We express our sincere gratitude to the authors of the two letters to the editor for their insightful and helpful criticism of our most recent research [1]. Their involvement and recognition of the clinical significance of our work, particularly with regard to spinal cord injury (SCI) rehabilitation in low- and middle-income countries (LMIC), is greatly appreciated.

Important methodological and statistical considerations have been correctly brought to light in both letters. As previously mentioned, our study’s retrospective design naturally restricts our ability to control for bias and confounding variables. We admit that a power calculation was not done beforehand and that the sample size (n=70) is rather small. Nonetheless, this restriction was openly addressed in the manuscript’s limitations section.

The sample size is indicative of a larger systemic issue: the low accessibility and cost of rehabilitation services in India severely limits the number of patients who can finish an entire course of SCI rehabilitation at a single facility. Due to logistical and socioeconomic limitations, many patients are unable to participate, even though this facility is one of the few with a dedicated SCI unit. These obstacles can impact follow-up and postpone rehabilitation, as both letters correctly point out.

With little real-world data from India and other LMICs, our study’s main goal was to draw attention to the observable advantages of early rehabilitation and its effects on functional, psychological, and vocational outcomes. Even though our results point to a strong correlation between early rehabilitation and better results, we are conscious that these findings need to be confirmed by larger, prospective, multicenter studies using sound methodology.

We recognize these limitations in relation to the issues of statistical rigor, including the absence of normality testing, effect size reporting, and post hoc analysis. Our goal was to present a preliminary real-world analysis using the full follow-up data that was available, and we are dedicated to using more thorough statistical planning in subsequent research. Our planned prospective blinded trial on this topic will incorporate the helpful recommendations, which include blinding of outcome assessors (which could not be done as it was a retrospective study), STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) compliance, and the inclusion of confidence intervals.

We also thank the authors for pointing out typographical discrepancies in Table 3 of [1] and data descriptions. These were inadvertent errors during proofreading, and we confirm that the table data are accurate.

In conclusion, we are encouraged by the positive reception of our study and thankful for the insightful feedback. We fully agree that a multicenter study with larger sample size and enhanced statistical robustness is necessary to further strengthen the evidence base for rehabilitation in SCI. We hope our study serves as a stepping stone toward that goal.