Rihab Moncer

Background: Myofascial pain syndrome is a common condition characterized by localized muscular discomfort and trigger points. Dry needling mechanically disrupts trigger points, while magnesium infiltration relaxes muscles and reduces inflammation. Evidence directly comparing these treatments is scarce. This study aimed to compare their effectiveness in reducing pain, improving quality of life, and alleviating anxiety and depression.Methods: A randomized controlled trial included 45 patients assigned to dry needling (Group A) or magnesium infiltration (Group B). Interventions were evaluated at baseline, 1, 3, and 6 months. The primary outcome was pain intensity measured with the Visual Analog Scale. Secondary outcomes were physical and mental health (12-Item Short-Form Health Survey) and anxiety and depression (Hospital Anxiety and Depression Scale).Results: Both treatments significantly improved pain, mental and physical health, and reduced anxiety and depression at 1 and 3 months. By 6 months, improvements were maintained but not statistically significant. No significant differences were observed between groups at any time point.Conclusion: Dry needling and magnesium infiltration were both effective in the short to medium term for reducing pain and enhancing quality of life in patients with myofascial pain syndrome. Although each treatment improved outcomes, neither demonstrated superior effectiveness. Both approaches remain viable therapeutic options. Further long-term studies are needed to clarify sustained benefits and guide clinical use (trial registration: PACTR202309751113430).

Background and Objectives: This study investigated whether crossover neuromuscular fatigue following unilateral handgrip exercise exhibits directional asymmetry, testing whether dominant-limb fatigue produces greater contralateral performance decrements than non-dominant-limb fatigue in adults and pre-peak-height-velocity children. Materials and Methods: Thirty-three healthy, right-handed males (16 adults: 22.5 ± 1.6 years; 17 pre-peak-height-velocity boys: 11.2 ± 0.8 years, maturity offset −2.2 ± 0.4 years) completed three counterbalanced experimental sessions (48–72 h apart): dominant-arm fatigue, non-dominant-arm fatigue, and control. The fatigue protocol consisted of 20 consecutive 6 s maximal voluntary isometric handgrip contractions. Primary outcomes were percentage changes in maximal voluntary isometric contraction of the contralateral limb across handgrip, elbow flexor, and elbow extensor muscle groups. Results: The experimental condition explained approximately 64% of crossover variance in adults (η_p² = 0.650, ηG² = 0.421) and children (η_p² = 0.638, ηG² = 0.448; both p < 0.001). Dominant-limb fatigue elicited substantially greater contralateral decrements than non-dominant-limb fatigue in adults (−11.00% vs. −3.92%, dz = −1.07) and children (−12.71% vs. −3.08%, dz = −1.33), representing 2.5- to 3.5-fold greater transfer efficiency (both p < 0.001). Age-group comparisons revealed no differences in crossover susceptibility (p = 0.627, η_p² = 0.008), with equivalence testing confirming developmental invariance. Crossover effects extended to heterologous proximal muscles without magnitude differences (p > 0.13). Conclusions: Crossover fatigue (contralateral performance decrement following unilateral exercise) exhibited directional asymmetry, with dominant-limb protocols eliciting 2.5- to 3.5-fold greater contralateral decrements. This pattern aligns with asymmetric transcallosal inhibitory projections demonstrated in prior transcranial magnetic stimulation studies, though direct neurophysiological confirmation was not obtained. Functional equivalence between pre-peak-height-velocity children and adults indicates that interhemispheric transfer mechanisms achieve operational maturity before peak height velocity. Extension to heterologous muscles implicates supraspinal mechanisms. The findings establish normative parameters for clinical populations with compromised transcallosal integrity.

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 Muscle injuries are the most frequent in football and may lead to the end of a player’s career. Many studies have evaluated the effectiveness of prevention programs for all injury types. Few studies have evaluated the effects of exercise on muscle injuries. The aim of this study is to report, through a systematic review of research of high level of proof (randomized controlled trial) the efficacy of preventive programs for muscle injuries for football players. Methods A documentary search was conducted in October 2022 from three databases: Medline via its PubMed interface, Google Scholar, and COCHRANE databases. We only included original articles published between October 2012 and October 2022 with a high level of evidence. The research was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The target population consisted of professional and semi-professional footballers. The intervention in question was structured injury preventive protocols, including specific training or pre-established protocols such as the FIFA 11+ program, compared to each other or with regular training sessions. The main outcomes were the incidence rates of muscle injuries and severe injury in each group, as well as the time loss to injury. Results Seven randomized controlled trials with a high level of evidence confirmed using the PEDRO scale were included. There were 3815 male professional football players. There was heterogeneity in the age, hours of exposure, and duration of the intervention. The prevention protocols used were FIFA 11+, bounding exercises, NHE, and stretching exercises. Structured exercises significantly reduce the severity of muscle injury and, consequently, time loss to injury. Discussion Despite the diversity of prevention programs, teams still lack standardized programs. Structured exercises, such as FIFA 11+ and bounding exercises, which combine strengthening, body kinesthesic awareness, and neuromuscular control, reduce the incidence and severity of muscle injury. FIFA 11+ is the first and most complete structured program, but lacks some exercises, such as adductor strengthening. Conclusion This review showed the interest in structured exercises in reducing severity and time loss to injury in professional football players. It shows that effective MI prevention program should combine variable structured programs taking into consideration risk evaluation. Registration This review was registered on 8/17/2023 in the International Prospective Register of Systematic Reviews under the reference code CRD42023452202.

Background: Determining the needs to access to rehabilitation structures is essential for developing effective improvement strategies. The objective of this study was to determine the percentage of unmet needs to admission to rehabilitation and their associated factors. Methods: It is a cross sectional study in the inpatient rehabilitation department Sahloul Hospital of Sousse, tertiary care center including all requests to admission. Patient demographics, diagnoses, admission decisions, and post-decision outcomes were collected for each request. Results: Of 329 admission requests, 316 were eligible. The mean patient age was 45 years, with a male-to-female ratio of 0.84. Most requests originated from the hospital’s outpatient department, neurology, and orthopedics. Among all requests, 40.5% were not admitted. Non-neurological diagnoses and patient residency were associated with non-admission. Patients with non-neurological conditions and those residing outside the city had twice the risk of non-admission. At one month, 63% of non-admitted patients experienced functional decline, and 18% were lost to follow-up. Conclusion: Unmet needs to admission in rehabilitation structures is high due to lack of beds. This is leading of inequity of access to such important phase of care more. This study highlighted throwing the example of physical and rehabilitation department the gap of needs and the capacity of inpatient rehabilitation facilities. Healthcare policies should prioritize increasing rehabilitation bed availability in all regions of the country.

Background Muscle injuries are the most frequent in football and may lead to the end of a player’s career. Many studies have evaluated the effectiveness of prevention programs for all injury types. Few studies have evaluated the effects of exercise on muscle injuries. Methods A documentary search was conducted in October 2022 from three databases: Medline via its PubMed interface, Google Scholar, and COCHRANE databases. We only included original articles published between October 2012 and October 2022 with a high level of evidence. The research was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The target population consisted of professional and semi-professional footballers. The intervention in question was structured injury preventive protocols, including specific training or pre-established protocols such as the FIFA 11+ program, compared to each other or with regular training sessions. The main outcomes were the incidence rates of muscle injuries and severe injury in each group, as well as the time loss to injury. Results Seven randomized controlled trials with a high level of evidence confirmed using the PEDRO scale were included. There were 3815 male professional football players. There was heterogeneity in the age, hours of exposure, and duration of the intervention. The prevention protocols used were FIFA 11+, bounding exercises, NHE, and stretching exercises. Structured exercises significantly reduce the severity of muscle injury and, consequently, time loss to injury. Discussion Despite the diversity of prevention programs, teams still lack standardized programs. Structured exercises, such as FIFA 11+ and bounding exercises, which combine strengthening, body kinesthesic awareness, and neuromuscular control, reduce the incidence and severity of muscle injury. FIFA 11+ is the first and most complete structured program, but lacks some exercises, such as adductor strengthening. Conclusion This review showed the interest in structured exercises in reducing severity and time loss to injury in professional football players. Registration This review was registered on 8/17/2023 in the International Prospective Register of Systematic Reviews under the reference code CRD42023452202.

Background Patients treated in Physical Medicine and Rehabilitation (PM&R) departments benefit from global and multidisciplinary long-term care. The study of satisfaction represents an important element in the evaluation of the quality of the healthcare provided. The aim of this study is to assess the level of satisfaction of patients treated in the PM&R department of Sahloul university hospital of Sousse Tunisia as well as the associated factors during the year 2020. Methods We conducted a cross-sectional study, including patients treated in the hospitalization and the outpatient units of the PM&R department. Monnin and Perneger scale validated in Arabic was used to measure satisfaction in its different dimensions. Medical data were completed from patients’ records. Results A total of 240 patients were included in our study. The level of satisfaction was significantly higher with the admission procedures for inpatients compared to outpatients (87.9% vs. 60.0%, p<0.001). Regarding the global assessment, 82.1% of patients were satisfied. Multivariate analysis showed that for administrative procedures, consultation for outpatients was a factor of dissatisfaction (aOR=0.18, p<0.001). Patients’ physiotherapy treatment during the Covid-19 period was negatively associated with satisfaction for logistics (aOR= 0.44, p=0.011) and for the global assessment of health care provided in our department (aOR= 0.46, p=0.04). Conclusion Our study showed overall good levels of satisfaction in the department of PM&R of Sahloul. However, more studies should follow to determine other factors that can influence satisfaction.