Post-traumatic brain injury consciousness disorders are associated with a poor prognosis and a high risk of secondary complications. There is a clinical absence of specific intervention methods. Non-invasive neuromodulation techniques have emerged as a research focus due to their high safety profile. However, existing evidence is lacking in systematic comparisons of different stimulation modalities and target sites, and the therapeutic efficacy of these modalities remains insufficiently demonstrated. There is an urgent need to identify optimal intervention strategies.

To evaluate and compare the awakening efficacy and safety of different non-invasive neuromodulation modalities in patients with disorders of consciousness after traumatic brain injury, providing evidence-based guidance for selecting the optimal intervention in clinical practice.

Randomized controlled trials on the effects of non-invasive neuromodulation on disorders of consciousness after traumatic brain injury were searched in PubMed, Embase, Web of Science, Cochrane Library, CNKI, CBM, and Wanfang Data from the inception of each database to July 2025. The control group received conventional treatment or sham stimulation, while the experimental group was given non-invasive neuromodulation in addition to the control group's treatment. The Cochrane Risk of Bias Tool will be used for quality assessment. Network meta-analysis will be performed using Stata 16.0, and the GRADE approach will be applied to evaluate the quality of evidence for outcome measures.

A total of 49 randomized controlled trials were included, among which 12 were rated as low risk of bias and 37 as some concerns; no study was judged to be at high risk. The pooled sample comprised 3 140 participants and encompassed 12 distinct non-invasive neuromodulation modalities. Network meta-analysis showed that, compared with conventional treatment: for improvement in Coma Recovery Scale-Revised (CRS-R) scores, the most effective intervention was transcranial direct current stimulation-dorsolateralprefrontal cortex (SMD=3.01, 95%CI=2.21 to 3.80, P<0.05; SUCRA=90.3%) followed by high-frequency repetitive transcranial magnetic stimulation- dorsolateralprefrontal cortex (SMD=2.77, 95%CI=1.97 to 3.56, P<0.05; SUCRA=83.5%) > high-frequency repetitive transcranial magnetic stimulation-primary motor cortex (SMD=2.44, 95%CI=1.73 to 3.14, P<0.05; SUCRA=70.6%) > transcutaneous auricular vagus nerve stimulation (SMD=2.38, 95%CI=1.51 to 3.25, P<0.05; SUCRA=69.9%) > median nerve electrical stimulation (SMD=2.31, 95%CI=1.13 to 3.49, P<0.05; SUCRA=67.7%); For improvement in Glasgow Coma Scale, (GCS) scores, the most effective intervention was high-frequency repetitive transcranial magnetic stimulation-primary motor cortex (SMD=2.94, 95%CI=2.21 to 3.67, P<0.05; SUCRA=94.1%), followed by transcutaneous auricular vagus nerve stimulation (SMD=2.46, 95%CI=1.73 to 3.19, P<0.05; SUCRA=78.8%) > high-frequency repetitive transcranial magnetic stimulation-dorsolateralprefrontal cortex (SMD=2.27, 95%CI=1.58 to 2.96, P<0.05; SUCRA=69.9%) > median nerve electrical stimulation (SMD=2.12, 95%CI=1.68 to 2.55, P<0.05; SUCRA=62.7%) > transcranial direct current stimulation- dorsolateralprefrontal cortex (SMD=1.51, 95%CI=0.72 to 2.30, P<0.05; SUCRA=40.1%).

The existing moderate evidence indicates that various types of non-invasive neuromodulation can improve consciousness after brain injury. For enhancing CRS-R scores, transcranial direct current stimulation-dorsolateralprefrontal cortex is the most effective modality, whereas for improving GCS scores, high-frequency repetitive transcranial magnetic stimulation-primary motor cortex is optimal.