Objective:The purpose of this study was to investigate the factor structure and psychometric properties of the Cardiac Rehabilitation Barriers Scale (CRBS).Design, setting, and participants:In total, 2636 cardiac inpatients from 11 hospitals completed a survey. One year later, participants completed a follow-up survey, which included the CRBS. A subsample of patients also completed a third survey which included the CRBS, the Cardiac Rehabilitation Enrolment Obstacles scale, and the Beliefs About Cardiac Rehabilitation scale three weeks later. The CRBS asked participants to rate 21 cardiac rehabilitation barriers on a five-point Likert scale regardless of cardiac rehabilitation referral or enrolment.Results:Maximum likelihood factor analysis with oblique rotation resulted in a four-factor solution: perceived need/healthcare factors (eigenvalue = 6.13, Cronbach’s α = .89), logistical factors (eigenvalue = 5.83, Cronbach’s α = .88), work/time conflicts (eigenvalue = 3.78, Cronbach’s α = .71), and comorbidities/functional status (eigenvalue = 4.85, Cronbach’s α = .83). Mean total perceived barriers were significantly greater among non-enrollees than cardiac rehabilitation enrollees (P < .001). Convergent validity with the Beliefs About Cardiac Rehabilitation and Cardiac Rehabilitation Enrolment Obstacles scales was also demonstrated. Test-retest reliability of the CRBS was acceptable (intraclass correlation coefficient = .64).Conclusion:The CRBS consists of four subscales and has sound psychometric properties. The extent to which identified barriers can be addressed to facilitate greater cardiac rehabilitation utilization warrants future study.

Given that the benefits of CR are achieved in older patients as well as the young, interventions to overcome these modifiable barriers to enrollment and participation are needed.

IntroductionDespite greater need, rural inhabitants and individuals of low socioeconomic status (SES) are less likely to undertake cardiac rehabilitation (CR). This study examined barriers to enrollment and participation in CR among these under-represented groups.MethodCardiac inpatients from 11 hospitals across Ontario were approached to participate in a larger study. Rurality was assessed by asking participants whether they lived within a 30-minute drive-time from the nearest hospital, with those >30 minutes considered “rural.” Participants completed a sociodemographic survey, which included the MacArthur Scale of Subjective Social Status. One year later, they were mailed a survey which assessed CR utilization and included the Cardiac Rehabilitation Barriers Scale. In this cross-sectional study, CR utilization and barriers were compared by rurality and SES.ResultsOf the 1809 (80.4%) retained, there were 215 (11.9%) rural participants, and the mean subjective SES was 6.37 ± 1.76. The mean CRBS score was 2.03 ± 0.73. Rural inhabitants reported attending significantly fewer CR sessions (p < .05), and greater CR barriers overall compared to urban inhabitants (p < .01). Patients of lower subjective SES were significantly less likely to be referred, enroll, and participate in CR, and reported significantly greater barriers to CR compared to their high SES counterparts (p < .01). Prominent barriers for both groups included distance, cost, and transportation problems. These relationships sustained adjustment, and a significant relationship between having undergone coronary artery bypass graft surgery and lower barriers was also identified.ConclusionsThe results confirm that rural inhabitants and patients of low SES experience greater barriers to CR utilization when compared to their urban, high SES counterparts. It is time to implement known strategies to overcome these barriers, to achieve equitable and greater use of CR.

Consistent with the general population, the prevalence of major depression is two-times greater in women than men with CAD. Women with CAD may warrant greater emphasis in efforts to identify and treat depression.

STRUCTURED ABSTRACTPurpose-Despite the established benefits of cardiac rehabilitation (CR), it remains significantly underutilized. It is unknown whether patient barriers to enrollment and adherence are addressed by offering choice of program type. The purpose of this study was to examine barriers to participation in CR by program type (site vs. home-based), and the relation of these barriers to degree of program participation and exercise behavior.Method-1809 cardiac patients from 11 hospitals across Ontario completed a sociodemographic survey in-hospital, and clinical data were extracted from charts. They were mailed a follow-up survey one year later, which included the Cardiac Rehabilitation Barriers Scale and the Physical Activity Scale for the Elderly. Participants were also asked whether they attended CR, the type of program model attended, and the percentage of prescribed sessions completed.Results-Overall, 939 (51.9%) patients participated in CR, with 96 (10.2%) participating in a home-based program. Home-based participants reported significantly greater CR barriers compared to site-based participants (p<0.001), including distance. Mean barrier scores were significantly and negatively related to session completion and physical activity among site-based (ps<0.05), but not home-based CR participants (p>0.05). To address many of the CR barriers such as lack of transportation access and distance to program facilities, home-based CR programs have been developed. Home-based CR programs offer the same core CR components as site-based programs, 5,6 but communication occurs through telephone or internet contact, education occurs through provision of written materials, and exercise is undertaken in the patient's community environment. Home-based and site-based programs do not differ in terms of mortality rates, cardiac events, exercise capacity, smoking cessation, or health-related quality of life. 7 Conclusion-ThePatients reporting greater barriers to CR use are significantly less likely to enrol, and are more likely to dropout, ultimately not achieving the health benefits of CR. 8 Yet, many patient barriers to CR could be addressed by appropriate allocation to site or home-based programs, although this has yet to be investigated. Thus, the objectives of this study were to:(1) describe and compare barriers to participation, and (2) investigate whether these barriers are related to (a) program adherence (percentage of site or phone CR sessions attended) and (b) exercise behavior, among patients participating in site versus home-based CR programs. METHOD Design and ProcedureThis is a secondary analysis of a larger study 9 for which cardiac in-patients from 11 hospitals in Ontario were recruited. CR services were provided through provincial healthcare at no cost to patients (although patients pay for transportation and/or parking at each visit). Ethics approval was granted from all participating institutions. After obtaining consent, clinical data were extracted from medical charts, and a self-report survey was prov...

BackgroundIn 2018, the World Health Organization reported that depression is the most common cause of disability worldwide, with over 300 million people currently living with depression. Depression affects an individual’s physical health and well-being, impacts psychosocial functioning, and has specific negative short- and long-term effects on maternal health, child health, developmental trajectories, and family health. The aim of these reviews is to identify evidence on the benefits and harms of screening for depression in the general adult population and in pregnant and postpartum women.MethodsSearch strategies were developed and tested through an iterative process by an experienced medical information specialist in consultation with the review team. We will search MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library, and a randomized controlled trial filter will be used. The general adult review will be an update of a systematic review previously used by the Canadian Task Force on Preventive Health Care for their 2013 guideline recommendation. The search strategy will be updated and will start from the last search date of the previous review (May 2012). The pregnant and postpartum review will be a de novo review with no date restriction. For both reviews, we will search for unpublished documents following the CADTH Grey Matters checklist and relevant websites. Titles and abstracts will be screened using the liberal accelerated method. Two reviewers will independently screen full-text articles for relevance using pre-specified eligibility criteria and assess the risk of bias of included studies using the Cochrane Risk of Bias tool. Outcomes of interest for the general adult population review include symptoms of depression or diagnosis of major depressive disorder, health-related quality of life, day-to-day functionality, lost time at work/school, impact on lifestyle behaviour, suicidality, false-positive result, labelling/stigma, overdiagnosis or overtreatment, and harms of treatment. Outcomes of interest for the pregnant and postpartum review include mental health outcomes (e.g. diagnosis of major depressive disorder), parenting outcomes (e.g. mother-child interactions), and infant outcomes (e.g. infant health and development).DiscussionThese two systematic reviews will offer informative evaluations of depression screening. The findings will be used by the Task Force to help develop guideline recommendations on depression screening in the general adult population and in pregnant and postpartum women in Canada.Systematic review registrationPROSPERO (CRD42018099690)Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0930-3) contains supplementary material, which is available to authorized users.

Given the proven benefits of CR, all healthcare providers are recommended to universally and strongly encourage CR participation among their patients in order to optimize utilization and subsequent recovery.

Introduction: Physical activity/exercise is regarded as an important self-management strategy for individuals with mental illness. The purpose of this study was to describe individuals with mood and/or anxiety disorders who were exercising or engaging in physical activity to help manage their disorders versus those who were not, and the facilitators for and barriers to engaging in physical activity/exercise.