BACKGROUND: Subacromial pain syndrome (SAPS) frequently causes functional limitations. Conventional therapies target impairments, whereas occupation-based approaches emphasize meaningful activity engagement to enhance functional recovery. OBJECTIVE: This pilot randomized controlled trial explored the feasibility and preliminary efficacy of an occupation-based intervention (OBI) for SAPS. METHODS: Thirty adults aged 18 to 65 years with chronic SAPS were randomly assigned to OBI (n = 15) or no-treatment control (NT, n = 15). OBI provided twelve sessions over four weeks, mixing preparatory exercises with meaningful tasks chosen via the Occupational Performance Measure (COPM). Outcomes were pain and disability (Shoulder Pain and Disability Index, SPADI), COPM performance and satisfaction, sleep, fatigue, and life satisfaction (SWLS). Nonparametric analyses were used with Wilcoxon signed-rank and Mann-Whitney U tests; effect sizes were rank-biserial r and Cliff's DELTA. RESULTS: OBI produced large within-group reductions in SPADI pain (r 0.88) and disability (r 0.87), marked improvements in COPM performance and satisfaction (r 1.0), and better sleep (r 0.79; between-group DELTA -0.56, p = 0.009). Fatigue decreased substantially within OBI (r -0.94) but the between-group contrast was small and not significant. The NT group showed no statistically significant change on any outcome; SWLS remained stable in both arms. CONCLUSION: A four-week occupation-based program is feasible and yields clinically meaningful improvements in pain, disability, sleep, and occupation-centred outcomes in people with SAPS. These preliminary findings support larger trials comparing OBI with standard rehabilitation to confirm efficacy and long-term benefits.

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