Efficacy of non-pharmacological interventions for cognitive impairment in patients with traumatic brain injury: a...

Non-pharmacological interventions may improve cognitive function in patients with traumatic brain injury (TBI); however, their comparative effectiveness and clinical prioritization remain unclear. This study aimed to evaluate multiple non-pharmacological interventions using a network meta-analysis and to assess the certainty of evidence while identifying existing research gaps.

Randomized controlled trials (RCTs) were systematically searched in English and Chinese databases up to August 15, 2025. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the Cochrane Risk of Bias Tool (RoB 1.0). A network meta-analysis was conducted using R to compare intervention effects on Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Modified Barthel Index (MBI). Evidence quality was assessed using the GRADE framework.

Nine RCTs involving 528 participants and eight non-pharmacological interventions were included. The evidence network was sparse, with most comparisons informed by single studies. Music therapy showed a potential benefit in improving MMSE scores. Comprehensive nursing intervention demonstrated a possible advantage in MoCA outcomes. Electroacupuncture combined with hyperbaric oxygen therapy showed a positive trend in improving MBI scores. However, effect estimates were imprecise, and overall evidence certainty was low or very low.

Current evidence suggests that several non-pharmacological interventions may offer potential benefits for cognitive and functional recovery in TBI patients; however, findings are highly uncertain and insufficient to support clinical prioritization. This study highlights important evidence gaps, and further large-scale, high-quality RCTs are needed to establish reliable comparative effectiveness.