Effect of Cognitive Rehabilitation Nursing on Cognitive Impairment in Patients With Schizophrenia: A Comprehensive Systematic Review and Meta-Analysis.

Cognitive impairment is a core feature of schizophrenia, significantly affecting patients' daily functioning and quality of life. Cognitive rehabilitation nursing (CRN) has emerged as a promising nonpharmacological approach to improve cognitive deficits. This systematic review and meta-analysis aimed to evaluate the efficacy of CRN in enhancing cognitive function in patients with schizophrenia. A systematic literature search was conducted in Web of Science, PubMed, and Scopus for studies published between 2020 and 2025, using a combination of controlled vocabulary and free-text terms. Eligible studies were original, peer-reviewed articles examining CRN interventions in individuals with schizophrenia, with cognitive or functional outcomes. Fifteen studies comprising 19 intervention arms met the inclusion criteria. Methodological quality was assessed using the Cochrane RoB-2 (Risk of Bias 2) tool for randomized trials and ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) for nonrandomized studies. Standardized mean differences (SMDs) with Hedges' g correction were calculated under a random-effects model. Heterogeneity was examined using I² statistics, and publication bias was evaluated through funnel plots and Egger's test. A total of 19 intervention arms from 15 studies were included. Overall, cognitive rehabilitation yielded a small but favorable effect across cognitive domains (SMD = 0.35, p = .084), with a significant moderate-to-large effect observed for executive function (SMD = 0.63, p = .035), particularly in studies employing computerized, individualized, or virtual reality-based interventions. Effects on global cognition, memory, and functional outcomes were smaller and nonsignificant, while social cognition, assessed in one study, showed a small negative effect (SMD = -0.34, p = .046). Pharmacological and game-based interventions showed inconsistent efficacy. Substantial heterogeneity was present (I² = 85.3%), with outcome domain emerging as a significant moderator (p < .001). Publication bias analysis indicated potential small-study effects, although no missing studies were identified via the trim-and-fill method. This meta-analysis supports the effectiveness of CRN in improving cognitive outcomes in schizophrenia, with the strongest effects on executive function. Targeted, multimodal, and tech-enhanced interventions showed the greatest promise. Despite heterogeneity, the findings were consistent, reinforcing CRN's role in multidisciplinary psychiatric care.