Statistical analysis
All reported Categorical variables are expressed as absolute and relative frequencies. Quantitative variables are expressed as means and standard deviations or medians and interquartile ranges according to the distribution of the data. Normality of the distribution was assessed by investigating skewness and kurtosis as well as QQ graphs and histograms. Categorical variables were compared using XContinuous variables were compared using an independent sample Student’s t-test for normally distributed data or the Mann–Whitney Changes in the BI at baseline and after were evaluated using the nonparametric analysis for longitudinal Data “nparLD” (R-software) [