Validity and Reliability of the Cardiac Rehabilitation Barriers Scale in the Czech Republic (CRBS-CZE): Determination of Key Barriers in East-Central Europe

Abstract

Cardiovascular rehabilitation (CR) is an effective secondary preventive model of care. However, the use of CR is insufficient, and the reasons for this are not well-characterized in East-Central Europe. This prospective observational study psychometrically validated the recently translated Cardiac Rehabilitation Barriers Scale for the Czech language (CRBS-CZE) and identified the main CR barriers. Consecutive cardiac in/out-patients were approached from January 2020 for 18 months, of whom 186 (89.9%) consented. In addition to sociodemographic characteristics, participants completed the 21-item CRBS-CZE (response options 1–5, with higher scores representing greater barriers), and their CR utilization was tracked. Forty-five (24.2%) participants enrolled in CR, of whom 42 completed the CRBS a second time thereafter. Factor analysis revealed four factors, consistent with other CRBS translations. Internal reliability was acceptable for all but one factor (Cronbach’s alpha range = 0.44–0.77). Mean total barrier scores were significantly higher in non-enrollers (p < 0.001), decreased from first and second administration in these enrollers (p < 0.001), and were lower in CR completers (p < 0.001), supporting criterion validity. There were also significant differences in barrier scores by education, geography, tobacco use, among other variables, further supporting validity. The biggest barriers to enrolment were distance, work responsibilities, lack of time, transportation problems, and comorbidities; and the greatest barriers to adherence were distance and travel. Several items were considered irrelevant at first and second administration. Other barriers included wearing a mask during the COVID-19 pandemic. The study demonstrated sufficient validity and reliability of CRBS-CZE, which supports its use in future research.

Are behaviour change techniques and intervention features associated with effectiveness of digital cardiac rehabilitation programmes? A systematic review protocol

“…We strongly agree to the authors’ assertion that the several barriers related to the underutilization of the traditional center-based CR programs can be addressed by the implementation of digital health interventions (DHIs) (Winnige et al (2021 2 )) Indeed, a recent critical review of ours has proclaimed the potential effective role of telehealth interventions as alternative sufficient methods of delivering CR during over demanding socioeconomic conditions, such is the ongoing COVID-19 pandemic (Stefanakis et al (2021 3 ), Pepera et al (2022 5 ))…”

Effectiveness of Home-Based Cardiac Rehabilitation, Using Wearable Sensors, as a Multicomponent, Cutting-Edge Intervention: A Systematic Review and Meta-Analysis

“…Despite the well-documented benefits of CR implementation in the cardiovascular population, attendance rates remain low and suboptimal [10,11]. Accessibility-related factors, including limited availability of programs, unwillingness to participate in group programs, inconvenient timing of programs, career responsibilities, transportation and parking costs, lack of time, and disbelief in their ability to control their CHD, are prominent barriers to CR enrollment and adherence [12][13][14]. Moreover, during the COVID-19 pandemic era, safe distancing measures were adopted to curb the spreading of the virus, thus leading to the temporary cessation of many CR programs, the discontinuation of CR provision, and thus the further deterioration of CVD patients' cardiovascular function [15][16][17].…”

Prognostic Utility of a New Risk Stratification Protocol for Secondary Prevention in Patients Attending Cardiac Rehabilitation

“…There are several reasons for this underuse. Patients identify distance, work responsibilities, lack of time, transportation problems, and comorbidities as the most significant barriers to enrolment [ 7 ]. Another limitation is logistics, as supervised exercise by physiotherapists, rehabilitation physicians, and cardiologists might not be available in all healthcare settings.…”