Exploratory meta-analysis of the effect of music intervention on arousal promotion in patients with disorders of consciousness: evidence from controlled studies

Introduction Disorders of consciousness (DoC) are common disabling conditions following severe brain injury that impose a substantial burden on families and society. Music intervention, as a non-invasive stimulation method, has garnered increasing attention in the field of neurorehabilitation. However, evidence regarding its awakening effects in patients with DoC remains inconsistent. This study systematically reviewed controlled trials investigating the effects of music intervention on the level of consciousness in patients with DoC and performed an exploratory meta-analysis. Methods We systematically searched five databases (PubMed, Cochrane Library, Web of Science, Embase, and CNKI) to identify controlled trials comparing the effects of music intervention and control conditions on the level of consciousness in patients with DoC. The Cochrane RoB 2.0 and ROBINS-I tools were used to assess risk of bias. Statistical analysis was performed using RevMan V5.4.1. The primary outcome was the standardized mean difference (SMD) in consciousness levels, calculated as the change in consciousness scores from baseline to endpoint between the music intervention and control groups. Results Seven studies (four randomized controlled trials and three non-randomized studies) comprising 296 patients were included. The meta-analysis showed that the music intervention group had significantly greater improvement in consciousness level scores compared with the control group (SMD = 1.51, 95% CI: 0.57–2.44, P 0.01), with high heterogeneity across studies ( I 2 = 91%). Sensitivity analysis indicated that heterogeneity decreased to a moderate level ( I 2 = 72%) after excluding one study involving interactive music therapy and decreased further ( I 2 = 34%) after excluding studies with short intervention durations. The GRADE certainty of the evidence was rated very low. Conclusion Music intervention may improve the level of consciousness in patients with DoC. However, the existing evidence is highly heterogeneous. Intervention type (interactive vs. passive) and intervention intensity may represent potential sources of heterogeneity. Further high-quality studies are required to confirm these hypotheses.