Statistical analysis
All data analysis was performed using SPSS software version 20. Descriptive statistics were presented as frequencies, percentages, and mean±standard deviation (SD). Categorical data were analyzed using the Chi-square test or Fisher exact test, while continuous variables were analyzed using analysis of variance (ANOVA), repeated measure analysis, and t-test. Within-group comparisons were made using Tukey's post-hoc analysis. Statistical significance was set at p<0.05.