Objective To investigate and model the rehabilitation effects of a digital occupational therapy (OT) training system incorporating game-based elements for patients with shoulder mobility impairment. Methods A retrospective analysis of data from 80 patients with shoulder mobility impairment admitted to the Department of Rehabilitation at Dongyang City People’s Hospital from January 2024 to January 2026. Based on different rehabilitation treatment plans, the participants were divided into a control group (38 cases) and an experimental group (42 cases), which received conventional OT training and a digital OT training system incorporating game-based elements, respectively. The range of motion (ROM), Fugl-Meyer motor assessment-upper extremity (FMA-UE), visual analogue scale (VAS) and training compliance were compared between the two groups before and after training. Results After training, the range of forward flexion, abduction and external rotation mobility of the experimental group were all superior to those of the control group (all P＜0.05). Moreover, the FMA-UE score of the experimental group was higher than that of the control group (P＜0.05), and the VAS score was lower than that of the control group (P＜0.05). In addition, the compliance rate of the experimental group was higher than that of the control group (P＜0.05). Conclusion The digital OT training system incorporating game-based elements can effectively improve the ROM and motor function, relieve pain and improve compliance of patients with shoulder mobility impairment, and has clinical promotion value.