Performance, Biomechanical Demands, Injury Burden, and Health Surveillance in Wheelchair Court Sports and Selected Para Sport Cohorts: A Systematic Review

Background: Research examining performance, biomechanics, workload, injury, and health in Para sport is heterogeneous and is particularly focused on wheelchair-based sports. This systematic review synthesized quantitative evidence focused predominantly on wheelchair basketball, wheelchair rugby, and wheelchair tennis, with additional evidence from Para-cycling, mixed wheelchair-sport populations, and broader Paralympic cohorts. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidance and predefined eligibility criteria, PubMed/MEDLINE, Scopus, Web of Science Core Collection, and Google Scholar were searched without publication-date restrictions. Owing to substantial heterogeneity in study designs, populations, sports, measurements, and outcomes, findings were synthesized narratively. Risk of bias was evaluated using design-specific appraisal tools. Results: Twenty-two quantitative studies were included. Evidence was focused on wheelchair basketball, wheelchair rugby, and wheelchair tennis, with additional evidence from Para-cycling, mixed wheelchair-sport populations, and broader Paralympic cohorts. Findings indicated associations among trunk function, functional classification, wheelchair mobility, upper-body function, propulsion characteristics, workload responses, and sport-specific performance. In one small study involving 10 wheelchair tennis athletes, medicine-ball throw performance was strongly correlated with serve accuracy (r = 0.874); this finding should not be generalized beyond that study. Prospective surveillance studies also identified meaningful injury and illness burdens across Para athlete populations. Conclusions: Available evidence suggests that performance and health in the represented Para sport populations are influenced by interacting functional, biomechanical, workload, and health-related factors. However, the evidence base is limited by small samples, heterogeneous methods, and a predominance of observational designs. Individualized assessment, workload monitoring, and health surveillance therefore represent provisional practice considerations rather than established best-practice recommendations.