The addition of motivational interventions to pulmonary rehabilitation does not improve physical and psychosocial outcomes in patients with chronic obstructive pulmonary disease: a systematic review with metanalyses

INTRODUCTION: Motivational interventions have been tested in addition to pulmonary rehabilitation in order to increase and prolong the benefits obtained, however it is not well established. Therefore, the aim of this study was to investigate whether motivational interventions increase the benefits of pulmonary rehabilitation in physical and psychosocial outcomes in patients with chronic obstructive pulmonary disease (COPD). METHODS: A systematic review of studies comparing pulmonary rehabilitation "with" versus "without" motivational techniques for adults with COPD was registred on PROSPERO (CRD42020162921) and performed in PubMed, Embase, EBSCO, PEDro, LILACS, the Cochrane Central Register of Controlled Trials, and Google Scholar. The outcomes analyzed were PADL, sedentary behavior, psychosocial factors, exacerbation, dyspnea symptoms, and patient self-efficacy after the intervention and after the follow-up period. The methodological quality and certainty of evidence were evaluated by PEDro Scale and GRADE, respectively. The data were meta-analyzed for the pooled studies and motivational technique subgroups. RESULTS: Ten studies with a total of 832 patients with COPD were included. The motivational techniques in trials used were behavioral interventions with and without pedometer-based feedback, and pedometer-based feedback alone. Half of the studies have good methodological quality. With a low to very low certainty of evidence, the meta-analyses showed that the addition of motivational techniques to pulmonary rehabilitation does not increase physical and psychosocial outcomes on the short- or medium to long-term. CONCLUSIONS: Despite efforts to incorporate motivational strategies into pulmonary rehabilitation for individuals with COPD to prolong its benefits, current evidence does not support significant improvements in physical or psychosocial outcomes. Among the interventions evaluated separately, only behavioral strategies incorporating pedometer-based feedback demonstrated potential to increase daily step counts in the medium to long term. However, the certainty of the available evidence is still rated as low to very low.