Objective:

To evaluate multiple non-pharmacological interventions for cognitive dysfunction in TBI patients and assess the certainty of evidence while identifying research gaps.

Approach:

• Study Selection: Randomized controlled trials (RCTs) were systematically searched in English and Chinese databases up to August 15, 2025.
• Data Extraction: Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the Cochrane Risk of Bias Tool (RoB 1.0).
• Network Meta-Analysis: A network meta-analysis was conducted using R to compare intervention effects on MMSE, MoCA, and MBI.
• Evidence Quality Assessment: Evidence quality was assessed using the GRADE framework.

Key Findings:

• Nine RCTs involving 528 participants and eight non-pharmacological interventions were included.
• 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.
• Overall evidence certainty was low or very low, and effect estimates were imprecise.

Interpretation:

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.

Limitations:

• The evidence network was sparse, with most comparisons informed by single studies, leading to imprecise effect estimates.

Conclusion:

Further large-scale, high-quality RCTs are needed to establish reliable comparative effectiveness.