The effectiveness of digital cognitive intervention in patients with traumatic brain injury: systematic review and meta-analysis

Abstract

Objective: This meta-analysis aims to quantitatively evaluate the effects of digital cognitive intervention (non-immersive computer- and immersive virtual reality (VR)-based) on cognitive function and psychosocial outcomes in patients with traumatic brain injury (TBI), and to explore potential moderating factors. Methods: A systematic search was conducted in PubMed, the Cochrane Library, Embase, and Web of Science databases from their inception to April 3, 2025. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated to estimate effect sizes, and heterogeneity was assessed using the I2 statistic. Results: A total of 16 studies were included; 9 employed computer-based cognitive interventions and 7 used VR-based interventions. The results showed that both types of interventions significantly improved global cognitive function (SMD: 0.64, 95% CI: 0.44 to 0.85, I2 = 0%), executive function (SMD: 0.32, 95% CI: 0.17 to 0.47, I2 = 15%), attention (SMD: 0.40, 95% CI: 0.02 to 0.78, I2 = 0%) and social cognitive function (SMD: 0.46, 95% CI: 0.20 to 0.72, I2 = 0%) in TBI patients. However, no significant improvements were observed in memory, processing speed, activities of daily living, or psychosocial outcomes (self-efficacy, anxiety/depression). Subgroup analysis indicated that VR-based interventions were more effective than traditional cognitive therapy. Moreover, VR interventions had a positive effect on depression in TBI patients. A greater number of training sessions may further enhance cognitive benefits. Conclusion: This meta-analysis supports the efficacy of digital cognitive intervention in improving cognitive function in TBI patients. We recommend individualized treatment programs to more effectively address cognitive impairments.