Sample size determination
A pre-study power analysis conducted using G Power software estimated that approximately 24 patients per group (with a total of 96) were required to detect a 35% improvement in physical function between the control and treatment groups, with a power of 0.8 and an alpha level of 0.05.The data was processed using IBM SPSS software. All statistical tests were two-sided, with differences considered statistically significant when P < 0.05. The analysis followed the principles of intention-to-treat (ITT).