Effectiveness and safety of nurse-led early cognitive and sensory rehabilitation in patients with severe traumatic brain injury: a systematic review protocol.

Background: Recovery from severe traumatic brain injury (sTBI) is frequently compromised by profound and prolonged disorders of consciousness. While critical care nurses are uniquely positioned to deliver early, structured cognitive and sensory rehabilitation at the bedside, the effectiveness and safety of such nurse-led protocols remain uncertain due to a lack of synthesized evidence. This critical knowledge gap hinders the standardization of neuro-rehabilitative nursing and the optimization of patient recovery trajectories. Objectives: The primary objective is to systematically evaluate the effectiveness of nurse-led early cognitive and sensory interventions on consciousness recovery and cognitive function in adult sTBI patients. The co-primary objective is to assess the safety of these interventions. Secondary objectives include impacts on functional status, length of ICU/hospital stay, and mortality. Methods: This systematic review will adhere to the PRISMA-P guidelines and is registered with PROSPERO (CRD420251075729). We will systematically search major international and Chinese databases for relevant randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSI) involving adult patients with severe traumatic brain injury (sTBI), defined as an initial post-resuscitation Glasgow Coma Scale (GCS) score of 8 or less. Two reviewers will independently screen studies, extract data, and assess risk of bias using the Cochrane RoB 2 and ROBINS-I tools. Data will be synthesized narratively. Where appropriate, random-effects meta-analyses will be performed. Pre-specified subgroup and sensitivity analyses will be conducted to explore heterogeneity and assess the robustness of the findings. The final certainty of evidence will be assessed using the GRADE framework. Conclusion: This review aims to deliver a definitive synthesis of evidence to directly inform the development and implementation of nurse-led neuro-rehabilitation protocols. By establishing the balance of effectiveness and safety, our findings will provide a rigorous foundation to empower nursing practice, enhance neurocritical care, and ultimately, improve the outcomes for this vulnerable patient population.