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.
Adriana C Lunardi, Cibele C Marques DA Silva, Caroline M Censo and 3 others
Adding motivational tools such as pedometers and behavioral plans to pulmonary rehabilitation did not improve daily steps, sedentary time, anxiety, depression, or quality of life in COPD patients.
One combination raised steps slightly, but the authors say this fell short of a clinically meaningful amount.
Key findings
1Across seven trials (644 patients), PR plus a motivational intervention was not superior to PR alone for increasing daily steps (MD = 819 steps/day, 95% CI: -33 to 1670), with very low certainty of evidence.
2The only motivational method that increased daily steps was a personalized behavioral plan combined with pedometer feedback (MD = 1286 steps/day, 95% CI: 164 to 2409). This effect persisted at follow-up in three trials (MD = 790 steps/day, 95% CI: 76 to 1503) but the studies disagreed strongly with each other (I² = 95%).
3No motivational intervention added to PR improved walking distance, moderate-to-vigorous activity, sedentary time, anxiety, depression, quality of life, breathlessness, or self-efficacy in the short or medium-to-long term.
Still to come
How it was doneWhat they foundWhat it means for PTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
All 10 included trials had methodological weaknesses; five scored 3 to 5 on the PEDro quality scale (out of 10). Two trials did not randomize participants, and seven did not report how allocation was concealed. Only three trials reported outcomes for more than 85% of their original participants, and six did not follow intention-to-treat analysis. The one positive subgroup (behavioral plan plus pedometer) had 95% heterogeneity, meaning the trials in that group disagreed strongly with each other. Publication bias could not be checked because fewer than 10 trials contributed to any single outcome. The behavioral interventions varied widely in duration, content, and who delivered them, making it hard to say what exactly would work. Pedometers do not capture upper-limb or other non-walking activity, so they may underestimate total activity. Only COPD patients were included; the findings cannot be extended to asthma, bronchiectasis, or interstitial lung disease. Three analysis decisions (adding a self-efficacy outcome, adding a follow-up analysis, and adding a subgroup analysis) were made after reading the full texts rather than before, which the authors acknowledge as protocol deviations.
Declared interests
No conflicts of interest were declared. The work was funded by two Brazilian government research bodies: the National Council for Scientific and Technological Development (CNPq, grant 406481/2023-7) and the São Paulo Research Foundation (FAPESP, grant 2018/017788-3).
The easy way to misread this
Do not read the 1286-step increase from the behavioral-plan-plus-pedometer subgroup as proof that this combination works. The overall primary outcome was null, the authors state the difference did not reach a clinically meaningful threshold, the subgroup showed 95% heterogeneity, and the certainty of evidence is very low.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →