Comparative efficacy of different digital health intervention modalities versus traditional pulmonary rehabilitation on daily step counts and exercise capacity in patients with COPD: a systematic review and network meta-analysis

Background and objectives: Digital health interventions (DHIs) provide essential technical support for home-based rehabilitation in patients with chronic obstructive pulmonary disease (COPD); however, the comparative efficacy of different technological modalities on objective exercise outcomes remains unclear. This study aimed to evaluate and rank the relative effectiveness of various digital intervention modalities in improving daily step counts and the 6-min walk distance (6MWD) in patients with COPD using a network meta-analysis. Methods: A systematic search was conducted in PubMed, Web of Science, and Embase databases for randomized controlled trials (RCTs) published from inception to October 28, 2025. Intervention modalities were categorized into: Composite Digital Interventions (App + Sensor), Wearables Only, Synchronous Tele-rehabilitation (Tele-rehab), Center-based Pulmonary Rehabilitation (Center-based PR), and Usual Care. A network meta-analysis was performed using a random-effects model. The Surface Under the Cumulative Ranking curve (SUCRA) was utilized for probabilistic ranking, and the GRADE framework was employed to assess the certainty of evidence. Results: = 0.0001). In terms of improving the 6MWD, the Wearables Only group showed the optimal ranking probability (SUCRA = 90.3%) with marginal statistical significance (SMD = 0.33, 95% CI: 0.00-0.66). Nevertheless, sensitivity analysis indicated that this conclusion was significantly influenced by individual large-sample studies. GRADE assessment indicated that the certainty of evidence for primary outcomes was "low." No significant publication bias was detected. Conclusion: Based on preliminary observations from existing evidence, digital health interventions hold potential value in improving exercise outcomes in patients with COPD. However, due to the low certainty of evidence and the presence of network inconsistency, the current SUCRA ranking results should be interpreted as exploratory and hypothesis-generating rather than a definitive hierarchy of superiority. Digital health interventions should not be viewed as a full replacement for traditional rehabilitation but rather positioned as a complementary strategy particularly for patient populations in resource-limited settings or those lacking access to center-based services to extend the coverage of pulmonary rehabilitation. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251271868, CRD420251271868.