Fig. 1

Participant Flow Diagram. A total of 580 participants underwent initial screening for eligibility. Among them, 412 participants were excluded based on predefined criteria. The remaining 168 eligible participants were randomly assigned to either the treatment group (n = 84), receiving electro-acupuncture, or the control group (n = 84), receiving sham acupuncture. Both groups underwent twice-weekly treatments over eight weeks, followed by a post-treatment follow-up session at eight weeks. Seven participants discontinued intervention or were lost to follow-up in the treatment group, and eight participants in the control group faced similar circumstances. The final analysis included 168 participants, adhering to the intention-to-treat (ITT) principle, for efficacy and safety assessments