Effect of Pulmonary Rehabilitation on Symptoms of Anxiety and Depression in COPD A Systematic Review and Meta-Analysis

BACKGROUND: Pulmonary rehabilitation (PR) improves exercise capacity and quality of life in people with COPD; however, its effect on anxiety and depression symptoms is less clear. Existing data are difficult to apply to clinical PR because of diverse interventions and comparators. This review evaluated the effectiveness of PR on anxiety and depression symptoms in people with COPD. METHODS: A systematic review and meta-analysis (PROSPERO CRD42018094172) was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on randomized controlled trials comparing PR (>= 4 weeks' duration) with usual care. Four electronic databases were searched to February 2018 using terms related to COPD, PR, anxiety, and depression. Data were extracted by two assessors using standardized templates. Study quality was appraised via the PEDro scale, and evidence was rated according to the Grading of Recommendations Assessment, Development and Evaluation. Data were analyzed in RevMan 5.3, with pooled effect estimates reported as standardized mean differences (SMDs). The effect of the program duration (<= 8 vs > 8 weeks) was explored via subgroup analysis. RESULTS: Eleven studies comprising 734 participants (median PEDro score, 4/10) were included. Compared with usual care, PR conferred significant benefits of a moderate magnitude for anxiety symptoms (SMD, -0.53; 95% CI, -0.82 to -0.23) and large magnitude for depression symptoms (SMD, -0.70; 95% CI, -0.87 to -0.53). The certainty of evidence for each outcome was moderate. Effects were not moderated by program duration. CONCLUSIONS: PR confers significant, clinically relevant benefits on anxiety and depression symptoms. Because further studies involving no treatment control groups are not indicated, these robust estimates of treatment effects are likely to endure.