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Evaluation of subjective satisfaction of dental implant patients

Identifieur interne : 003223 ( Pmc/Corpus ); précédent : 003222; suivant : 003224

Evaluation of subjective satisfaction of dental implant patients

Auteurs : Young-Kyun Kim ; Hyun-Suk Kim ; Yang-Jin Yi ; Pil-Young Yun

Source :

RBID : PMC:4095807

Abstract

Objectives

The goal of this study was to estimate the overall satisfaction level of dental implant patients and further evaluate factors influencing satisfaction.

Materials and Methods

Self-administered questionnaires were mailed to patients who received dental implant therapy at Seoul National University Bundang Hospital (Seongnam, Korea) from October 2003 to April 2005. The main portion of the questionnaire was shared to evaluate the level of satisfaction with implant therapy. The questionnaires contained evaluations of influencing factors, which were classified as pain-related, service-related, and complication-related.

Results

The responses from 93 patients (41 males, 52 females) with a total of 325 implants were included in the analysis, and the mean score for overall satisfaction level with implant therapy was 8.26. Female patients showed higher visual analogue scale (VAS) scores for both pain during (P=0.000) and after implant surgery (P=0.016). Male patients showed more 'negative' values for the reasonability of treatment cost (P=0.008) and the adequacy of the treatment period (P=0.022).

Conclusion

The subjective satisfaction of patients was influenced by various factors, especially complication-related factors.


Url:
DOI: 10.5125/jkaoms.2014.40.3.130
PubMed: 25045640
PubMed Central: 4095807

Links to Exploration step

PMC:4095807

Le document en format XML

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<name sortKey="Kim, Young Kyun" sort="Kim, Young Kyun" uniqKey="Kim Y" first="Young-Kyun" last="Kim">Young-Kyun Kim</name>
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<nlm:aff id="A1">Department of Oral and Maxillofacial Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.</nlm:aff>
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<name sortKey="Kim, Hyun Suk" sort="Kim, Hyun Suk" uniqKey="Kim H" first="Hyun-Suk" last="Kim">Hyun-Suk Kim</name>
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<nlm:aff id="A1">Department of Oral and Maxillofacial Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.</nlm:aff>
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<name sortKey="Yi, Yang Jin" sort="Yi, Yang Jin" uniqKey="Yi Y" first="Yang-Jin" last="Yi">Yang-Jin Yi</name>
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<nlm:aff id="A2">Department of Prosthodontics, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea.</nlm:aff>
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<name sortKey="Yun, Pil Young" sort="Yun, Pil Young" uniqKey="Yun P" first="Pil-Young" last="Yun">Pil-Young Yun</name>
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<name sortKey="Yi, Yang Jin" sort="Yi, Yang Jin" uniqKey="Yi Y" first="Yang-Jin" last="Yi">Yang-Jin Yi</name>
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<name sortKey="Yun, Pil Young" sort="Yun, Pil Young" uniqKey="Yun P" first="Pil-Young" last="Yun">Pil-Young Yun</name>
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<title>Objectives</title>
<p>The goal of this study was to estimate the overall satisfaction level of dental implant patients and further evaluate factors influencing satisfaction.</p>
</sec>
<sec>
<title>Materials and Methods</title>
<p>Self-administered questionnaires were mailed to patients who received dental implant therapy at Seoul National University Bundang Hospital (Seongnam, Korea) from October 2003 to April 2005. The main portion of the questionnaire was shared to evaluate the level of satisfaction with implant therapy. The questionnaires contained evaluations of influencing factors, which were classified as pain-related, service-related, and complication-related.</p>
</sec>
<sec>
<title>Results</title>
<p>The responses from 93 patients (41 males, 52 females) with a total of 325 implants were included in the analysis, and the mean score for overall satisfaction level with implant therapy was 8.26. Female patients showed higher visual analogue scale (VAS) scores for both pain during (
<italic>P</italic>
=0.000) and after implant surgery (
<italic>P</italic>
=0.016). Male patients showed more 'negative' values for the reasonability of treatment cost (
<italic>P</italic>
=0.008) and the adequacy of the treatment period (
<italic>P</italic>
=0.022).</p>
</sec>
<sec>
<title>Conclusion</title>
<p>The subjective satisfaction of patients was influenced by various factors, especially complication-related factors.</p>
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<pmc article-type="research-article">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">J Korean Assoc Oral Maxillofac Surg</journal-id>
<journal-id journal-id-type="iso-abbrev">J Korean Assoc Oral Maxillofac Surg</journal-id>
<journal-id journal-id-type="publisher-id">JKAOMS</journal-id>
<journal-title-group>
<journal-title>Journal of the Korean Association of Oral and Maxillofacial Surgeons</journal-title>
</journal-title-group>
<issn pub-type="ppub">2234-7550</issn>
<issn pub-type="epub">2234-5930</issn>
<publisher>
<publisher-name>The Korean Association of Oral and Maxillofacial Surgeons</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">25045640</article-id>
<article-id pub-id-type="pmc">4095807</article-id>
<article-id pub-id-type="doi">10.5125/jkaoms.2014.40.3.130</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Original Article</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Evaluation of subjective satisfaction of dental implant patients</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Kim</surname>
<given-names>Young-Kyun</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kim</surname>
<given-names>Hyun-Suk</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Yi</surname>
<given-names>Yang-Jin</given-names>
</name>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Yun</surname>
<given-names>Pil-Young</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
</contrib-group>
<aff id="A1">
<label>1</label>
Department of Oral and Maxillofacial Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.</aff>
<aff id="A2">
<label>2</label>
Department of Prosthodontics, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea.</aff>
<author-notes>
<corresp>Corresponding author: Pil-Young Yun. Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam 463-707, Korea. TEL: +82-31-787-7545, FAX: +82-31-787-4068,
<email>pilyoung@snubh.org</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub">
<month>6</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="epub">
<day>27</day>
<month>6</month>
<year>2014</year>
</pub-date>
<volume>40</volume>
<issue>3</issue>
<fpage>130</fpage>
<lpage>134</lpage>
<history>
<date date-type="received">
<day>23</day>
<month>3</month>
<year>2014</year>
</date>
<date date-type="rev-recd">
<day>21</day>
<month>4</month>
<year>2014</year>
</date>
<date date-type="accepted">
<day>21</day>
<month>4</month>
<year>2014</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright © 2014 The Korean Association of Oral and Maxillofacial Surgeons. All rights reserved.</copyright-statement>
<copyright-year>2014</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">
<license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (
<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>
) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract>
<sec>
<title>Objectives</title>
<p>The goal of this study was to estimate the overall satisfaction level of dental implant patients and further evaluate factors influencing satisfaction.</p>
</sec>
<sec>
<title>Materials and Methods</title>
<p>Self-administered questionnaires were mailed to patients who received dental implant therapy at Seoul National University Bundang Hospital (Seongnam, Korea) from October 2003 to April 2005. The main portion of the questionnaire was shared to evaluate the level of satisfaction with implant therapy. The questionnaires contained evaluations of influencing factors, which were classified as pain-related, service-related, and complication-related.</p>
</sec>
<sec>
<title>Results</title>
<p>The responses from 93 patients (41 males, 52 females) with a total of 325 implants were included in the analysis, and the mean score for overall satisfaction level with implant therapy was 8.26. Female patients showed higher visual analogue scale (VAS) scores for both pain during (
<italic>P</italic>
=0.000) and after implant surgery (
<italic>P</italic>
=0.016). Male patients showed more 'negative' values for the reasonability of treatment cost (
<italic>P</italic>
=0.008) and the adequacy of the treatment period (
<italic>P</italic>
=0.022).</p>
</sec>
<sec>
<title>Conclusion</title>
<p>The subjective satisfaction of patients was influenced by various factors, especially complication-related factors.</p>
</sec>
</abstract>
<kwd-group>
<kwd>Implants</kwd>
<kwd>Satisfaction</kwd>
<kwd>Subjective</kwd>
</kwd-group>
</article-meta>
</front>
<body>
<sec>
<title>I. Introduction</title>
<p>As the average life span increases, people are becoming increasingly interested in quality of life, including dietary life. Dental implants are considered one of the most common and popular treatment options for edentulous patients, and there has been remarkable advancement in the techniques and materials in the field. It is known that dental implants have many advantages such as superior masticatory efficiency and adjacent teeth preservation compared to other prosthetics; however, high cost and long treatment period remain the main limitations of dental implant therapy. The fact that a surgical procedure is required is also problematic. In some cases, more invasive procedures such as maxillary sinus elevation or bone graft are necessary for implantation.</p>
<p>Since patients who spend more money and time for their dental treatment expect satisfactory results and dental services in return, it is important to understand the factors influencing patient satisfaction in order to provide better services in the future
<xref rid="B1" ref-type="bibr">1</xref>
,
<xref rid="B2" ref-type="bibr">2</xref>
.</p>
<p>The objective of this study was to estimate the overall satisfaction level of dental implant patients with implant therapy and to monitor patients during the maintenance period to further evaluate factors influencing patient satisfaction.</p>
</sec>
<sec>
<title>II. Materials and Methods</title>
<p>This study was approved by the Institutional Review Board at Seoul National University Bundang Hospital (B-1109-136-303). For the study, self-administered questionnaires were mailed to patients who had received dental implant therapy at Seoul National University Bundang Hospital (Seongnam, Korea) from October 2003 to April 2005. The main portion of the questionnaires dealt with the evaluation of satisfaction level with implant therapy. Implant therapy was evaluated independently as implant surgery and implant prostheses. Next, evaluation of satisfaction level during the maintenance period was followed in a functional aspect. The questionnaires also contained evaluations of influencing factors that were categorized as pain-related factors, service-related factors, and complication-related factors.</p>
<p>Respondents rated their level of satisfaction on an 11-point scale where '10' was the most positive and '0' was the least positive response. The midpoint in the scale was '5'. In other words, the scores were " '10'=completely satisfied, '0'=completely dissatisfied, and '5'=neither satisfied nor dissatisfied". For the evaluation of influencing factors, a visual analogue scale (VAS) for pain-related factors and a 5-point scale for service-related factors were utilized. The 5-point scale ranged from 'strongly agree' to 'strongly disagree'. For the evaluation of complication-related factors, respondents were asked to report their experience of complications for implant surgery and implant prostheses, independently.</p>
<p>Surgical complications were grossly categorized as neurologic problems (i.e., paresthesia), bleeding problems, temporomandibular joint (TMJ) problems, postoperative infection, implant failure, and others (comment or description). Prosthetic discomfort included occlusal problems, fitting problems, food impaction, repetitive gingival swelling, habitual cheek or tongue biting, and others.</p>
<p>The differences in satisfaction between the groups were analyzed by independent t-test and Mann-Whitney U test using SPSS ver. 15.0 for Windows (SPSS Inc., Chicago, IL, USA).
<italic>P</italic>
-values <0.05 were considered statistically significant.</p>
</sec>
<sec>
<title>III. Results</title>
<sec>
<title>1. Patient characteristics</title>
<p>The responses from 93 patients (41 males, 52 females) with a total of 325 implants were included in the analysis. The age of the patients ranged from 25 to 82 years, and the mean age was 55.8 (standard deviation [SD], ±13.1) years.(
<xref ref-type="table" rid="T1">Table 1</xref>
) The mean duration of occlusal loading was 30.8 (SD, ±11.6) months. The prosthetic types of the patients included 40 single implant restorations, 23 fixed partial prostheses, 53 splinted prostheses with adjacent natural teeth, and 5 fixed full dentures.</p>
</sec>
<sec>
<title>2. Evaluation of satisfaction level with implant therapy (
<xref ref-type="table" rid="T2">Table 2</xref>
)</title>
<p>The mean score of overall satisfaction level with implant therapy was 8.26. A 'highly-satisfied' response (score over '8') was marked in 71 (76.3%) patients. The mean scores of satisfaction level with implant surgery and implant prostheses were 8.47 and 8.45, respectively. The same 'highly-satisfied' response with both implant surgery and implant prostheses was reported in 75 (80.6%) patients.</p>
<p>On the contrary, a 'dissatisfied' response (the score under '5') was detected in 5 (5.4%) patients with overall implant therapy, 8 (8.6%) patients with implant surgery, and 6 (6.5%) patients with implant prostheses.</p>
</sec>
<sec>
<title>3. The evaluation of satisfaction level in the maintenance period (
<xref ref-type="table" rid="T2">Table 2</xref>
)</title>
<p>The evaluation of satisfaction level in the maintenance period was composed of aesthetic function, masticatory function, phonetic function, comfort, and convenience of oral hygiene self-care. The mean scores of satisfaction level with aesthetic, masticatory, and phonetic function were 8.20, 8.31, and 8.91, respectively. 'Highly-satisfied' responses were marked in 69 (74.2%), 74 (79.6%), and 78 (83.9%) patients, respectively, while 'dissatisfied' responses were expressed in 6 (6.5%), 5 (5.4%), and 4 (4.3%) patients, respectively. The mean scores for comfort and convenience of oral hygiene self-care were 8.32 and 8.34, respectively. 'Highly-satisfied' responses were expressed in 75 (80.6%) and 72 (77.4%) patients, respectively, while 'dissatisfied' responses were checked in 5 (5.4%) and 8 (8.6%) patients, respectively.</p>
</sec>
<sec>
<title>4. The evaluation of factors influencing patients' satisfaction</title>
<sec>
<title>1) Pain-related factors</title>
<p>The mean VAS scores for intra- and post-implant surgery were 4.33 and 4.06, respectively. In the evaluation of intraoperative pain, 'no pain (VAS=0)' was reported in 14 (15.1%) patients, 'mild pain (0<xref ref-type="table" rid="T3">Table 3</xref>
)</p>
</sec>
<sec>
<title>2) Service-related factors</title>
<p>A 5-point scale was used for the evaluation of service-related factors, and the mean score of the reasonability of treatment cost was 2.15. Only two patients reported 'positive' responses ('4: agree' or '5: strongly agree'). Seventy patients gave 'negative' responses ('2: disagree' or '1: strongly disagree'). On the other hand, the mean score for the kindness of dental staff members was 4.47. 'Positive' responses were reported by 86 patients. For the adequacy of the treatment period, the mean score was 2.47. 'Negative' responses were returned by 47 patients.</p>
</sec>
<sec>
<title>3) Complication-related factors (
<xref ref-type="table" rid="T4">Table 4</xref>
)</title>
<p>Out of all the patients, 54 (58.1%) answered 'none', in other words 'no experience of complications related with implant surgery'. The complications evaluated are listed in
<xref ref-type="table" rid="T4">Table 4</xref>
. The major surgical complications were paresthesias in 15 (16.1%) patients and TMJ problems in 8 (8.6%). With regard to prosthetic discomfort, 33 (35.5%) patients responded 'none'. Frequently reported prosthetic discomfort symptoms included food impaction (33.3%), habitual cheek/tongue biting (18.3%), and repetitive gingival swelling (8.6%).</p>
<p>To evaluate the influence of complications on satisfaction, differences in the satisfaction level between the 'complication' group and 'complication-free' group were analyzed. Patients in the 'complication-free' group showed significantly higher satisfaction scores for both implant therapy and maintenance periods.(
<xref ref-type="table" rid="T5">Table 5</xref>
)</p>
</sec>
</sec>
<sec>
<title>5. Difference in satisfaction level and influencing factors between genders (
<xref ref-type="table" rid="T6">Table 6</xref>
)</title>
<p>There was no gender difference for satisfaction level in this study. Additionally, differences in factors influencing satisfaction levels between genders were analyzed. For pain-related factors, female patients showed a higher VAS score for both pain during the implant surgery (5.40 vs. 2.98,
<italic>P</italic>
=0.000) and after the implant surgery (4.77 vs. 3.17,
<italic>P</italic>
=0.016). In contrast, male patients checked more 'negative' values than female patients for the reasonability of treatment cost (1.98 vs. 2.30,
<italic>P</italic>
=0.008) and the adequacy of the treatment period (2.32 vs. 2.60,
<italic>P</italic>
=0.022).</p>
</sec>
</sec>
<sec>
<title>IV. Discussion</title>
<p>There have been a number of studies that examined the satisfaction level of implant patients by comparing conditions before and after surgery. Siadat et al.
<xref rid="B3" ref-type="bibr">3</xref>
performed a study on the satisfaction level in mandibular implant overdenture patients by comparing previous prosthetic forms. Wismeijer et al.
<xref rid="B4" ref-type="bibr">4</xref>
commented that implant overdenture treatment gave patients social rehabilitation as well as oral rehabilitation. Numerous studies were done with edentulous patients who were treated with implant-supported overdentures or implant fixed full dentures, and patients showed high-satisfaction with both treatments
<xref rid="B5" ref-type="bibr">5</xref>
,
<xref rid="B6" ref-type="bibr">6</xref>
,
<xref rid="B7" ref-type="bibr">7</xref>
,
<xref rid="B8" ref-type="bibr">8</xref>
. The patients who were treated with implant-supported overdentures showed a higher level of satisfaction than those who were treated with conventional full dentures
<xref rid="B9" ref-type="bibr">9</xref>
,
<xref rid="B10" ref-type="bibr">10</xref>
,
<xref rid="B11" ref-type="bibr">11</xref>
. Also, studies on patients who were treated with a single implant prosthesis showed a high level of satisfaction
<xref rid="B12" ref-type="bibr">12</xref>
,
<xref rid="B13" ref-type="bibr">13</xref>
. Another study that compared the satisfaction of patients after implant treatment used the VAS to examine the comfort of chewing and compare masticatory function, pronunciation, aesthetics, and hygienic management between natural teeth and implants. This study also used surveys to compare hygienic management, satisfaction of patients' expectations, and cost between natural teeth and implants. They found that 90% or more of patients were satisfied with masticatory function, with 72% responding that there was no difference in masticatory function between their own teeth and the implants. Additionally, 8% of patients responded that their implants felt safer for chewing, and 92% were satisfied with the implants for pronunciation and 83% with the aesthetics
<xref rid="B14" ref-type="bibr">14</xref>
.</p>
<p>This study was designed to estimate the overall satisfaction level of dental implant patients with implant therapy and maintenance period and to further evaluate factors influencing patient satisfaction in the aspects of pain, service, and complications. In this study, the patients' overall satisfaction level with implant therapy turned out to be high in general (mean score: 8.26). Only 5 (5.4%) patients replied 'dissatisfied', while 71 (76.3%) patients responded 'highly-satisfied'. The functional aspects of the maintenance period were also encouraging in that the mean score ranged from 8.20 to 8.91 and a 'dissatisfied' response was reported by fewer than 8 (8.6%) patients.</p>
<p>Evaluation of factors influencing patient satisfaction was also performed. For pain-related factors, VAS scores for more than 60% of patients during and after implant surgery were reported as 'mild' to 'moderate' grade. Interestingly, 10 (10.8%) patients checked a VAS score of '10' under the local or general anesthesia, possibly due to psychological bias. Overall, there was no impact of either intra-operative or postoperative pain on patient satisfaction (
<italic>P</italic>
>0.05). For service-related factors, it was remarkable that 70 (75.3%) patients responded 'negative' to the reasonability of treatment cost. It was difficult to statistically compare the 'negative' group with the 'positive' group, because only two patients responded 'positive'. Although it was a hospital-limited score, 90 (96.8%) patients answered that the dental staff and hospital workers at the Seoul National University Bundang Hospital were kind. This was considered to be a result of periodic education on customer-satisfaction as this is an important factor in the evaluation of service facilities. Forty-seven patients reported a 'negative' opinion on the adequacy of the treatment period, while 44 patients answered 'neither agree nor disagree'. Approximately 50% of the patients believed that the treatment period was too long. Therefore, it is important that patients fully understand the healing process for dental implants at the time of informed consent. For complication-related factors, the experience of complications had a negative impact on patient satisfaction level. Although there was a sample size discrepancy between the groups, the influence of each complication and discomfort was examined. Patients who experienced paresthesia (
<italic>P</italic>
=0.049), implant failure (
<italic>P</italic>
=0.015), occlusal problems (i.e., chewing difficulty) (
<italic>P</italic>
=0.001), and repetitive gingival swelling (
<italic>P</italic>
=0.001) showed significantly lower satisfaction levels with implant therapy.</p>
<p>In the evaluation of gender differences in influencing factors, female patients showed a higher VAS score for pain than male patients during and after implant surgery. In addition, male patients expressed more 'negative' opinions regarding treatment cost and treatment period. It is recommended that less aggressive surgery or more intensive pain control should be considered for the management of female patients while cost-effectiveness and shortening of the treatment period should be the primary consideration in the treatment planning stage for male patients.</p>
</sec>
<sec>
<title>V. Conclusion</title>
<p>This study shows that the subjective satisfaction of implant patients was influenced by various factors, especially complication-related factors. It is suggested that the prevention of surgical complications is important in delivering satisfaction to patients undergoing implant therapy. For safer implant procedures, further development of surgical technique and instruments is necessary. Gender differences in the treatment planning stage also could be considered.</p>
</sec>
</body>
<back>
<fn-group>
<fn fn-type="conflict">
<p>No potential conflict of interest relevant to this article was reported.</p>
</fn>
</fn-group>
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<floats-group>
<table-wrap id="T1" orientation="portrait" position="float">
<label>Table 1</label>
<caption>
<p>Patients' age and gender</p>
</caption>
<graphic xlink:href="jkaoms-40-130-i001"></graphic>
<table-wrap-foot>
<fn>
<p>Values are presented as number of patients (number of implants).</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T2" orientation="portrait" position="float">
<label>Table 2</label>
<caption>
<p>Satisfaction level of patients (11-point scale)</p>
</caption>
<graphic xlink:href="jkaoms-40-130-i002"></graphic>
</table-wrap>
<table-wrap id="T3" orientation="portrait" position="float">
<label>Table 3</label>
<caption>
<p>Pain-related factors (VAS) and service-related factors (5-point interval scale)</p>
</caption>
<graphic xlink:href="jkaoms-40-130-i003"></graphic>
<table-wrap-foot>
<fn>
<p>(VAS: visual analogue scale)</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T4" orientation="portrait" position="float">
<label>Table 4</label>
<caption>
<p>Complication-related factors</p>
</caption>
<graphic xlink:href="jkaoms-40-130-i004"></graphic>
</table-wrap>
<table-wrap id="T5" orientation="portrait" position="float">
<label>Table 5</label>
<caption>
<p>Influence of the experience of complications after surgery on satisfaction score</p>
</caption>
<graphic xlink:href="jkaoms-40-130-i005"></graphic>
<table-wrap-foot>
<fn>
<p>
<sup>1</sup>
By two-tailed tests.</p>
<p>
<sup>*</sup>
<italic>P</italic>
<0.05.</p>
<p>Values are presented as mean±standard deviation.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T6" orientation="portrait" position="float">
<label>Table 6</label>
<caption>
<p>Differences of influencing factors between genders</p>
</caption>
<graphic xlink:href="jkaoms-40-130-i006"></graphic>
<table-wrap-foot>
<fn>
<p>
<sup>1</sup>
By two-tailed tests.</p>
<p>
<sup>*</sup>
<italic>P</italic>
<0.05</p>
<p>Values are presented as mean±standard deviation.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
</record>

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