Authors’ response

Sir,

We appreciate Dr. Mithun Rao and Dr. Ramesh Holla for their thoughtful engagement with our article.¹ Our study followed a pragmatic approach that employed a quasi-experimental design within a real-world clinical setting. We used the word effectiveness in the abstract and objectives to describe this context.² The word efficacy was intentionally used in the title and conclusion to signify the primary aim of the study, which was to determine if the intervention could produce the expected therapeutic result under the structured and supervised conditions of our protocol. We acknowledge that this dual terminology could be confusing and thank the authors for allowing us to clarify this distinction.

The term paraspinal myalgia was used to describe localized paraspinal discomfort experienced by patients, based on existing literature describing musculoskeletal symptoms in post-COVID patients.^3,4 COVID-19 infection history was confirmed by official RT-PCR test reports and discharge summaries for hospitalized individuals. We acknowledge that specific data on COVID-19 vaccination history was not analyzed as a distinct variable. This is a valid limitation of the study.

Prospective registration with the Clinical Trials Registry of India (CTRI) was not undertaken at the time of study initiation. However, this study received prior approval from the Institutional Ethics Committee, and the ethical and safety standards were adhered to throughout the conduct of our study. We recognize that trial registration enhances transparency and scientific credibility, and the absence of CTRI registration is therefore acknowledged as a limitation of the present study.

It is important to clarify the function of our exclusion criteria with respect to the history of chronic back issues. Patients with significant comorbidities and autoimmune diseases (e.g., rheumatoid arthritis, myositis) were excluded from the study.² This was intentionally implemented to create a homogenous study population focused on post-COVID sequelae, excluding individuals with chronic back pain caused by other pathologies.

The cohort of male manual laborers aged 40-50 yr from Belagavi inherently represents a population facing socioeconomic challenges, for whom telerehabilitation is a particularly relevant and scalable solution to prevent loss of wages. While detailed sociodemographic data were not presented, the homogeneity of the recruited participants and zero losses to attrition over the 12 wk intervention period provided the context for the statement in the discussion on role of telerehabilitation in overcoming the socioeconomic barriers.

As stated in the materials and methods, recruitment and baseline assessments were conducted in October 2023. This was followed by the 12 wk intervention period from November 2023 to January 2024.² We confirm that 60 participants were ultimately enrolled from 127 individuals screened for eligibility.

Overall, we believe our work to be a valuable contribution to the evolving rehabilitation strategies for post-COVID syndromes in underserved populations. We thank the authors for their valuable feedback and commentary that allowed us to add clarity to our study methodology and findings.