Effectiveness of nursing care intervention on the management of patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background. Chronic obstructive pulmonary disease (COPD) contributes considerably to morbidity and mortality worldwide, necessitating innovative interventions to enhance patient outcomes. Objectives. The present synthesis aimed to discern the impact of nursing interventions on physical, mental and social health outcomes among COPD patients, focusing on 6-minute walk distance (6MWD), self-efficacy, anxiety, depression, dyspnea, hospitalization, St. George’s Respiratory Questionnaire score, patient satisfaction, and all-cause mortality. Materials and methods. This review was conducted to include randomized controlled trials exploring nursing interventions for COPD patients without demographic restriction and sourced from several databases (MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and OpenGrey) until September 2023. Quality assessments were done using the Cochrane Risk of Bias 2 (RoB 2) tool, followed by meta-analysis using a random-effects model with continuous outcomes interpreted as standardized mean difference (SMD) and categorical outcomes as risk ratio (RR). Results. Thirty-six studies were incorporated, revealing nursing interventions to notably enhance 6MWD (SMD: 0.628, p = 0.001) and self-efficacy (SMD: 0.800, p < 0.001), and significantly decrease anxiety (SMD: –0.952, p = 0.015) and depression levels (SMD: –0.952, p = 0.006). However, the effects of hospitalization, quality of life (QoL) and dyspnea did not reach statistical significance. Notably, high heterogeneity was observed in several outcomes. Conclusions. Nursing interventions yielded significant improvements for 6MWD, self-efficacy, anxiety, and depression among COPD patients. However, their impact on hospitalization and QoL remains indeterminate, necessitating further nuanced research to optimize and tailor nursing care strategies for this demographic. Enhanced intervention standardization and larger, multicenter trials are warranted to confirm and expand these findings.