The Cardiac Rehabilitation Barriers Scale (CRBS)
Cardiac rehabilitation (CR) programs offer a multidisciplinary approach to secondary prevention of heart disease. According to the Cardiac Care Network of Ontario Consensus Panel, CR “consists of integrated and multifactorial interventions which are intended to enhance and maintain the physical, psychosocial, and vocational status of individuals with established heart disease or at high risk for the development of cardiac disease.” The multidisciplinary CR team generally offers exercise training, education, and counselling for both client and family regarding risk factors, lifestyle modifications, and coping with the disease, through an outpatient program of an average six-month duration.
CR effectively reduces cardiac risk, significantly decreases recurrence of cardiac events, and decreases death by 25%. Despite these well-established benefits of CR, it is greatly underutilized. The Cardiac Rehabilitation Barriers Scale (CRBS) was developed to systematically and comprehensively assess the patient, provider, and system-level barriers to CR enrollment and participation.
The 21 items of the CRBS are rated on a 5-point Likert-type scale that ranges from 1=strongly disagree to 5=strongly agree. Regardless of CR referral or enrollment, participants are asked to rate their level of agreement with the statements. A sample patient-level item is “I find exercise tiring or painful;” a sample provider-level item is “My doctor did not feel it was necessary;” and a sample health system-level item is “I think I was referred, but the rehab program didn’t contact me.” Higher scores indicate greater barriers to patient enrollment or participation in a CR program.
The CRBS might be provided to patients for completion as in-patients, or as outpatients during specialist or primary care appointments. It may even be used at a CR intake appointment to identify any barriers to full program participation. While the CRBS has been developed for research purposes, future research is needed to investigate whether it would also be useful clinically to addressing barriers.