Six rehabilitation methods with acupuncture on consciousness in patients with traumatic brain injury: protocol for a...

Disorders of consciousness (DoC) are common after traumatic brain injury (TBI) and are associated with prolonged hospitalization, high care needs, and long-term functional burden. In clinical practice, acupuncture is frequently delivered alongside other rehabilitation modalities such as repetitive transcranial magnetic stimulation, hyperbaric oxygen therapy, peripheral or cranial nerve stimulation, structured sensory stimulation, and Chinese herbal medicine. However, existing trials are small, heterogeneous, and rarely compared head to head; current evidence syntheses are largely modality-specific and do not provide a unified cross-modality comparative framework.

The protocol of our systematic review and network meta-analysis (NMA) is reported following the PRISMA-P guidelines. We will search the following databases from inception to February 2026: PubMed, the Cochrane Central Register of Controlled Trials, Embase, Web of Science, CNKI, Wanfang Data, VIP, and SinoMed, as well as major clinical trial registries and gray literature sources. We will include randomized controlled trials enrolling adults with TBI-related DoC. Eligible interventions will be six rehabilitation modalities delivered in combination with acupuncture, and comparators will include the same modality without acupuncture, sham acupuncture, or usual care. The primary outcomes will be recovery of consciousness, measured as change in validated behavioral scales; secondary outcomes will include functional disability, neurological severity, mortality, and adverse events. We will conduct a Bayesian NMA in Stata (v15.1) and R (v4.1.3) using random-effects models, assess both global and local consistency, and evaluate small-study effects and publication bias. Interventions will be ranked using surface under the cumulative ranking curve, and certainty of evidence will be rated using the GRADE framework adapted for NMA.

This study will provide a comprehensive NMA of RCTs testing the added value of acupuncture across six rehabilitation modalities for TBI-related DoC. The synthesis will provide decision-ready, certainty-graded comparative evidence to guide practice, guideline development, and priorities for dosing, timing, and target populations.