For full details, please see: Stewart, C., Ghisi, G.L.M, Davis, E. & Grace, S.L. (2023). Cardiac Rehabilitation Barriers Scale (CRBS). (2023). In Krageloh, C.U., Alyami, M., & Medvedev, O.N. (Eds.) International Handbook of Behavioral Health Assessment. Springer, Cham. https://doi.org/10.1007/978-3-030-89738-3_39-1. https://link.springer.com/referencework/10.1007/978-3-030-89738-3
Grace et al. developed the CRBS to assess patient’s perceptions of patient, provider and health system-level barriers to phase II CR utilization (i.e., post-acute care discharge) (Shanmugasegaram et al. 2012). A sample patient-level item is ‘I find exercise tiring or painful’; a sample provider-level item is ‘My doctor or other healthcare provider did not feel it was necessary or encourage me’; and a sample healthcare system-level item is ‘It took too long to get in to the program’.
The scale can be administered to patients who have not yet enrolled (or even been referred) as well as patients who have enrolled but not yet completed their CR program, such that it assesses enrolment as well as adherence barriers; mean scores are lower in enrolled samples.
The scale was developed following an extensive review of the literature, with feedback from cardiologists and CR staff to establish content and face validity (Shanmugasegaram et al. 2012). It was then administered in two cohorts for validation. The CRBS has since been administered in over 50 studies in over 30 countries.
A revised version of the scale (CRBS-R), applicable to hybrid CR and updated based on the above review of the CRBS literature, has been psychometrically validated in 2024 (see https://sgrace.info.yorku.ca/cr-barriers-scale/crbs-instructions-and-languages-translations/; https://bmjopen.bmj.com/content/14/10/e090261.full). It is comprised of four subscales, namely: lack of perceived need, unmet CR preferences, work/family/time conflicts and logistical factors (eg., distance, cost and including clinical [eg., comorbidities] and healthcare system issues such as lack of referral); note some translations with cultural adaptation comprise 5 subscales.
In the chapter cited above, the measurement properties of each language version of the CRBS is provided, included structure, internal reliability, and many forms of validity (face, cross-cultural, construct, criterion). Because barriers can change over time, test-retest is not applicable (i.e., the CRBS is sensitive to change / responsive). Contact sgrace@yorku.ca for access if needed.
