Fig. 5: CONSORT flow chart.

The CONSORT (Consolidated Standards of Reporting Trials) flow diagram outlines the progression of participants through the stages of a randomized controlled trial, including enrollment, allocation, follow-up, and analysis. A total of 480 individuals were assessed for eligibility, with 240 excluded due to not meeting inclusion criteria (n = 80), declining participation (n = 80), or other reasons (n = 80). The remaining 240 participants were randomized into two groups: 121 were allocated to the intervention group, and 119 to the control group, with all receiving their allocated interventions. During follow-up, 17 participants in the intervention group and 24 in the control group were lost to follow-up, with no discontinuations in either group. All participants (121 in the intervention group and 119 in the control group) were included in the final analysis, with no exclusions.