Statistical analysis
In this study, data analysis was conducted using SPSS version 23.0 (IBM Corp, Armonk, NY). Descriptive statistics, such as the mean and standard deviation (SD), were employed to present quantitative variables. The normality of data was assessed using the Shapiro‒Wilk test. An independent t test was applied to assess whether the means of the two groups were significantly different from each other, given the variation within each group. Cohen's d was employed to estimate effect size, with a confidence interval of 95% and a significance level of 