Objectives To study the associations between daily self-reported stress, sleep quality, muscle soreness and fatigue in the previous week and weekly injury status and injury-related time loss in the following week among Para athletes. Methods Data were collected from January to December 2022 at two Brazilian Paralympic Reference Centers, including Para athletes from swimming, athletics, powerlifting and taekwondo. The OSTRC-H2 questionnaire was administered weekly to record injuries, while the Hooper questionnaire was applied daily to assess sleep quality, stress, muscle soreness and fatigue. Multilevel logistic regression estimated ORs and 95% CIs for associations between daily Hooper variables in the previous week and injury status and injury-related time loss in the following week. Results Sixty-one Para athletes participated. High stress levels were associated with greater odds of presenting a gradual-onset injury status in the following week compared with low stress levels (OR 1.73, 95% CI 1.10 to 2.72). High fatigue levels were associated with increased odds of presenting a substantial gradual-onset injury status (OR 1.99; 95% CI 1.16 to 3.45). Moderate fatigue (OR 0.69; 95% CI 0.53 to 0.89) and muscle soreness (OR 0.76; 95% CI 0.57 to 0.99) were associated with lower odds of injury-related time loss, while moderate sleep quality was linked to increased odds of time loss (OR 1.50; 95% CI 1.16 to 1.93). Conclusion Monitoring self-reported stress, fatigue and muscle soreness may help identify athletes more likely to report gradual-onset or substantial gradual-onset injury status or to experience injury-related time loss, highlighting the value of tailored injury prevention strategies in Para sports.
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