The Combined Efficacy of Adjunctive Psychological Interventions and Pulmonary Rehabilitation in People With Chronic Obstructive Pulmonary Disease - A Systematic Review and Meta-Analysis.

Abstract

Background Depression and anxiety exacerbate the pernicious cycle of dyspnea, inactivity, and deconditioning in people with chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation (PR) is a well-proven management for improving exercise capacity and health-related quality of life in people with COPD. Recently, evidence suggested that adjunctive psychological interventions may enhance the efficacy of PR by targeting the bidirectional dyspnea-anxiety cycle and modifying maladaptive behaviors. Objective To evaluate the added benefit of psychological interventions in comparison to conventional PR alone. Methods Four electronic databases (PubMed, EMBASE, Web of Science, and CINAHL) were searched from their inception to March 31, 2025. Studies retrieved were screened according to the selection criteria. Statistical analyses were performed using Cochrane RevMan Manager 5.4. Appraisal of study quality and the certainty of evidence were evaluated. Results Five studies were included in this meta-analysis. Primary analysis results showed significant improvements in anxiety (Standardized Mean Difference, SMD = -0.55; 95% CI: -0.85 to -0.25, p = 0.0004). There was no improvement in depression (SMD = -0.38, 95% CI = -0.97 to 0.22, p = 0.22) or physical outcomes (6-minute walking distance: (Mean difference, MD = 16.45, 95% CI = -17.38 to 50.27, p = 0.34). Subgroup analysis results demonstrated significantly greater improvement in depression among people with clinical symptoms at baseline (p = 0.004). Conclusion The addition of adjunctive psychological interventions may enhance the efficacy of PR for people with COPD when compared to those receiving PR alone. The findings suggest that better improvements were observed among patients with clinical psychological symptoms at baseline.