Among the 112 participants, 77.68% were male, 86.61% were married, and 60.71% had completed education up to middle school or below. Half of the participants were in the age group of 50 years. The majority of participants had experienced a recent injury within the past year (85.71%), and traumatic injuries were more prevalent (54.46%). The largest proportion of injuries were classified as ASIA grade C (40.18%), followed by B, A, and D, constituting 31.25%, 25%, and 3.57%, respectively.

The majority had sustained traumatic injuries. In terms of injury levels, the most prevalent was T7-T12 (33.93%), while the lowest was T1-T6 (12.50%). Paraplegia and tetraplegia were diagnosed in an equal proportion of participants (50%). The most common cause of injury was traffic accidents (63.39%), followed by falls on roads (18.75%). The majority of injuries were categorized as incomplete (91.07%), with the remaining 8.93% classified as complete injuries.

Quality of life, Depression, and anxiety

Table 1 displays measures of central tendency and dispersion, including mean, SD, median, and interquartile range, for the variables examined. The mean values for overall QOL based on the first item of WHOQOL– BREF were 3.14, and for overall health, they were 2.69. The means for the transformed scores of the WHOQOL– BREF domains of psychological health and social relationships were the higher range (75.00), followed by physical and environmental health in the (69.00) range. The mean value for “the impact of disability” item was 2.78, while the mean score for the 12-item DIS module was 35.28. The means for the standardized scores of the SDS were higher than those of the SAS: 50.45 and 52.75, respectively.

Table 1 Descriptive analysis for quality of life, anxiety, and depressionChanges in QOL in two periods (before and during) pandemic COVID-19

Table 2 shows the findings of the paired-samples t-tests that examined the QOL differences before and during the COVID-19 pandemic. The results reveal a significant decrease in the psychological and social relationships domains (p < 0.001). Furthermore, there was a notable reduction in the physical health (p = 0.050) and environmental domains (p = 0.071). These declines in QOL were generally described as having medium- to large-sized effects on SCI patients during COVID-19. SCI patients showed a notable reduction in their QOL and health satisfaction, with observed decreases in the other domains (physical health, psychological, social relationships, and environmental). These declines were particularly evident in areas such as the need for medical treatment, satisfaction with sleep, ability to concentrate, support from friends, personal relationships, perception of the physical environment’s healthiness, and satisfaction with living conditions.

Table 2 Comparisons in quality of life before and during the COVID-19 pandemicChanges in the WHO modules on QOL-DIS, Anxiety/depression before and during COVID-19 pandemic

The paired-samples t-tests revealed the results of a comparison between scores on the DIS, SDS, and SAS before and during the COVID-19 pandemic (Table 3). Participants reported a significantly higher impact of disability during COVID-19 when compared to the pre-pandemic period (p < 0.001, Cohen’s d = 1.02). Moreover, the total scores for SDS and SAS were also higher during COVID-19 (p = 0.001, < 0.001, Cohen’s d = -0.42, -0.89). The prevalence estimates for mild depression were 52.7% before COVID-19, while anxiety was interpreted as normal by 67.9% of participants. During the COVID-19 pandemic, the prevalence of mild depression and anxiety increased to 68.8% and 77.9%, respectively (Fig. 1).

Table 3 Changes in DIS, SDS, and SAS before vs. during the pandemic COVID-19Fig. 1

Bar charts showing Changes in the severity of anxiety and depression levels before vs. during the COVID-19 pandemic

The WHOQOL–BREF and DIS scores comparison for participants stratified by demographics characteristics (gender and age) before and during COVID-19

Table 4 shows the comparison of the WHOQOL– BREF, dimensions, and DIS for the gender and age groups before and during COVID-19. In the male group during COVID-19, there were significant decreases in various dimensions: the physical dimension showed lower scores and a small effect size compared to before COVID-19 (p = 0.074, d = 0.29). Furthermore, the psychological dimension was significantly lower with a large effect size compared to before COVID-19 (p = 0.000, d = 0.97). Additionally, the social relationships dimension showed lower scores with a medium effect size compared to before COVID-19 (p = 0.003, d = 0.61). Moreover, the environmental dimension showed lower scores and a smaller effect size during COVID-19 compared to before COVID-19 (p = 0.288, d = 0.17). In addition, the DIS was significantly lower with a large effect size during COVID-19 than before COVID-19 (p = 0.000, d = 1.83). However, in the female group during COVID-19, there were significant decreases in various dimensions: the physical dimension showed lower scores and a large effect size compared to before COVID-19 (p = 0.053, d = 0.84). Furthermore, the psychological dimension was significantly lower with a large effect size compared to before COVID-19 (p = 0.154, d = 0.84), and the social relationships dimension was lower with a large effect size during COVID-19 compared to before COVID-19 (p = 0.003, d = 1.49). Moreover, the environmental dimension showed lower scores and a medium effect size during COVID-19 compared to before COVID-19 with a medium effect size (p = 0.151, d = 0.76), and the DIS was significantly lower with a large effect size during COVID-19 than before COVID-19 (p = 0.001, d = 1.77). For participants in the < 30 years old group during COVID-19, there were decreases in various dimensions: physical, psychological, and environmental dimensions with a large effect size (d = 0.89, 1.16, and 0.96, respectively), while the social dimension had a medium effect size (d = 0.69) and the DIS showed a large effect size (d = 2.10). For participants in the 31–40 years old group during COVID-19, there were significant decreases in various dimensions: physical, psychological, and environmental dimensions with a large effect size (d = 1.84, 1.58, and 1.39), respectively, while the social dimension had a small effect size (d = 0.26) and the DIS had a large effect size (d = 2.20). For participants in the 41–50 year old group during COVID-19, there were significant decreases in various dimensions: physical, social, and environmental dimensions with a medium effect size (d = 0.69, 0.63, and 0.56), respectively, while the psychological dimension had a large effect size (d = 1.45) and the DIS had a large effect size (d = 1.58). For those in the age group > 50 year, during COVID-19 there were significant decreases in various dimensions: physical and environmental dimensions, with a small effect size (d = 0.00, 0.03), respectively. While the psychological dimension had a medium effect size (d = 0.59), the social dimension had a large effect size (d = 0.86), and the DIS had a large effect size (d = 1.74).

Table 4 Comparisons between before and during COVID-19 scores for the WHOQOL–BREF and the DIS stratified by gender and age groupsThe WHOQOL– BREF and DIS scores comparison based on stratification by injury characteristics (level of injury and ASIA scale) before and during COVID-19

Table 5 displays the comparisons in the two periods for the WHOQOL– BREF, dimensions, and DIS for the level of injury. During COVID-19, the participants in the C1-C4 level injuries experienced significant decreases in various dimensions: physical, psychological, social dimensions, and DIS, with large effect sizes (d = 1.10, 1.09, 0.82, and 1.33), respectively, while experiencing a medium effect size (d = 0.50) in the environmental dimension. For participants in the C5-C8 level injuries, during COVID-19 there were significant decreases in various dimensions: a smalleffect size for physical health (d = -0.06) and large effect sizes for psychological and social dimensions (d = 1.05, 1.20), respectively. The environmental dimension had a medium effect size (d = 0.52) and DIS showed a large effect size (d = 1.72). For participants with T1-T6 level injuries during COVID-19, there were significant decreases in various dimensions: physical, psychological, and environmental dimensions with small effect sizes (d = 0.43, 0.38, and 0.34), respectively, while the social dimension and DIS exhibited large effect sizes (d = 1.05, 2.27), respectively. For those with T7-T12-level injuries, during COVID-19 there were significant decreases in various dimensions: physical, social, and environmental dimensions with small effect sizes (d = 0.16, 0.36, and 0.28), respectively, while the psychological dimension and DIS showed large effect sizes (d = 1.43, 1.92), respectively. For the participants in the lumbar or sacral level group during COVID-19, there were significant decreases in various dimensions: physical, social, and environmental dimensions with large effect sizes (d = 2.09, 0.78, and 1.20), respectively, while the psychological dimension had a small effect size (d = 0.22) and the DIS exhibited a large effect size (d = 1.67).

Table 5 Comparisons between before and during COVID-19 scores for WHOQOL–BREF and DIS stratified by injury level

Table 6 presents the comparisons in the two periods for the WHOQOL– BREF, dimensions, and DIS for ASIA groups. For SCI with the ASIA grade A group during COVID-19, there were significant decreases in various dimensions: large effect sizes in physical and psychological dimensions and DIS (d = 0.76, 0.98, and 1.70), respectively, while the social and environment dimensions showed small effect sizes (d = 0.46, 0.12). For participants with ASIA B during COVID-19, there were significant decreases in various dimensions: small effect sizes for physical and psychological dimensions (d = 0.160, 1.31), respectively, while the social dimension and DIS had large effect sizes (d = 0.92, 1.78), and the environment dimension had a medium effect size (d = 0.56). For participants with ASIA scale C during COVID-19, there were significant decreases in various dimensions: the physical dimension had a small effect size (d = 0.32), while the psychological, social, and environment dimensions exhibited medium effect sizes (d = 0.70, 0.70, and 0.54), respectively. However, the DIS has a large effect size (d = 1.85). For the participants in the ASIA grade D group during COVID-19, there were significant decreases in various dimensions: a small effect size for the physical, psychological, and environment dimensions (d = 1.83, 1.70, and 2.29), respectively, while the social dimension had a medium effect size (d = 0.02) and DIS exhibited a large effect size (d = 3.00).

Table 6 Comparisons between before and during COVID-19 scores for WHOQOL–BREF and DIS stratified by ASIA groupsPractices sample with respect to COVID-19

The percentage of individuals always practicing good habits varied from 66.23% for home disinfection to 93.5% for active quarantine and high-risk groups. The practice of keeping warm and avoiding catching a cold had an average value of 90.91%. Except for a few items such as “after the outbreak, stay at home to prevent infection,” “wear a mask when going out,” “wash hands,” “open windows to keep the air fresh,” “reduce time in airtight, airless environments,” “reduce visits to crowded places,” and “avoid direct contact with public facilities that may be infected,” the adherence rate to good practices was above 80% (Table 7).

Table 7 The COVID-19 prevention practices by cross secotional survey sample (N = 77)