Introduction: The flipped classroom (FC) integrates online content delivery with in-class activities focused on knowledge application, such as discussions and problem-solving. While increasingly prevalent in medical education field, the efficacy of FC remains a subject of debate. Objective : This protocol outlines a systematic review (SR) to examine the scope and methodological quality of studies on the FC teaching approach in medical education. Methods: The protocol was registered in PROSPERO (CRD420251008268) and adhered to the Preferred Reporting Items for SRs Protocols guidelines. A thorough literature search will be performed using Scopus, PubMed/Medline, the Cochrane Library, and Google Scholar. The review will consider comparative controlled studies that focus on FC in the medical learning field. Two independent reviewers will carry out a rigorous data extraction. The Medical Education Research Study Quality Instrument will be used to evaluate the study's quality. Synthetizing the findings of this SR will provide a thorough understanding of the impact of FC in academic performance and students’ satisfaction in medical learning. Expected results: This qualitative summary will offer a narrative overview of the included papers, emphasizing interventions designed to evaluate the impact of FC. Results will be discussed according to the review's objectives, evaluating both study quality and consistency of findings, and will be clearly illustrated using tables and graphs. Conclusion: The SR developed from this protocol will undoubtedly provide evidence of the effectiveness of FC in medical education and will effectively contribute to increasing the present body of information on FC interventions for improving outcomes.

Background: Cerebral palsy (CP) represents the most common and disabling motor disorder in childhood. It can lead to chronic pain and reduced quality of life (QOL). These challenges can also affect mothers, who are typically the primary caregivers, contributing to physical and psychosocial strain.Objectives: This study explored the associations between motor impairment, chronic pain, and QOL in children with CP, as well as maternal stress and pain intensity, and examined their mediating roles.Method: A cross-sectional study was conducted with 132 mother–child dyads in Tunisia. Children were aged 4 to 12 years. The Gross Motor Function Classification System, the Cerebral Palsy Quality of Life Questionnaire, the Visual Analogue Scale, and the Perceived Stress Scale were used to assess motor impairment, quality of life, and chronic pain intensity in children with CP, as well as maternal pain intensity and stress.Results: Motor impairment was significantly associated with lower child QOL (β = −0.671; SE = 0.657, p 0.001) and higher pain intensity (β = 0.5; SE = 1.213, p 0.001). Maternal stress partially mediated the relationship between motor impairment and child QOL (Sobel test = −4.073; p 0.001). Maternal pain also partially mediated the relationship between motor impairment and child pain (Sobel test = 2.505; p = 0.012).Conclusion: These findings highlight the significant impact of motor impairment on QOL and chronic pain intensity in children with CP.Contribution: This study emphasises the mediating roles of maternal stress and pain intensity, suggesting that interventions should address both the physical symptoms of CP and the psychosocial well-being of children and their mothers.

Background/Objectives: Spinal cord injury represents a devastating neurological condition affecting approximately 27 million individuals globally, with particularly severe impacts on sexual function. Sexual dysfunction in SCI patients is multifactorial, with prevalence rates reaching 80–90% across different populations. In low- and middle-income countries, sexual health remains critically neglected in rehabilitation settings due to cultural barriers, inadequate healthcare infrastructure, and limited clinician training. Tunisia, with an estimated 31,000 SCI cases, lacks comprehensive data on sexual dysfunction prevalence and healthcare communication patterns in this vulnerable population. Based on identified research gaps, our study aimed to (i) assess the prevalence and severity of sexual dysfunction among Tunisian SCI patients using validated assessment tools, (ii) identify clinical and demographic factors associated with sexual dysfunction, and (iii) evaluate the current state of sexual health communication and rehabilitation services. Methods: A cross-sectional observational study was conducted at Sahloul University Hospital, Sousse, Tunisia, between July and September 2025. Fifty-one adults with chronic SCI (≥12 months post-injury) were recruited through consecutive sampling. Sexual function was assessed using the International Index of Erectile Function (IIEF) for men and the Female Sexual Function Index (FSFI) for women. Additional assessments included demographic data, injury characteristics using the American Spinal Injury Association Impairment Scale, pain evaluation, functional status, psychological well-being, and sleep quality. Statistical analysis included descriptive statistics, Spearman correlations, and significance testing (p < 0.05). Results: Sexual dysfunction affected 84.3% of participants (43/51), with 88.5% of men experiencing moderate-to-severe erectile dysfunction (median IIEF: 12 [7–36.25]) and 80% of women reporting sexual dysfunction (median FSFI: 7.2 [4–24.25]). Severe dysfunction (FSFI ≤ 10) was present in 56% of female participants. Sexual dysfunction correlated significantly with urinary incontinence (p = 0.045) and with measures of functional independence, including SCIM-III (ρ = 0.466, p = 0.016) and FIM (ρ = 0.569, p = 0.002) among men, and SCIM-III (ρ = 0.469, p = 0.018) and FIM (ρ = 0.495, p = 0.012) among women, indicating moderate positive associations between sexual and functional outcomes. Only 11.5% of men achieved normal erectile function (IIEF ≥48). Psychological factors (HAD-S) and pain scores (NRS, DN4) were not significantly associated with sexual function. A total of 92% of patients reported never discussing sexual health with their healthcare providers, and 100% lacked access to dedicated sexual rehabilitation services, underscoring severe care and communication gaps in the Tunisian SCI rehabilitation system. Conclusions: Sexual dysfunction is highly prevalent among Tunisian spinal cord injury patients and is closely associated with reduced functional independence and urinary issues. Despite its significant impact, sexual health remains largely neglected in rehabilitation care. These findings highlight an urgent need to integrate sexual health into national rehabilitation protocols through provider training, multidisciplinary services, and culturally sensitive education. Systematic sexual health assessment and rehabilitation should be considered essential to improving the quality of life and restoring dignity for affected individuals.