Impact of early ergonomics exposure on awareness and postural assessment in second year pre-clinical undergraduate dental students

Impact of early ergonomics exposure on awareness and postural assessment in second year pre-clinical undergraduate dental students | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of early ergonomics exposure on awareness and postural assessment in second year pre-clinical undergraduate dental students Sidhyesh Baviskar, Abhijit Tambe, Triveni Kale, Mokshada Badadare, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9003574/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 15 You are reading this latest preprint version Abstract Background and objectives: Dental health professionals are commonly associated with the development of musculoskeletal pain and soreness, which often progress gradually. Early introduction to right posture habit according to ergonomics is very important, so that can be practiced and followed in future work. Objective of the study was to compare the awareness and postural assessment related to dental operatory position among second-year preclinical undergraduate students before and after early exposure to ergonomics in dentistry. Materials and Methods: A prospective interventional study was conducted involving 60 second-year Bachelor of Dental Surgery (BDS) students recruited through simple random sampling. Each participant performed a standardized tooth preparation task in a simulated environment. During the procedure, ergonomic assessment was conducted using the Rapid Upper Limb Assessment (RULA) method by three trained observers. RULA scores were calculated by evaluating posture, muscle use, and force related to the upper limb, neck, trunk, and legs. The RULA scores and test scores (Pre and post awareness scores) obtained were then statistically analyzed. Results: There was a statistically significant improvement in both ergonomic awareness and postural scores following the intervention. Mean awareness scores decreased significantly across all observers (p < 0.001). Inter-observer reliability was high (Cronbach’s alpha: pre 0.793, post 0.890). Most questionnaire and RULA items showed highly significant improvement (p < 0.001), except for questions related to attitudes toward continuing dental education and stretching exercises, which were already positive at baseline. Conclusion: A structured, simulation-based ergonomic awareness program significantly improved both knowledge and practical application of ergonomic principles among dental students. These findings support the integration of ergonomics into dental education to promote healthier work practices and reduce the risk of musculoskeletal disorders. Ergonomics musculoskeletal disorders postural assessments Rapid Upper Limb Assessment undergraduate dental students Figures Figure 1 Figure 2 Introduction Ergonomics as defined by the International Ergonomics Association (IEA) is the scientific discipline concerned with the understanding of the interaction between humans and as a profession that applies relevant theories, principles, data, and methods to design in order to optimize human well-being and overall system performance. 1 , 2 The application of ergonomics has become a focal point across various fields promoting the overall well-being and safety of workers in the workplace. 1 Dentistry is a profession commonly associated with the development of musculoskeletal pain and soreness, which often progress gradually. These symptoms are frequently overlooked until they become chronic and lead to permanent damage. Poor ergonomic practices, high workloads, and lack of awareness contribute to the high prevalence of MSDs, particularly neck and lower back pain, among dental students and professionals. 3 , 4 Early introduction to right posture habit according to ergonomics is very important, so that can be practiced and followed in future work. Second-year students as they just started their work on mannequins, must be properly exposed to term ergonomics and proper postural habits. So, the early exposure of ergonomics in the second-year pre-clinical students’ needs time. 9 Given the growing concern over work-related musculoskeletal disorders among dental professionals and students, there is a clear need to assess the impact of early ergonomics education. Also, there is a gap between theoretical knowledge and practical application of ergonomics. Therefore, proper work-related posture is important to reduce musculoskeletal pain, improve clinical efficiency and longevity of the dentist. 5 – 9 This study aims to evaluate the effect of introducing ergonomic principles to second-year pre-clinical students by assessing their awareness and postural behavior before and after early clinical exposure. The findings may support the integration of ergonomics training early in the dental curriculum. Material and methods Study design An educational interventional prospective study was conducted on second year pre-clinical students in the Department of Prosthodontics and Crown and Bridge. Ethical Considerations The study was approved by MGVs KBH dental college and hospital, Nashik; Institutional Ethical Committee ((MGV/KBHDC/897/2020-21) This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Participation for the research study was voluntary and anonymous, with no incentives provided. Informed written consent was obtained from all the participants before start of study including the publication of results of the study. Study population and settings: This study was designed as an educational interventional study and included 60 second-year undergraduate dental students aged 18 years and above. The participants were selected using a simple random sampling method. (Clinical trial number: not applicable) Only second-year students attending pre-clinical postings were included, while students from other years, interns, and postgraduates were excluded. A written informed consent was obtained from all participants prior to inclusion in the study. All participants completed a standardized assignment (maxillary central incisor tooth preparation). The questionnaire format was made to evaluate awareness among the students and postural assessment is performed by using the RULA method. Study intervention: First Phase- Postural assessment from video recordings was assessed by RULA methodology and analysis of knowledge about ergonomics was checked by using questionnaire format of the preclinical undergraduate student before awareness program. (Fig. 1) Second Phase- After the first visit awareness program was conducted. The ergonomics term was explained and the application of ergonomics in dentistry was discussed in a broad sense. The correct ergonomic posture was shown to students practically. The wrong postures reduce the working efficiency and longevity of dentists, how? Such questions were discussed. Also, a question-answer session was conducted at the end of the awareness program. Third Phase- After the awareness program knowledge of students was checked by using the same questionnaire response format and also standardized video (visuals) recordings were taken while participants were performing given exercise. Fourth Phase- Comparison of questionnaire response format and visual assessment before and after awareness program was done. The comparison was done for- Questionnaire response format scores were compared (First score). Visual recordings were obtained before and after the awareness video, and RULA scores were calculated from these recordings and subsequently compared (Second score) (Fig. 2). Body is divided into two different sections (Section A –upper arm, lower arm and wrist. Section B – neck, trunk and legs For each section three scores were calculated Posture score Muscle use score Force score Assessing the movements, postures are given scores in the range of 1 to 7 or more. If minimal risk factor given a lesser number and as risk factors or deviation from standard ergonomic posture increases, posture score shifts to higher number. It was a final score obtained from RULA assessment sheet. From that score level of MSD risk detected. The muscle use score is estimated by increasing the score by 1. The force score was then calculated for postures which exert force or maintain external load while working, the force score ranges from 0 to 3 (according to the external load value range). 6 The questionnaire response format results (both pre as well as post awareness programme) were analyzed quantitatively for awareness of ergonomics. By using section A and B scores, grand score from section C was determined that grand score was the final RULA score for that posture (RULA sheet). 6 Comparison of postural assessment were performed by statistical analysis of collected pre and post-awareness postural scores. Statistical analysis Paired T-test for statistical analysis, Inter-observer One-way ANOVA. Results The study highlighted a notable enhancement in ergonomic awareness and postural practices among second-year dental students following an educational intervention. As shown in Table 1, paired t-test analysis revealed a significant decrease in mean awareness scores from pre- to post-awareness across all three observers (Observer 1: 6.33 to 5.72; Observer 2: 6.42 to 5.72; Observer 3: 6.42 to 5.75; all p < 0.001), indicating increased awareness and understanding after the intervention. One-way ANOVA showed no significant differences between observer scores either before or after the awareness program, supporting the assessment process's standardization and objectivity (Table no 1 Graph no 1 to 3). The use of a standardized operative task (maxillary central incisor preparation) ensured procedural uniformity, thereby isolating posture as the primary variable. The integration of standardized visual recording further enhanced objectivity and reproducibility. Observer variation was one of the most important aspects. Pre and post inter observer variation for the postural assessment was not significant (Table 2) which showed the importance a prior training of all three observers for the research work. The postural assessment analysis and reporting in the form of RULA score was very precisely covered during structured training of observers. The reliability of the awareness questionnaire was assessed using Cronbach’s alpha. The pre-awareness scale demonstrated good internal consistency (α = 0.793), while the post-awareness scale showed improved reliability (α = 0.890) (Table 3). Values above 0.70 are generally considered acceptable, while values approaching 0.90 indicate strong internal coherence among items. The inter-observer reliability was high, with Cronbach’s alpha values of 0.793 pre-awareness and 0.890 post-awareness, confirming the questionnaire's good internal consistency. Postural assessment using the Wilcoxon Signed Ranks test demonstrated statistically significant improvements across multiple components following intervention (p < 0.001 for most paired comparisons) (Table 4). The dominance of positive ranks and absence of negative ranks in several domains indicate a clear directional improvement in ergonomic posture. These findings align with previous studies reporting that early ergonomic sensitization significantly improves working posture among dental students. 7–13 Discussion This study confirms that a structured awareness program can significantly enhance both the theoretical understanding and practical application of ergonomic principles among dental students. The use of the RULA method provided objective, reliable postural assessment, with inter-observer agreement ensuring consistency. The significant improvement in post-intervention scores aligns with previous findings that targeted ergonomic education and hands-on demonstrations are effective in improving ergonomic behaviour and reducing risk factors for musculoskeletal disorders.1 The lack of significant change in some attitude-based questions suggests that students already recognized the importance of ongoing education and stretching exercises prior to the intervention, reflecting a generally positive baseline awareness. However, the marked improvement in knowledge and practical application underscores the need for integrating ergonomics into the dental curriculum, as students initially demonstrated limited understanding of ergonomics and its implications in dental practice. The results echo earlier studies emphasizing the gap between theoretical knowledge and its practical implementation, and the value of continuous ergonomic training in dental education. Overall, this study highlights the effectiveness of simulation-based ergonomic training in promoting safer work habits and reducing the risk of musculoskeletal disorders among dental students, supporting recommendations for the inclusion of ergonomics as a core component of dental education. Observer calibration is central to minimizing measurement bias in ergonomic research. In this study, inter-observer variability was assessed both before and after intervention. One-way ANOVA revealed no statistically significant differences among the three observers in pre-awareness scores (p = 0.667) and post-awareness scores (p = 0.927) (Table 2 ). The absence of significant variation indicates strong agreement and confirms the effectiveness of prior structured training. All observers underwent standardized calibration sessions focusing on accurate interpretation of the Rapid Upper Limb Assessment (RULA) scoring criteria. The RULA method has been widely validated as a reliable ergonomic assessment tool in occupational and clinical settings. By ensuring uniform understanding of joint angles, trunk inclination, neck posture, and upper limb positioning, subjective interpretation bias was minimized.The consistency observed across observers strengthens the internal validity of the study. Improvements in postural scores following intervention can therefore be attributed to the ergonomics training rather than assessor variability. In educational intervention research, especially when observational tools are employed, such calibration is critical for methodological rigor McAtamney and Corlett et al introduced the Rapid Upper Limb Assessment (RULA) method, a practical and equipment-free tool for evaluating work-related upper limb disorders. 10 The method assigns risk scores to various postures, where higher scores indicate greater risk, making it a valuable and accessible screening tool for workplace assessments. Gandavadi et al used RULA to compare dental students’ postures on conventional versus ergonomic seats, finding that conventional seating led to higher RULA risk scores and thus greater predisposition to MSDs, while ergonomic seating like the Bambach Saddle Seat promoted healthier postures. 11 , 12 Dental professionals are known to be at high risk for work-related musculoskeletal disorders (MSDs), often beginning during undergraduate training. Early correction of postural habits may therefore serve as a preventive strategy rather than a remedial one. In our present study RULA (rapid upper limb assessment) is a survey method developed for use in ergonomics where work-related upper limb disorders are reported. 6 The postural assessment was done by comparison of pre-awareness and post-awareness postural RULA scores. For the standardization of results and to avoid bias in study three trained observers were appointed to watch the recorded postural videos and give the scores accordingly. A similar process repeated after the awareness program i.e. recording of posture observation of recorded videos by three observers and scoring were done. Both the scores pre-awareness and post awareness were compared by statistical tests. The improvement in Cronbach’s alpha following intervention suggests not only enhanced knowledge but greater conceptual clarity among participants. Post-intervention responses appeared more aligned, reflecting a more structured understanding of ergonomic principles. This pattern indicates that the educational exposure strengthened cognitive integration of concepts such as chair positioning, operator posture, instrument handling, and stretching practices. Improved internal consistency post-intervention has been reported in similar educational intervention studies, where structured training enhances both knowledge levels and response stability. The pre and post questionnaire shows highly significant results except for question 7 & 10 which shows no significant results. This could be due to the students having some knowledge regarding continuing dental education and the importance of stretching exercises in the dental profession. So, statistically, it is not significant but students have some knowledge about following topics before awareness program is the positive aspect related to our research work. 13 – 17 The correct ergonomic posture was shown to students practically. The wrong postures reduce the working efficiency and longevity of dentists, how? Such questions were discussed. Also, a question-answer session was conducted at the end of the awareness program. 2 , 8 This is following the study by Gupta S et al and Patrica P who co-related the theoretical knowledge and its practical applications. 2 , 8 Each student responded to a multiple-choice questionnaire on the requirements of ergonomic posture. 8 The questionnaire format is designed for the assessment of the knowledge of the students before and after awareness about ergonomics in dentistry. In the questionnaire response sheet, the questions are attitude-based, theoretical knowledge-based, and practical knowledge base. 12 – 19 For the assessment of knowledge pre-awareness and post-awareness questionnaire responses were compared and the significance of theoretical explanation of the concept by lectures, by video demonstration, by a practical demonstration was checked. The questionnaire response sheet comparison shows highly significant results. For the knowledge assessment questionnaire response sheet was used and for postural assessment, RULA's postural assessment methodology was used. And both knowledge, as well as the practical implication, were checked by comparing before and after awareness program questionnaire responses and RULA score. 18 , 19 The findings highlight the importance of introducing ergonomics training during the pre-clinical phase. Postural habits formed early in professional education tend to persist into clinical practice. Integrating ergonomics into the undergraduate curriculum may therefore reduce long-term musculoskeletal morbidity among dental practitioners. Importantly, the study demonstrates that structured training influences not only awareness but also observable behavioral outcomes. The simultaneous improvement in RULA scores and questionnaire reliability suggests that knowledge translation into practice occurred effectively. Novelty of present study Students were at high risk of MSD when they were not aware of standardized ergonomic posture. After awareness of students about standardized ergonomic posture, potential risks were relatively least found. Early awareness is the best solution for almost every problem, so the early ergonomics exposure of the second-year pre- clinical students is considered in the present study. Strengths of the study Strengths of the study include observer calibration, use of a validated ergonomic assessment tool, objective visual documentation, and reliability testing of the awareness instrument. These methodological elements enhance internal consistency and reproducibility. Limitations of the study The training for postural assessment by RULA method is very crucial aspect for the study. Training of all three accessors and procedural recording of each participant may be overlooked with the digital way to make it simpler and time bound. However, the study was conducted within a single institutional cohort and evaluated short-term outcomes. Longitudinal assessment would be valuable to determine sustainability of ergonomic improvements during clinical postings. Conclusion Within the limitations of the study, results demonstrates that a focused awareness program-combining theoretical knowledge, practical demonstrations, and interactive discussions-significantly improves students’ understanding and application of ergonomic principles, as reflected by highly significant improvements in both questionnaire and RULA postural assessment scores. There is a need for the inclusion of ergonomics in the dental curriculum in a more sophisticated manner than the dental student can understand in a better way, also stressing not only on the theoretical knowledge but more on practical implication is need of time. Second-year students as they just started their work on the mannequin, should be properly exposed to the term ergonomics. Ergonomics awareness helps in the application and contributes significantly to the safety of dentists as per the results of the study. Declarations Ethical approval The study received approval from the Institutional Ethics Committee of MGV’s KBH Dental College and Hospital, Nashik (Approval No: MGV/KBHDC/897/2020–21). All procedures carried out in this research were performed in accordance with the ethical standards outlined in the Declaration of Helsinki. Consent to participate Written informed consent was obtained from all participants before their inclusion in the study. Participation was entirely voluntary, and the responses were recorded anonymously. No incentives or compensation were provided to the participants. Consent to publish All participants provided written informed consent for the publication of data and any identifiable images included in this study. Competing interests The authors declare that they have no competing interests related to this study. Funding This research was supported by the Indian Council of Medical Research (ICMR) through the Short-Term Studentship (STS) 2021 programme (Reference No: 2020–03125). The funding agency had no involvement in the design of the study, data collection, analysis and interpretation of results, or in the preparation of the manuscript. Author Contribution AT conceived and designed the study, supervised the overall research process, carried out the statistical analysis, and prepared the initial manuscript draft.SB assisted in data collection and conducted the literature review.TK contributed to the study design, development of the methodology, and interpretation of the findings.MB supported data compilation and assisted in manuscript preparation.MS contributed to statistical validation and critically reviewed the manuscript for important intellectual content.AD assisted in data analysis and helped refine the manuscript through editing.All authors reviewed and approved the final version of the manuscript. Acknowledgement The authors sincerely acknowledge the support of the Indian Council of Medical Research (ICMR) STS 2021 programme and express gratitude to the participating undergraduate dental students for their cooperation and engagement in the study. Data Availability The datasets generated and analysed during the current study are available from the corresponding author upon reasonable request. References Khan SA, Chew KY. Effect of working characteristics and taught ergonomics on the prevalence of musculoskeletal disorders amongst dental students. BMC Musculoskelet Disord. 2013;14(1):1–8. Gupta S. Ergonomic applications to dental practice. Indian J Dent Res. 2011;22(6):816. Kalghatgi S, Prasad KV, Chhabra KG, Deolia S, Chhabra C. Insights into ergonomics among dental professionals of a dental institute and private practitioners in Hubli–Dharwad twin cities, India. Saf health work. 2014;5(4):181–5. Alexopoulos EC, Stathi IC, Charizani F. Prevalence of musculoskeletal disorders in dentists. BMC Musculoskelet Disord. 2004;5(1):1–8. Gupta A, Bhat M, Mohammed T, Bansal N, Gupta G. Ergonomics in dentistry. Int J Clin Pediatr dentistry. 2014;7(1):30. Dable RA, Wasnik PB, Yeshwante BJ, Musani SI, Patil AK, Nagmode SN. Postural assessment of students evaluating the need of ergonomic seat and magnification in dentistry. J Indian Prosthodontic Soc. 2014;14(1):51–8. Valachi B, Valachi K. Mechanisms leading to musculoskeletal disorders in dentistry. J Am Dent Association. 2003;134(10):1344–50. Garcia PP, Gottardello AC, Wajngarten D, Presoto CD, Campos JA. Ergonomics in dentistry: experiences of the practice by dental students. Eur J Dent Educ. 2017;21(3):175–9. Raman V, Ramlogan S, Sweet J, Sweet D. Application of the Rapid Entire Body Assessment (REBA) in assessing chairside ergonomic risk of dental students. Br Dent J. 2020 Aug;14:1–6. McAtamney L, Corlett EN. RULA: a survey method for the investigation of work- related upper limb disorders. Appl Ergon. 1993;24(2):91–9. Valachi B, Valachi K. Preventing musculoskeletal disorders in clinical dentistry: strategies to address the mechanisms leading to musculoskeletal disorders. J Am Dent Association. 2003;134(12):1604–12. Gandavadi A, Ramsay J, Burke F. Assessment of dental student posture in two seating conditions using RULA methodology – a pilot study. ©British Dent J. 2007;203:601–5. Díaz Caballero AJ, Gomez Palencia IP, Díaz Cárdenas S. Ergonomic factors that cause the presence of pain muscle in students of dentistry. Pîrvu C, Pătraşcu I, Pîrvu D, Ionescu C, Department of Oro-Dental Diagnosis, Ergonomics and, Methodology R. Carol Davila University of Medicine and Pharmacy, Bucharest Department of Dentures Technology and Dental Materials, Carol Davila University of Medicine and Pharmacy, Bucharest. Journal of Medicine and Life Vol.7, Issue 2, April-June 2014, pp.177–182. Siddiqui TM, Wali A, Khan OH, Khan M, Zafar F. Assessment of knowledge, practice, and work environment related to ergonomics among dental students and dental practitioners. International Journal of Contemporary Dental & Medical Reviews. 2016;2016. Alyahya F, Algarzaie K, AlsubehY,Khounganian R et al. Awareness of ergonomics and work-related musculoskeletal disorders among dental professionals and students in Riyadh,Saudi A rabia.J.Phys. Ther Sci 30:770–7762018. Kalra TA, Kalra GE, Bansal MO, Uppal SW. Ergonomics: Need of the hour. Int Healthc Res J. 2018;1:365–70. Salimi F, Sheikhmozafari MJ, Tayebisani S, Ahmadi O. Risk Assessment of Musculoskeletal Disorders Prevalence in Female Hairdressers using RULA and NERPA Techniques. Int J Musculoskelet Pain Prev. 2021;6(3):545–53. Rambhad C, Pande N, Radke U. Assessment of knowledge of ergonomics among preclinical undergraduate students: A cross-sectional study. J Int Clin Dent Res Organ. 2018;10:65–70. Tables Table 1: Paired T-Test: Pre and post awareness assessment showing the post assessment awareness was highly significant. Awareness of ergonomics Mean score N SD T Df P value Pre-awareness OBSERVER 1 6.33 60 0.542 8.6 59 < 0.001; Highly significant Post-awareness OBSERVER 1 5.72 60 0.524 Awareness of ergonomics Mean score N SD T Df P value Pre-awareness OBSERVER 2 6.42 60 0.619 9.7 59 < 0.001; Highly significant Post-awareness OBSERVER 2 5.72 60 0.555 Awareness of ergonomics Mean score N SD T Df P value Pre-awareness OBSERVER 3 6.42 60 0.591 10.1 59 < 0.001; Highly significant Post-awareness OBSERVER 3 5.75 60 0.541 Table 2: Inter-observer One-way ANOVA Awareness of ergonomics N Mean score SD F df P value Pre-awareness score Observer 1 60 6.33 0.542 0.406 2 0.667; Not significant Observer 2 60 6.42 0.619 Observer 3 60 6.42 0.591 Total 180 6.39 0.583 Awareness of ergonomics N Mean score SD F df P value Post-awareness score Observer 1 60 5.72 0.524 0.076 2 0.927; Not significant Observer 2 60 5.72 0.555 Observer 3 60 5.75 0.541 Total 180 5.73 0.537 Table 3: Cronbach's Alpha is a measure of internal consistency of a questionnaire that is made of multiple Likert-type scale/items. The internal consistency of the awareness questionnaire was assessed using Cronbach’s alpha. The pre-awareness scale demonstrated good reliability (α = 0.793), while the post-awareness scale showed better reliability (α = 0.890), indicating improved internal consistency following the intervention. Scale Cronbach’s Alpha Number of Items (Observers) Interpretation Pre-awareness Score 0.793 3 Good reliability Post-awareness Score 0.890 3 Better reliability Table 4: Wilcoxon Signed Ranks Test: Postural Assessment- Pre and post analysis. Pairs N Mean Rank Sum of Ranks Z P value PostQ2 - PreQ2 Negative Ranks 0 a 0.00 0.00 -6.41 < 0.001; Highly significant Positive Ranks 51 b 26.00 1326.00 Ties 9 c Total 60 PostQ3 - PreQ3 Negative Ranks 0 d 0.00 0.00 -4.90 < 0.001; Highly significant Positive Ranks 24 e 12.50 300.00 Ties 36 f Total 60 PostQ4 - PreQ4 Negative Ranks 0 g 0.00 0.00 -4.24 < 0.001; Highly significant Positive Ranks 18 h 9.50 171.00 Ties 42 i Total 60 PostQ5 - PreQ5 Negative Ranks 0 j 0.00 0.00 -6.9 < 0.001; Highly significant Positive Ranks 56 k 28.50 1596.00 Ties 4 l Total 60 PostQ6 - PreQ6 Negative Ranks 1 m 20.50 20.50 -6.4 < 0.001; Highly significant Positive Ranks 49 n 25.60 1254.50 Ties 10 o Total 60 PostQ7 - PreQ7 Negative Ranks 0 p 0.00 0.00 0.00 1.000; Not significant Positive Ranks 0 q 0.00 0.00 Ties 60 r Total 60 PostQ12 - PreQ12 Negative Ranks 0 ae 0.00 0.00 -7.13 PreQ2; e. PostQ3 > PreQ3; h. PostQ4 > PreQ4; k. PostQ5 > PreQ5; n. PostQ6 > PreQ6; q. PostQ7 > PreQ7; af. PostQ12 > PreQ12 Pairs N Mean Rank Sum of Ranks Z P value PostQ8 - PreQ8 Negative Ranks 0 s 0.00 0.00 -4.00 < 0.001; Highly significant Positive Ranks 16 t 8.50 136.00 Ties 44 u Total 60 PostQ9 - PreQ9 Negative Ranks 0 v 0.00 0.00 -7.14 < 0.001; Highly significant Positive Ranks 51 w 26.00 1326.00 Ties 9 x Total 60 PostQ10 - PreQ10 Negative Ranks 0 y 0.00 0.00 -1.73 0.083; Not significant Positive Ranks 3 z 2.00 6.00 Ties 57 aa Total 60 PostQ11 - PreQ11 Negative Ranks 0 ab 0.00 0.00 -7.75 PreQ8 w. PostQ9 > PreQ9 z. PostQ10 > PreQ10 ac. PostQ11 > PreQ11 Pairs N Mean Rank Sum of Ranks Z P value PostQ13 - PreQ13 Negative Ranks 28 ah 14.50 406.00 -5.29 < 0.001; Highly significant Positive Ranks 0 ai 0.00 0.00 Ties 32 aj Total 60 PostQ14 - PreQ14 Negative Ranks 0 ak 0.00 0.00 -4.12 < 0.001; Highly significant Positive Ranks 17 al 9.00 153.00 Ties 43 am Total 60 ah. PostQ13 PreQ13 aj. PostQ13 = PreQ13 ak. PostQ14 PreQ14 am. PostQ14 = PreQ14 Graphs Graphs 1 to 3 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files supplimentarydocument.docx Graph13.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 07 May, 2026 Reviews received at journal 30 Apr, 2026 Reviews received at journal 26 Apr, 2026 Reviewers agreed at journal 18 Apr, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviews received at journal 17 Apr, 2026 Reviewers agreed at journal 08 Apr, 2026 Reviews received at journal 02 Apr, 2026 Reviewers agreed at journal 02 Apr, 2026 Reviewers invited by journal 26 Mar, 2026 Editor invited by journal 09 Mar, 2026 Editor assigned by journal 09 Mar, 2026 Submission checks completed at journal 06 Mar, 2026 First submitted to journal 06 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Tambe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABE0lEQVRIiWNgGAWjYDCCAwxszAwGbDwgNjMDgw0zP4iVUECEFh42sJY0dskGkBYDQlqAAKrlML/BARAXjxa+24efPS4o4JOxl29+urmgglna+PzqxA8PDBjk+cUOYNUieS7N3HgG2GFsZrdnnGEzNrvxdrME0GGGM2cnYNVicIbBTJoH4hez27xtPMlmN85uAGlJMLiNSwv7N6gW9m+3ef9J1G+ecXbzD/xaeGC28ABtaTBgNuDv3YbXFskzPOXGYC3HcspuzziWwCxxg3ebRYKBBE6/8J1h3/aY588xe/bm49tuF9T8Z+bvP7v55o8KG3l+aexaoOAYElsCrFICn3IQqEFi8x8gpHoUjIJRMApGGAAAYGlXXws39GoAAAAASUVORK5CYII=","orcid":"","institution":"Sau Mathurabai Bhausaheb Thorat (SMBT) Institute of dental sciences and research","correspondingAuthor":true,"prefix":"","firstName":"Abhijit","middleName":"","lastName":"Tambe","suffix":""},{"id":612660473,"identity":"d7c0b474-9b29-48d8-b1d5-f5f61403acf7","order_by":2,"name":"Triveni Kale","email":"","orcid":"","institution":"Mahatma Gandhi Vidyamandir’s KBH Dental College and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Triveni","middleName":"","lastName":"Kale","suffix":""},{"id":612660474,"identity":"70b3de1e-4804-4a16-9502-6d71a8fe2c3c","order_by":3,"name":"Mokshada Badadare","email":"","orcid":"","institution":"Bharti Vidyapeeth Dental college and Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mokshada","middleName":"","lastName":"Badadare","suffix":""},{"id":612660475,"identity":"6adedfef-58ba-4d52-9d99-9ebc852a3c39","order_by":4,"name":"Monesh Sharma","email":"","orcid":"","institution":"Sau Mathurabai Bhausaheb Thorat (SMBT) Institute of dental sciences and research","correspondingAuthor":false,"prefix":"","firstName":"Monesh","middleName":"","lastName":"Sharma","suffix":""},{"id":612660476,"identity":"6076d98f-2d19-4fbd-bcf1-1f5dedc23dc6","order_by":5,"name":"Adrija Deka","email":"","orcid":"","institution":"Regional Dental college","correspondingAuthor":false,"prefix":"","firstName":"Adrija","middleName":"","lastName":"Deka","suffix":""}],"badges":[],"createdAt":"2026-03-01 19:38:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9003574/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9003574/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105574470,"identity":"d18ff520-0579-404e-91c0-5c1790ea7e16","added_by":"auto","created_at":"2026-03-27 13:35:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":839824,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Fig1Representativepreandpostawarenessimagesofthesameparticipantillustratingsignificantimprovementinposturalalignmentfollowingtheergonomicsawarenessintervention..png","url":"https://assets-eu.researchsquare.com/files/rs-9003574/v1/5f364e21e8bd0bad22a42aa1.png"},{"id":105574888,"identity":"62ca8e6a-40bd-4a35-828e-acfb5d3a8592","added_by":"auto","created_at":"2026-03-27 13:36:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":149455,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Fig2SchematicrepresentationoftheRapidUpperLimbAssessmentRULAscoringsystemshowingSectionAandSectionBcomponentswithcalculationofscoreAandscoreB.png","url":"https://assets-eu.researchsquare.com/files/rs-9003574/v1/8f03f2a38b1a51a74c0a643a.png"},{"id":105575454,"identity":"7cb80183-59e0-4362-9b50-ad3aac0c0d00","added_by":"auto","created_at":"2026-03-27 13:39:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2118202,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9003574/v1/f8409f69-72da-44e6-b3ca-c9e2ace6528d.pdf"},{"id":105574514,"identity":"b83eb511-2a5e-4a35-86a3-17504663eea6","added_by":"auto","created_at":"2026-03-27 13:35:13","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1028359,"visible":true,"origin":"","legend":"","description":"","filename":"supplimentarydocument.docx","url":"https://assets-eu.researchsquare.com/files/rs-9003574/v1/11e10e73e1166058f47a8a94.docx"},{"id":105574850,"identity":"ffa604e1-b95d-437a-9b07-83d5fd204215","added_by":"auto","created_at":"2026-03-27 13:36:26","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":108220,"visible":true,"origin":"","legend":"","description":"","filename":"Graph13.docx","url":"https://assets-eu.researchsquare.com/files/rs-9003574/v1/abdb101a3eaaabda9a925cd0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of early ergonomics exposure on awareness and postural assessment in second year pre-clinical undergraduate dental students","fulltext":[{"header":"Introduction","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eErgonomics as defined by the International Ergonomics Association (IEA) is the scientific discipline concerned with the understanding of the interaction between humans and as a profession that applies relevant theories, principles, data, and methods to design in order to optimize human well-being and overall system performance.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e The application of ergonomics has become a focal point across various fields promoting the overall well-being and safety of workers in the workplace.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDentistry is a profession commonly associated with the development of musculoskeletal pain and soreness, which often progress gradually. These symptoms are frequently overlooked until they become chronic and lead to permanent damage. Poor ergonomic practices, high workloads, and lack of awareness contribute to the high prevalence of MSDs, particularly neck and lower back pain, among dental students and professionals.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEarly introduction to right posture habit according to ergonomics is very important, so that can be practiced and followed in future work. Second-year students as they just started their work on mannequins, must be properly exposed to term ergonomics and proper postural habits. So, the early exposure of ergonomics in the second-year pre-clinical students\u0026rsquo; needs time.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Given the growing concern over work-related musculoskeletal disorders among dental professionals and students, there is a clear need to assess the impact of early ergonomics education. Also, there is a gap between theoretical knowledge and practical application of ergonomics. Therefore, proper work-related posture is important to reduce musculoskeletal pain, improve clinical efficiency and longevity of the dentist.\u003csup\u003e\u003cspan additionalcitationids=\"CR6 CR7 CR8\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study aims to evaluate the effect of introducing ergonomic principles to second-year pre-clinical students by assessing their awareness and postural behavior before and after early clinical exposure. The findings may support the integration of ergonomics training early in the dental curriculum.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003e \u003cstrong\u003eStudy design\u003c/strong\u003e \u003cp\u003eAn educational interventional prospective study was conducted on second year pre-clinical students in the Department of Prosthodontics and Crown and Bridge.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical Considerations\u003c/strong\u003e \u003cp\u003e The study was approved by MGVs KBH dental college and hospital, Nashik; Institutional Ethical Committee ((MGV/KBHDC/897/2020-21) This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Participation for the research study was voluntary and anonymous, with no incentives provided. Informed written consent was obtained from all the participants before start of study including the publication of results of the study.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population and settings:\u003c/h2\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThis study was designed as an educational interventional study and included 60 second-year undergraduate dental students aged 18 years and above. The participants were selected using a simple random sampling method. (Clinical trial number: not applicable) Only second-year students attending pre-clinical postings were included, while students from other years, interns, and postgraduates were excluded. A written informed consent was obtained from all participants prior to inclusion in the study. All participants completed a standardized assignment (maxillary central incisor tooth preparation). The questionnaire format was made to evaluate awareness among the students and postural assessment is performed by using the RULA method.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy intervention:\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cb\u003eFirst Phase-\u003c/b\u003e Postural assessment from video recordings was assessed by RULA methodology and analysis of knowledge about ergonomics was checked by using questionnaire format of the preclinical undergraduate student before awareness program. (Fig.\u0026nbsp;1)\u003c/p\u003e \u003cp\u003e \u003cb\u003eSecond Phase-\u003c/b\u003e After the first visit awareness program was conducted. The ergonomics term was explained and the application of ergonomics in dentistry was discussed in a broad sense. The correct ergonomic posture was shown to students practically. The wrong postures reduce the working efficiency and longevity of dentists, how? Such questions were discussed. Also, a question-answer session was conducted at the end of the awareness program.\u003c/p\u003e \u003cp\u003e \u003cb\u003eThird Phase-\u003c/b\u003e After the awareness program knowledge of students was checked by using the same questionnaire response format and also standardized video (visuals) recordings were taken while participants were performing given exercise.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFourth Phase-\u003c/b\u003e Comparison of questionnaire response format and visual assessment before and after awareness program was done. The comparison was done for-\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eQuestionnaire response format scores were compared (First score).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eVisual recordings were obtained before and after the awareness video, and RULA scores were calculated from these recordings and subsequently compared (Second score) (Fig.\u0026nbsp;2).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eBody is divided into two different sections (Section A \u0026ndash;upper arm, lower arm and wrist. Section B \u0026ndash; neck, trunk and legs\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eFor each section three scores were calculated\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003ePosture score\u003c/p\u003e\u003cp\u003eMuscle use score\u003c/p\u003e\u003cp\u003eForce score\u003c/p\u003e\u003cp\u003eAssessing the movements, postures are given scores in the range of 1 to 7 or more. If minimal risk factor given a lesser number and as risk factors or deviation from standard ergonomic posture increases, posture score shifts to higher number. It was a final score obtained from RULA assessment sheet. From that score level of MSD risk detected. The muscle use score is estimated by increasing the score by 1. The force score was then calculated for postures which exert force or maintain external load while working, the force score ranges from 0 to 3 (according to the external load value range).\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e The questionnaire response format results (both pre as well as post awareness programme) were analyzed quantitatively for awareness of ergonomics.\u003c/p\u003e\u003cp\u003eBy using section A and B scores, grand score from section C was determined that grand score was the final RULA score for that posture (RULA sheet).\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Comparison of postural assessment were performed by statistical analysis of collected pre and post-awareness postural scores.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStatistical analysis\u003c/strong\u003e \u003cp\u003ePaired T-test for statistical analysis, Inter-observer One-way ANOVA.\u003c/p\u003e \u003c/p\u003e "},{"header":"Results","content":"\u003cp\u003eThe study highlighted a notable enhancement in ergonomic awareness and postural practices among second-year dental students following an educational intervention. As shown in Table\u0026nbsp;1, paired t-test analysis revealed a significant decrease in mean awareness scores from pre- to post-awareness across all three observers (Observer 1: 6.33 to 5.72; Observer 2: 6.42 to 5.72; Observer 3: 6.42 to 5.75; all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating increased awareness and understanding after the intervention. One-way ANOVA showed no significant differences between observer scores either before or after the awareness program, supporting the assessment process's standardization and objectivity (Table no 1 Graph no 1 to 3). The use of a standardized operative task (maxillary central incisor preparation) ensured procedural uniformity, thereby isolating posture as the primary variable. The integration of standardized visual recording further enhanced objectivity and reproducibility.\u003c/p\u003e\n\u003cp\u003eObserver variation was one of the most important aspects. Pre and post inter observer variation for the postural assessment was not significant (Table\u0026nbsp;2) which showed the importance a prior training of all three observers for the research work. The postural assessment analysis and reporting in the form of RULA score was very precisely covered during structured training of observers.\u003c/p\u003e\n\u003cp\u003eThe reliability of the awareness questionnaire was assessed using Cronbach\u0026rsquo;s alpha. The pre-awareness scale demonstrated good internal consistency (\u0026alpha;\u0026thinsp;=\u0026thinsp;0.793), while the post-awareness scale showed improved reliability (\u0026alpha;\u0026thinsp;=\u0026thinsp;0.890) (Table\u0026nbsp;3). Values above 0.70 are generally considered acceptable, while values approaching 0.90 indicate strong internal coherence among items. The inter-observer reliability was high, with Cronbach\u0026rsquo;s alpha values of 0.793 pre-awareness and 0.890 post-awareness, confirming the questionnaire's good internal consistency.\u003c/p\u003e\n\u003cdiv\u003e\u0026nbsp;\u003c/div\u003e\n\u003cp\u003ePostural assessment using the Wilcoxon Signed Ranks test demonstrated statistically significant improvements across multiple components following intervention (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for most paired comparisons) (Table\u0026nbsp;4). The dominance of positive ranks and absence of negative ranks in several domains indicate a clear directional improvement in ergonomic posture. These findings align with previous studies reporting that early ergonomic sensitization significantly improves working posture among dental students.\u003csup\u003e7\u0026ndash;13\u003c/sup\u003e\u003c/p\u003e\n\u003cdiv\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv\u003e\u0026nbsp;\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study confirms that a structured awareness program can significantly enhance both the theoretical understanding and practical application of ergonomic principles among dental students. The use of the RULA method provided objective, reliable postural assessment, with inter-observer agreement ensuring consistency. The significant improvement in post-intervention scores aligns with previous findings that targeted ergonomic education and hands-on demonstrations are effective in improving ergonomic behaviour and reducing risk factors for musculoskeletal disorders.1\u003c/p\u003e \u003cp\u003eThe lack of significant change in some attitude-based questions suggests that students already recognized the importance of ongoing education and stretching exercises prior to the intervention, reflecting a generally positive baseline awareness. However, the marked improvement in knowledge and practical application underscores the need for integrating ergonomics into the dental curriculum, as students initially demonstrated limited understanding of ergonomics and its implications in dental practice. The results echo earlier studies emphasizing the gap between theoretical knowledge and its practical implementation, and the value of continuous ergonomic training in dental education. Overall, this study highlights the effectiveness of simulation-based ergonomic training in promoting safer work habits and reducing the risk of musculoskeletal disorders among dental students, supporting recommendations for the inclusion of ergonomics as a core component of dental education.\u003c/p\u003e \u003cp\u003eObserver calibration is central to minimizing measurement bias in ergonomic research. In this study, inter-observer variability was assessed both before and after intervention. One-way ANOVA revealed no statistically significant differences among the three observers in pre-awareness scores (p\u0026thinsp;=\u0026thinsp;0.667) and post-awareness scores (p\u0026thinsp;=\u0026thinsp;0.927) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The absence of significant variation indicates strong agreement and confirms the effectiveness of prior structured training.\u003c/p\u003e \u003cp\u003eAll observers underwent standardized calibration sessions focusing on accurate interpretation of the Rapid Upper Limb Assessment (RULA) scoring criteria. The RULA method has been widely validated as a reliable ergonomic assessment tool in occupational and clinical settings. By ensuring uniform understanding of joint angles, trunk inclination, neck posture, and upper limb positioning, subjective interpretation bias was minimized.The consistency observed across observers strengthens the internal validity of the study. Improvements in postural scores following intervention can therefore be attributed to the ergonomics training rather than assessor variability. In educational intervention research, especially when observational tools are employed, such calibration is critical for methodological rigor\u003c/p\u003e \u003cp\u003eMcAtamney and Corlett et al introduced the Rapid Upper Limb Assessment (RULA) method, a practical and equipment-free tool for evaluating work-related upper limb disorders.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e The method assigns risk scores to various postures, where higher scores indicate greater risk, making it a valuable and accessible screening tool for workplace assessments. Gandavadi et al used RULA to compare dental students\u0026rsquo; postures on conventional versus ergonomic seats, finding that conventional seating led to higher RULA risk scores and thus greater predisposition to MSDs, while ergonomic seating like the Bambach Saddle Seat promoted healthier postures.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Dental professionals are known to be at high risk for work-related musculoskeletal disorders (MSDs), often beginning during undergraduate training. Early correction of postural habits may therefore serve as a preventive strategy rather than a remedial one.\u003c/p\u003e \u003cp\u003eIn our present study RULA (rapid upper limb assessment) is a survey method developed for use in ergonomics where work-related upper limb disorders are reported.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e The postural assessment was done by comparison of pre-awareness and post-awareness postural RULA scores. For the standardization of results and to avoid bias in study three trained observers were appointed to watch the recorded postural videos and give the scores accordingly. A similar process repeated after the awareness program i.e. recording of posture observation of recorded videos by three observers and scoring were done. Both the scores pre-awareness and post awareness were compared by statistical tests. The improvement in Cronbach\u0026rsquo;s alpha following intervention suggests not only enhanced knowledge but greater conceptual clarity among participants. Post-intervention responses appeared more aligned, reflecting a more structured understanding of ergonomic principles. This pattern indicates that the educational exposure strengthened cognitive integration of concepts such as chair positioning, operator posture, instrument handling, and stretching practices.\u003c/p\u003e \u003cp\u003eImproved internal consistency post-intervention has been reported in similar educational intervention studies, where structured training enhances both knowledge levels and response stability.\u003c/p\u003e \u003cp\u003eThe pre and post questionnaire shows highly significant results except for question 7 \u0026amp; 10 which shows no significant results. This could be due to the students having some knowledge regarding continuing dental education and the importance of stretching exercises in the dental profession. So, statistically, it is not significant but students have some knowledge about following topics before awareness program is the positive aspect related to our research work.\u003csup\u003e\u003cspan additionalcitationids=\"CR14 CR15 CR16\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe correct ergonomic posture was shown to students practically. The wrong postures reduce the working efficiency and longevity of dentists, how? Such questions were discussed. Also, a question-answer session was conducted at the end of the awareness program.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e This is following the study by Gupta S et al and Patrica P who co-related the theoretical knowledge and its practical applications.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Each student responded to a multiple-choice questionnaire on the requirements of ergonomic posture.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe questionnaire format is designed for the assessment of the knowledge of the students before and after awareness about ergonomics in dentistry. In the questionnaire response sheet, the questions are attitude-based, theoretical knowledge-based, and practical knowledge base.\u003csup\u003e\u003cspan additionalcitationids=\"CR13 CR14 CR15 CR16 CR17 CR18\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e For the assessment of knowledge pre-awareness and post-awareness questionnaire responses were compared and the significance of theoretical explanation of the concept by lectures, by video demonstration, by a practical demonstration was checked. The questionnaire response sheet comparison shows highly significant results.\u003c/p\u003e \u003cp\u003eFor the knowledge assessment questionnaire response sheet was used and for postural assessment, RULA's postural assessment methodology was used. And both knowledge, as well as the practical implication, were checked by comparing before and after awareness program questionnaire responses and RULA score.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e The findings highlight the importance of introducing ergonomics training during the pre-clinical phase. Postural habits formed early in professional education tend to persist into clinical practice. Integrating ergonomics into the undergraduate curriculum may therefore reduce long-term musculoskeletal morbidity among dental practitioners.\u003c/p\u003e \u003cp\u003eImportantly, the study demonstrates that structured training influences not only awareness but also observable behavioral outcomes. The simultaneous improvement in RULA scores and questionnaire reliability suggests that knowledge translation into practice occurred effectively.\u003c/p\u003e\n\u003ch3\u003eNovelty of present study\u003c/h3\u003e\n\u003cp\u003eStudents were at high risk of MSD when they were not aware of standardized ergonomic posture. After awareness of students about standardized ergonomic posture, potential risks were relatively least found. Early awareness is the best solution for almost every problem, so the early ergonomics exposure of the second-year pre- clinical students is considered in the present study.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStrengths of the study\u003c/strong\u003e \u003cp\u003eStrengths of the study include observer calibration, use of a validated ergonomic assessment tool, objective visual documentation, and reliability testing of the awareness instrument. These methodological elements enhance internal consistency and reproducibility.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLimitations of the study\u003c/strong\u003e \u003cp\u003eThe training for postural assessment by RULA method is very crucial aspect for the study. Training of all three accessors and procedural recording of each participant may be overlooked with the digital way to make it simpler and time bound. However, the study was conducted within a single institutional cohort and evaluated short-term outcomes. Longitudinal assessment would be valuable to determine sustainability of ergonomic improvements during clinical postings.\u003c/p\u003e \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eWithin the limitations of the study, results demonstrates that a focused awareness program-combining theoretical knowledge, practical demonstrations, and interactive discussions-significantly improves students\u0026rsquo; understanding and application of ergonomic principles, as reflected by highly significant improvements in both questionnaire and RULA postural assessment scores. There is a need for the inclusion of ergonomics in the dental curriculum in a more sophisticated manner than the dental student can understand in a better way, also stressing not only on the theoretical knowledge but more on practical implication is need of time. Second-year students as they just started their work on the mannequin, should be properly exposed to the term ergonomics. Ergonomics awareness helps in the application and contributes significantly to the safety of dentists as per the results of the study.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e The study received approval from the Institutional Ethics Committee of MGV\u0026rsquo;s KBH Dental College and Hospital, Nashik (Approval No: MGV/KBHDC/897/2020\u0026ndash;21). All procedures carried out in this research were performed in accordance with the ethical standards outlined in the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to participate\u003c/strong\u003e \u003cp\u003e Written informed consent was obtained from all participants before their inclusion in the study. Participation was entirely voluntary, and the responses were recorded anonymously. No incentives or compensation were provided to the participants.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to publish\u003c/strong\u003e \u003cp\u003eAll participants provided written informed consent for the publication of data and any identifiable images included in this study.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests related to this study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research was supported by the Indian Council of Medical Research (ICMR) through the Short-Term Studentship (STS) 2021 programme (Reference No: 2020\u0026ndash;03125). The funding agency had no involvement in the design of the study, data collection, analysis and interpretation of results, or in the preparation of the manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAT conceived and designed the study, supervised the overall research process, carried out the statistical analysis, and prepared the initial manuscript draft.SB assisted in data collection and conducted the literature review.TK contributed to the study design, development of the methodology, and interpretation of the findings.MB supported data compilation and assisted in manuscript preparation.MS contributed to statistical validation and critically reviewed the manuscript for important intellectual content.AD assisted in data analysis and helped refine the manuscript through editing.All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors sincerely acknowledge the support of the Indian Council of Medical Research (ICMR) STS 2021 programme and express gratitude to the participating undergraduate dental students for their cooperation and engagement in the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analysed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKhan SA, Chew KY. Effect of working characteristics and taught ergonomics on the prevalence of musculoskeletal disorders amongst dental students. BMC Musculoskelet Disord. 2013;14(1):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupta S. Ergonomic applications to dental practice. Indian J Dent Res. 2011;22(6):816.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKalghatgi S, Prasad KV, Chhabra KG, Deolia S, Chhabra C. Insights into ergonomics among dental professionals of a dental institute and private practitioners in Hubli\u0026ndash;Dharwad twin cities, India. Saf health work. 2014;5(4):181\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlexopoulos EC, Stathi IC, Charizani F. Prevalence of musculoskeletal disorders in dentists. BMC Musculoskelet Disord. 2004;5(1):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupta A, Bhat M, Mohammed T, Bansal N, Gupta G. Ergonomics in dentistry. Int J Clin Pediatr dentistry. 2014;7(1):30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDable RA, Wasnik PB, Yeshwante BJ, Musani SI, Patil AK, Nagmode SN. Postural assessment of students evaluating the need of ergonomic seat and magnification in dentistry. J Indian Prosthodontic Soc. 2014;14(1):51\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eValachi B, Valachi K. Mechanisms leading to musculoskeletal disorders in dentistry. J Am Dent Association. 2003;134(10):1344\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarcia PP, Gottardello AC, Wajngarten D, Presoto CD, Campos JA. Ergonomics in dentistry: experiences of the practice by dental students. Eur J Dent Educ. 2017;21(3):175\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaman V, Ramlogan S, Sweet J, Sweet D. Application of the Rapid Entire Body Assessment (REBA) in assessing chairside ergonomic risk of dental students. Br Dent J. 2020 Aug;14:1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcAtamney L, Corlett EN. RULA: a survey method for the investigation of work- related upper limb disorders. Appl Ergon. 1993;24(2):91\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eValachi B, Valachi K. Preventing musculoskeletal disorders in clinical dentistry: strategies to address the mechanisms leading to musculoskeletal disorders. J Am Dent Association. 2003;134(12):1604\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGandavadi A, Ramsay J, Burke F. Assessment of dental student posture in two seating conditions using RULA methodology \u0026ndash; a pilot study. \u0026copy;British Dent J. 2007;203:601\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eD\u0026iacute;az Caballero AJ, Gomez Palencia IP, D\u0026iacute;az C\u0026aacute;rdenas S. Ergonomic factors that cause the presence of pain muscle in students of dentistry.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eP\u0026icirc;rvu C, Pătraşcu I, P\u0026icirc;rvu D, Ionescu C, Department of Oro-Dental Diagnosis, Ergonomics and, Methodology R. Carol Davila University of Medicine and Pharmacy, Bucharest Department of Dentures Technology and Dental Materials, Carol Davila University of Medicine and Pharmacy, Bucharest. Journal of Medicine and Life Vol.7, Issue 2, April-June 2014, pp.177\u0026ndash;182.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiddiqui TM, Wali A, Khan OH, Khan M, Zafar F. Assessment of knowledge, practice, and work environment related to ergonomics among dental students and dental practitioners. International Journal of Contemporary Dental \u0026amp; Medical Reviews. 2016;2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlyahya F, Algarzaie K, AlsubehY,Khounganian R et al. Awareness of ergonomics and work-related musculoskeletal disorders among dental professionals and students in Riyadh,Saudi A rabia.J.Phys. Ther Sci 30:770\u0026ndash;7762018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKalra TA, Kalra GE, Bansal MO, Uppal SW. Ergonomics: Need of the hour. Int Healthc Res J. 2018;1:365\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalimi F, Sheikhmozafari MJ, Tayebisani S, Ahmadi O. Risk Assessment of Musculoskeletal Disorders Prevalence in Female Hairdressers using RULA and NERPA Techniques. Int J Musculoskelet Pain Prev. 2021;6(3):545\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRambhad C, Pande N, Radke U. Assessment of knowledge of ergonomics among preclinical undergraduate students: A cross-sectional study. J Int Clin Dent Res Organ. 2018;10:65\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Paired T-Test:\u0026nbsp;\u003c/strong\u003ePre and post awareness assessment showing the post assessment awareness was highly significant.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eAwareness of ergonomics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMean score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eDf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ePre-awareness\u003c/p\u003e\n \u003cp\u003eOBSERVER 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e6.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.542\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001;\u003c/p\u003e\n \u003cp\u003eHighly significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ePost-awareness\u003c/p\u003e\n \u003cp\u003eOBSERVER 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eAwareness of\u003c/p\u003e\n \u003cp\u003eergonomics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMean score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eDf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ePre-awareness\u003c/p\u003e\n \u003cp\u003eOBSERVER 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e6.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001;\u003c/p\u003e\n \u003cp\u003eHighly significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ePost-awareness\u003c/p\u003e\n \u003cp\u003eOBSERVER 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.555\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eAwareness of\u003c/p\u003e\n \u003cp\u003eergonomics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMean score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eDf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ePre-awareness\u003c/p\u003e\n \u003cp\u003eOBSERVER 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e6.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.591\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026lt; 0.001;\u003c/p\u003e\n \u003cp\u003eHighly significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ePost-awareness\u003c/p\u003e\n \u003cp\u003eOBSERVER 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.541\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Inter-observer One-way ANOVA\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"630\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eAwareness of ergonomics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003cp\u003escore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePre-awareness score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eObserver 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.542\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.667;\u003c/p\u003e\n \u003cp\u003eNot significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eObserver 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.619\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eObserver 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.591\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"630\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eAwareness of ergonomics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003cp\u003escore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePost-awareness score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eObserver 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.927;\u003c/p\u003e\n \u003cp\u003eNot significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eObserver 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.555\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eObserver 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.541\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.537\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Cronbach\u0026apos;s Alpha\u0026nbsp;\u003c/strong\u003eis a measure of internal consistency of a questionnaire that is made of multiple Likert-type scale/items. The internal consistency of the awareness questionnaire was assessed using Cronbach\u0026rsquo;s alpha. The pre-awareness scale demonstrated good reliability (\u0026alpha; = 0.793), while the post-awareness scale showed better reliability (\u0026alpha; = 0.890), indicating improved internal consistency following the intervention.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eScale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCronbach\u0026rsquo;s Alpha\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Items (Observers)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eInterpretation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePre-awareness Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.793\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGood reliability\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePost-awareness Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.890\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eBetter reliability\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Wilcoxon Signed Ranks Test: Postural Assessment- Pre and post analysis.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"635\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003ePairs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003cp\u003eRank\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eSum of\u003c/p\u003e\n \u003cp\u003eRanks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePostQ2 - PreQ2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eNegative Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e0\u003c/sub\u003ea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e-6.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001;\u003c/p\u003e\n \u003cp\u003eHighly significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003ePositive Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e51\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e26.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1326.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e9\u003c/sub\u003ec\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePostQ3 - PreQ3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eNegative Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e0\u003c/sub\u003ed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e-4.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001;\u003c/p\u003e\n \u003cp\u003eHighly significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003ePositive Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e24\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e12.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e300.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e36\u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePostQ4 - PreQ4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eNegative Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e0\u003c/sub\u003eg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e-4.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001;\u003c/p\u003e\n \u003cp\u003eHighly significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003ePositive Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e18\u003csup\u003eh\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e9.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e171.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e42\u003csup\u003ei\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePostQ5 - PreQ5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eNegative Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e0\u003c/sub\u003ej\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e-6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001;\u003c/p\u003e\n \u003cp\u003eHighly significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003ePositive Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e56\u003csup\u003ek\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e28.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1596.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e4\u003c/sub\u003el\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePostQ6 - PreQ6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eNegative Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e1\u003c/sub\u003em\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e20.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e20.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e-6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001;\u003c/p\u003e\n \u003cp\u003eHighly significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003ePositive Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e49\u003csup\u003en\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e25.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1254.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e10\u003csup\u003eo\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePostQ7 - PreQ7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eNegative Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e0\u003c/sub\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e1.000;\u003c/p\u003e\n \u003cp\u003eNot significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003ePositive Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e0\u003c/sub\u003eq\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e60\u003csup\u003er\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePostQ12 - PreQ12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eNegative Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e0\u003c/sub\u003eae\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e-7.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001;\u003c/p\u003e\n \u003cp\u003eHighly significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003ePositive Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e60\u003c/sub\u003eaf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e30.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1830.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e0\u003c/sub\u003eag\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eb. PostQ2 \u0026gt; PreQ2; e. PostQ3 \u0026gt; PreQ3; h. PostQ4 \u0026gt; PreQ4; k. PostQ5 \u0026gt; PreQ5; n. PostQ6 \u0026gt; PreQ6; q. PostQ7 \u0026gt; PreQ7; af. PostQ12 \u0026gt; PreQ12\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"635\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePairs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eRank\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSum of\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eRanks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eZ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePostQ8 - PreQ8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eNegative Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e0\u003c/sub\u003es\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-4.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001;\u003c/p\u003e\n \u003cp\u003eHighly significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003ePositive Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e16\u003csup\u003et\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e8.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e136.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e44\u003csup\u003eu\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePostQ9 - PreQ9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eNegative Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e0\u003c/sub\u003ev\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-7.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001;\u003c/p\u003e\n \u003cp\u003eHighly significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003ePositive Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e51\u003csup\u003ew\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e26.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1326.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e9\u003c/sub\u003ex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePostQ10 - PreQ10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eNegative Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e0\u003c/sub\u003ey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0.083;\u003c/p\u003e\n \u003cp\u003eNot significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003ePositive Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e3\u003c/sub\u003ez\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e6.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e57\u003c/sub\u003eaa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePostQ11 - PreQ11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eNegative Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e0\u003c/sub\u003eab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-7.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001;\u003c/p\u003e\n \u003cp\u003eHighly significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003ePositive Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e60\u003c/sub\u003eac\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e30.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1830.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e0\u003c/sub\u003ead\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003et. PostQ8 \u0026gt; PreQ8\u003c/p\u003e\n\u003cp\u003ew. PostQ9 \u0026gt; PreQ9\u003c/p\u003e\n\u003cp\u003ez. PostQ10 \u0026gt; PreQ10 ac. PostQ11 \u0026gt; PreQ11\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"635\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePairs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eRank\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSum of\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eRanks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eZ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePostQ13 - PreQ13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eNegative Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e28\u003c/sub\u003eah\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e14.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e406.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-5.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001;\u003c/p\u003e\n \u003cp\u003eHighly significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003ePositive Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e0\u003c/sub\u003eai\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e32\u003c/sub\u003eaj\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePostQ14 - PreQ14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eNegative Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e0\u003c/sub\u003eak\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-4.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001;\u003c/p\u003e\n \u003cp\u003eHighly significant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003ePositive Ranks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e17\u003c/sub\u003eal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e9.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e153.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e\u003csub\u003e43\u003c/sub\u003eam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eah. PostQ13 \u0026lt; PreQ13 ai. PostQ13 \u0026gt; PreQ13 aj. PostQ13 = PreQ13 ak. PostQ14 \u0026lt; PreQ14 al. PostQ14 \u0026gt; PreQ14 am. PostQ14 = PreQ14\u003c/p\u003e"},{"header":"Graphs","content":"\u003cp\u003eGraphs 1 to 3 are available in the Supplementary Files section\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"diedu","sideBox":"Learn more about [Discover Education](https://www.springer.com/journal/44217)","snPcode":"44217","submissionUrl":"https://submission.nature.com/new-submission/44217/3","title":"Discover Education","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Ergonomics, musculoskeletal disorders, postural assessments, Rapid Upper Limb Assessment, undergraduate dental students","lastPublishedDoi":"10.21203/rs.3.rs-9003574/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9003574/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and objectives:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDental health professionals are commonly associated with the development of musculoskeletal pain and soreness, which often progress gradually. Early introduction to right posture habit according to ergonomics is very important, so that can be practiced and followed in future work. Objective of the study was to compare the awareness and postural assessment related to dental operatory position among second-year preclinical undergraduate students before and after early exposure to ergonomics in dentistry.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA prospective interventional study was conducted involving 60 second-year Bachelor of Dental Surgery (BDS) students recruited through simple random sampling. Each participant performed a standardized tooth preparation task in a simulated environment. During the procedure, ergonomic assessment was conducted using the Rapid Upper Limb Assessment (RULA) method by three trained observers. RULA scores were calculated by evaluating posture, muscle use, and force related to the upper limb, neck, trunk, and legs. The RULA scores and test scores (Pre and post awareness scores) obtained were then statistically analyzed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was a statistically significant improvement in both ergonomic awareness and postural scores following the intervention. Mean awareness scores decreased significantly across all observers (p \u0026lt; 0.001). Inter-observer reliability was high (Cronbach’s alpha: pre 0.793, post 0.890). Most questionnaire and RULA items showed highly significant improvement (p \u0026lt; 0.001), except for questions related to attitudes toward continuing dental education and stretching exercises, which were already positive at baseline.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA structured, simulation-based ergonomic awareness program significantly improved both knowledge and practical application of ergonomic principles among dental students. These findings support the integration of ergonomics into dental education to promote healthier work practices and reduce the risk of musculoskeletal disorders.\u003c/p\u003e","manuscriptTitle":"Impact of early ergonomics exposure on awareness and postural assessment in second year pre-clinical undergraduate dental students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-27 13:11:45","doi":"10.21203/rs.3.rs-9003574/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-07T18:23:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T06:57:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-26T16:37:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"198293310065095911243799769461759851638","date":"2026-04-18T06:01:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"303575774734112638481226907395259121750","date":"2026-04-18T03:52:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86608555295121352537504558776221434227","date":"2026-04-17T21:10:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-17T17:58:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"239963821467840531711981605158451763608","date":"2026-04-08T06:18:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-02T22:41:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"10029801177931924432005994376429951983","date":"2026-04-02T22:31:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-26T06:09:41+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-09T14:58:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-09T08:56:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-06T20:40:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Education","date":"2026-03-06T20:37:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"diedu","sideBox":"Learn more about [Discover Education](https://www.springer.com/journal/44217)","snPcode":"44217","submissionUrl":"https://submission.nature.com/new-submission/44217/3","title":"Discover Education","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"37aa31cd-feee-40e8-98e7-3e645e489fac","owner":[],"postedDate":"March 27th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-07T18:23:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T06:57:07+00:00","index":86,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T18:38:49+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-27 13:11:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9003574","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9003574","identity":"rs-9003574","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}