The effect of multimodal sensory therapy in consciousness improvement in patients with acquired brain injury: a systematic review and meta-analysis.

Abstract

Adults with severe or profound acquired brain injury (ABI) frequently develop disorders of consciousness (DoC). Multimodal sensory therapy (MST) has been proposed to promote arousal and recovery, but effect estimates vary. This review evaluated MST for consciousness outcomes in adults with ABI-related DoC. We searched MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL from inception to 28 October 2025 for studies enrolling adults with ABI-related DoC and comparing MST with usual care, sham, or no stimulation. Outcomes were consciousness scores and coma emergence. Risk of bias was assessed using RoB 2 or ROBINS-I. Random-effects models calculated standardized mean differences (SMDs) and odds ratios (ORs). Eighteen studies with 20 comparisons and 884 participants were included. MST improved consciousness levels versus control (SMD, 1.48; 95% CI, 1.04-1.92). Effects were more consistent with CRS-R assessments (SMD, 1.23; 95% CI, 0.55-1.91). MST was associated with higher odds of coma emergence (OR, 9.85; 95% CI, 3.86-25.01). Risk-of-bias concerns were identified in most studies. MST was associated with improved consciousness levels and increased probability of coma emergence in adults with ABI-related DoC, but evidence is limited by heterogeneity and methodological limitations. Future trials should use standardized protocols and validated assessments. The protocol for this study was prospectively registered in the International Prospective Register of Systematic Reviews (CRD420251177793).