Author Response: Letter in Response to the Article: Network Meta-analysis of the Efficacy of Different Music Therapy Interventions for Delirium in Adult Intensive Care Unit Patients

We sincerely thank Kwakernaak and Klimek for their thoughtful comments on our article, "Network Meta-analysis of the Efficacy of Different Music Therapy Interventions for Delirium in Adult Intensive Care Unit Patients."We appreciate the opportunity to clarify several methodological and interpretative issues raised in their Letter to Editor.First, the authors state that the transitivity assumption is not met.We agree that transitivity is central to the validity of any network meta-analysis, particularly in a clinically heterogeneous intensive care unit (ICU) population.However, we would like to clarify that transitivity was not overlooked in our study.As described in the Methods section, we assessed the plausibility of transitivity qualitatively by considering key potential effect modifiers, including patient age, ICU population or diagnosis, delirium assessment instruments and schedules, baseline sedation and ventilation status when reported, and intervention dose, frequency, and total course.We also explicitly acknowledged that some effect modifiers were incompletely reported, and therefore, indirect comparisons required cautious interpretation.Thus, our position was not that perfect exchangeability existed across all trials, but that the available randomized evidence could be synthesized with appropriate methodological caution.Second, we agree that music-based interventions are heterogeneous.Music type, delivery mode, frequency, total intervention duration, and co-intervention components varied across the included trials.This was described in the Results section and summarized in the intervention characteristics table.For this reason, we categorized interventions into separate nodes, namely simple music (SM) therapy, traditional chinese medicine (TCM) five-element music, family voice stimulation (FS) combined with music, and combined music (CM) therapy, rather than pooling all music-related interventions into a single category.We also agree that future studies should adopt more standardized reporting frameworks, such as template for intervention description and replication (TIDieR)-based descriptions, to improve reproducibility and enable more refined analyses of intervention components.Third, regarding the statement that study-level specification was lacking, we respectfully clarify that study-level intervention characteristics were reported in our article, including intervention type, control condition, outcome measures, assessment tools, and intervention dose.Nevertheless, we acknowledge that the reporting quality of the original trials was variable, and some