality and functional ability in individuals with chronic SCI and to determine whether poor sleep is associated with greater dependence in daily activities.
Methods: A cross-sectional study was conducted on 150 participants with chronic SCI, aged 18 to 25 years, recruited from outpatient clinics, rehabilitation centers, and support groups. Inclusion criteria required a confirmed diagnosis of SCI (C1–S5) for more than six months, stable medical condition, and ability to provide informed consent. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while functional ability was evaluated using the Barthel Index. Actigraphy data were collected to objectively measure sleep patterns, including sleep duration, efficiency, and nocturnal awakenings. Pearson correlation analysis was performed to assess the association between sleep quality and functional dependence, adjusting for pain levels, spasticity, and psychological comorbidities. Statistical analysis was conducted using SPSS version 27, with significance set at p < 0.05.
Results: The mean age of participants was 21.1 years (SD = 2.3), with 56% being male and 44% female. Sleep disturbances were prevalent, with 88.0% reporting poor sleep quality, including 20.0% experiencing mild, 32.0% moderate, and 36.0% severe sleep disturbances. Functional ability assessment revealed that 32.0% of participants were completely dependent, 24.0% had severe dependence, 24.0% had moderate dependence, 24.0% exhibited slight dependence, and only 4.0% achieved complete independence. Pearson correlation analysis indicated a statistically significant negative association between sleep quality and functional ability (p = 0.000), demonstrating that poorer sleep was linked to higher levels of functional dependence.
Conclusion: Sleep disturbances were strongly associated with reduced functional ability in individuals with chronic SCI, highlighting the need for targeted interventions to improve sleep quality. Given the significant impact of poor sleep on rehabilitation outcomes, integrating sleep assessments and management strategies into standard SCI care could enhance functional independence and overall quality of life. Addressing pain, spasticity, and psychological factors through a multidisciplinary approach may further optimize recovery and daily functioning in this population.