CRBS Development

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 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’.

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. First, a 19-item version of the scale was administered to 272 cardiac inpatients from two hospitals (Grace et al. 2004). In the former study, participants were also asked to list additional CR barriers in open-ended fashion. Based on these responses, some CRBS items were revised and two added. In the second cohort, investigators administered the scale to 1497 cardiac outpatients of 97 cardiologists (Grace et al., 2009) to initiate psychometric validation.

A revised version of the scale, applicable to hybrid CR and updated based on a 2022 review of the CRBS literature (see International Handbook of Behavioral Health Assessment, Springer), is under psychometric validation. The English CRBS-R is available here.