Efficacy of psychosocial interventions on psychological and physical health outcomes in chronic obstructive pulmonary disease: A systematic review and meta-analysis

Background: Psychosocial intervention has been suggested as a potentially effective supplement to medical treatment in chronic obstructive pulmonary disease (COPD), but no reviews so far have quantified the existing research in terms of both psychological and physical health outcomes. We therefore conducted a systematic review and meta-analysis of controlled trials evaluating the effects of psychosocial interventions on psychological and physical health outcomes in COPD. Methods: Two independent raters screened 1,491 references for eligibility. Twenty independent studies investigating a total of 1,361 patients were included, assessed for their methodological quality, and subjected to meta-analytic evaluation. Results: After adjusting for potential publication bias, a statistically significant overall effect was found for psychological (Hedges' g = 0.38, 95% confidence interval, CI = 0.19-0.58; p < 0.001) outcomes. When analyzing individual intervention types, cognitive behavioral therapy appeared to be effective (g = 0.39, CI = 0.15-0.62; p = 0.001) for improving psychological outcomes. In contrast, for physical outcomes, only mind-body interventions (e.g. mindfulness-based therapy, yoga, and relaxation) revealed a statistically significant effect (g = 0.40; CI = 0.01-0.79; p = 0.042). Conclusions: Taken together, the results lend support to psychosocial intervention as a tool in the management of COPD. However, due to indications of possible publication bias towards positive findings, the results should be interpreted with some caution, and more high quality research is needed.