Introduction
Cardiovascular diseases remain a leading cause of global morbidity and mortality. Consequently, implementing effective secondary prevention strategies is critical for improving long-term patient outcomes. While cardiac rehabilitation (CR) improves outcomes for patients with cardiovascular disease, yet participation rates remain low. Consequently, tools like the Cardiac Rehabilitation Barriers Scale (CRBS) have become essential. Developed in 2012, the CRBS has garnered over 160 citations. Researchers and clinicians use it extensively to understand and address barriers to enrollment and adherence.
Therefore, this article presents the CRBS’s structure, psychometric properties, applications, and practical considerations for scientific research and clinical practice.
Key Features of the Cardiac Rehabilitation Barriers Scale (CRBS)
Purpose and Use
The primary purpose of the CRBS is to identify barriers that prevent patients from enrolling in or adhering to cardiac rehabilitation programs. Moreover, it evaluates system-level barriers, practical barriers, health-related limitations, psychological, and motivational factors. Therefore, it supports targeted interventions to improve CR uptake.
Target Population
The CRBS is optimized for adult populations aged 18 years and older. Specifically, it is designed for and validated across the following groups:
- Young Adults (18-24 years)
- Middle-Aged Adults (25-44 years)
- Older Adults (45-64 years)
- Older People (65+ years)
Ultimately, its primary clinical target consists of patients diagnosed with various cardiovascular diseases who are eligible for rehabilitative care.
Structure
The questionnaire consists of 21 items that comprehensively evaluate system-level barriers, practical barriers, health-related limitations, and psychological or motivational factors. These items are categorized into four distinct subscales within the cardiology domain:
- Perceived Need/Healthcare Factors: Evaluates how a patient perceives the necessity of rehabilitation and their interactions with healthcare systems.
- Logistical Factors: Assesses practical challenges such as travel, distance, and transportation.
- Work/Time Conflicts: Measures scheduling conflicts related to professional or personal commitments.
- Comorbidities/Functional Status: Explores physical limitations and concurrent health conditions that hinder participation.
Scoring Method
The CRBS is scored using a five-point Likert-type scale, typically ranging from
- 1 (strongly disagree)
- 5 (strongly agree)
Higher scores consistently indicate greater perceived barriers to cardiac rehabilitation participation.
However, to interpret the data, researchers can calculate a total mean score across all 21 items, or they can calculate individual mean scores within each specific subdomain. Notably, there are no established cut-off scores for this instrument; therefore, results are interpreted dimensionally to highlight the most prominent obstacles.
Administration Format
Because the scale requires no specialized training or certification, it can be easily self-administered by the patient. Furthermore, healthcare teams enjoy great flexibility as the tool can be administered via several formats:
- Paper-based formats
- Digital (Online) platforms
- In-person interviews
- Phone or video calls
Completing the CRBS typically takes between 5 to 10 minutes, making it highly feasible for busy clinical environments.
Applications of the Cardiac Rehabilitation Barriers Scale (CRBS)
Researchers and clinicians apply the CRBS in multiple ways:
- Screening: Healthcare teams utilize the tool to identify patients at risk of non-participation early in their recovery pathway.
- Monitoring: Clinicians can consistently track changes in perceived barriers over time, allowing them to adapt care as a patient’s personal or medical situation evolves.
- Research: Investigators widely use the scale as a standardized outcome measure in empirical studies focused on improving CR access and adherence.
Consequently, the CRBS informs treatment planning and health system improvements, ultimately allowing providers to systematically dismantle healthcare delivery barriers and boost program enrollment.
Languages and availability
The CRBS is available in several languages, including:
- English
- Arabic
- Mandarin Chinese
- Spanish
- Portuguese
- Hindi
This multilingual support facilitates international research and culturally sensitive clinical use.
Reliability and Validity
The CRBS is a moderately reliable and valid measurement instrument. It demonstrates strong internal consistency, supported by a documented Cronbach’s alpha of 0.83. Statistical validation studies across multiple global populations confirm its psychometric soundness, ensuring that the tool accurately captures genuine barriers to care.
Limitations and Considerations
Despite its strengths, the CRBS has a few limitations:
- Self-report measure: Respondents may be influenced by social desirability bias or personal interpretation.
- Cultural Bias: Potential for cultural bias exists, which may affect the interpretation of responses across diverse populations.
- Age Restrictions: The instrument is explicitly designed for adults and is not suitable for pediatric or adolescent age groups.
- Social Desirability Bias: Because the instrument relies entirely on self-reporting, patients might alter their answers to present themselves in a more favorable light to their healthcare providers.
Other Versions And Related Questionnaires
Researchers often combine the CRBS with complementary tools such as:
- Coronary Artery Disease Education Questionnaire – Second Version (CADE-Q II)
- Coronary Artery Disease Education Questionnaire Short Version (CADE-Q SV)
- Self-Care of Coronary Heart Disease Inventory (SC-CHDI)
- Heart Disease Fact Questionnaire (HDFQ)
Additionally, there are no other alternative versions or shorter adaptations of the CRBS questionnaire recorded.
Additional Resources
- The Original Validation Study link
- You can access the questionnaire as a PDF here: Link
- For inquiries, contact Sherry L. Grace at sgrace@yorku.ca
Frequently Asked Questions (FAQ)
- Who can use the CRBS?
Clinicians, researchers, and healthcare providers use the CRBS for adult patients (aged 18 and older) with cardiovascular diseases. - How long does it take to complete the CRBS?
Patients typically take 5 to 10 minutes to complete the CRBS, making it practical for busy clinical and research environments. - How is the CRBS administered?
Healthcare teams can administer the questionnaire via paper-based, digital, interview, or phone/video formats—offering excellent flexibility. - Is there any cost to using the CRBS?
The CRBS is free for non-commercial research and clinical use.
A Word From ResRef about the Cardiac Rehabilitation Barriers Scale (CRBS)
The CRBS is a 21-item validated questionnaire used to assess barriers to cardiac rehabilitation participation. It captures system, logistical, health-related, and psychosocial factors, making it a valuable tool for improving access and adherence to rehabilitation programs.
References
- Shanmugasegaram, S., Gagliese, L., Oh, P., Stewart, D. E., Brister, S. J., Chan, V., & Grace, S. L.. (2011). Psychometric validation of the cardiac rehabilitation barriers scale. Clinical Rehabilitation, 26(2), 152-164. Link
- Aljehani, R., Grace, S. L., Aburub, A., Turk-Adawi, K., & Ghisi, G. L. D. M.. (2023). Translation, cross-cultural adaptation and psychometric validation of the arabic version of the cardiac rehabilitation barriers scale (crbs-a) with strategies to mitigate barriers. Healthcare, 11(8), 1196. Link
- Liu, X., Fowokan, A., Grace, S. L., Ding, B., Meng, S., Chen, X., Xia, Y., & Zhang, Y.. (2021). Translation, cross-cultural adaptation, and psychometric validation of the chinese/mandarin cardiac rehabilitation barriers scale (crbs-c/m). Rehabilitation Research And Practice, 2021, 1-14. Link
- Jácome Hortúa, A. M., Angarita-Fonseca, A., Villamizar Jaimes, C. J., Martínez Marín, R. D. P., Dutra de Souza, H. C., de Paula Facioli, T., & Sánchez-Delgado, J. C.. (2021). Reliability of the scale of barriers for cardiac rehabilitation in the colombian population. International Journal Of Environmental Research And Public Health, 18(8), 4351. Link
- Ghisi, G. L. D. M., Santos, R. Z. D., Schveitzer, V., Barros, A. L., Recchia, T. L., Oh, P., Benetti, M., & Grace, S. L.. (2012). Desenvolvimento e validação da versão em português da escala de barreiras para reabilitação cardíaca. Arquivos Brasileiros De Cardiologia, 98(4), 344-352. Link
- Winnige, P., Filakova, K., Hnatiak, J., Dosbaba, F., Bocek, O., Pepera, G., Papathanasiou, J., Batalik, L., & Grace, S. L.. (2021). Validity and reliability of the cardiac rehabilitation barriers scale in the czech republic (crbs-cze): determination of key barriers in east-central europe. International Journal Of Environmental Research And Public Health, 18(24), 13113. Link
