{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T02:15:13Z","timestamp":1783304113443,"version":"3.54.6"},"reference-count":40,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2024,10,15]],"date-time":"2024-10-15T00:00:00Z","timestamp":1728950400000},"content-version":"unspecified","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,9,23]]},"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To test the measurement properties of the revised version of the English Cardiac Rehabilitation Barriers Scale (CRBS-R), suitable for hybrid delivery, structural validity, internal reliability, as well as face, cross-cultural, construct and criterion validity were assessed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Cross-sectional study, where participants completed an online survey via Qualtrics (2023\u20132024).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Multicentre, with cardiac rehabilitation (CR) programmes recruiting patients globally; most patients stemmed from a hybrid programme in Iran and supervised programme in Brazil.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>Participants include inpatients or outpatients with a cardiovascular diagnosis or procedure that is indicated for participation in CR.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Measures<\/jats:title>\n                  <jats:p>In addition to sociodemographic and CR use items, the 21-item CRBS-R was administered. It assesses multilevel barriers and was revised based on a literature review. Responses range from 1 to 5, with higher scores indicating greater barriers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>235 patients participated from all 6 WHO regions. Items were rated as highly applicable, and open-ended responses revealing no key barriers were omitted, supporting face and cross-cultural validity. Cronbach\u2019s \u03b1 for the total CRBS-R was 0.82. Principal components analysis resulted in the extraction of 4 components, which collectively accounted for 60.5% of the variance and were all internally consistent. Construct validity was supported by associations of total CRBS scores with work status (p=0.04), exercise history (p=0.01) and social support (p=0.03). Total CRBS-R scores were significantly lower in patients who were referred and enrolled versus those who were not (both p\u22640.01), confirming criterion validity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The CRBS-R is a reliable and valid scale comprising four subscales, applicable to hybrid CR across diverse settings. It can serve as a valuable tool to support identification of patient\u2019s CR barriers, to optimise secondary prevention utilisation globally.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-090261","type":"journal-article","created":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T00:50:35Z","timestamp":1729039835000},"page":"e090261","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Psychometric validation of the Cardiac Rehabilitation Barriers Scale Revised (CRBS-R) for hybrid delivery"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7063-3610","authenticated-orcid":false,"given":"Sherry L","family":"Grace","sequence":"first","affiliation":[{"name":"Faculty of Health, York University, Toronto, Ontario, Canada"},{"name":"KITE Research Institute, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahdieh","family":"Ghanbari","sequence":"additional","affiliation":[{"name":"Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayara Moura Alves da","family":"Cruz","sequence":"additional","affiliation":[{"name":"Adamantina University Center, Adamantina, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz Carlos Marques","family":"Vanderlei","sequence":"additional","affiliation":[{"name":"School of Technology and Sciences, S\u00e3o Paulo State University (UNESP), Presidente Prudente, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7946-3718","authenticated-orcid":false,"given":"Gabriela Lima de Melo","family":"Ghisi","sequence":"additional","affiliation":[{"name":"KITE Research Institute, University Health Network, Toronto, Ontario, Canada"},{"name":"Department pf Physical Therapy, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,10,15]]},"reference":[{"key":"2025101812500179000_14.10.e090261.1","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1016\/S0140-6736(24)00757-8","article-title":"Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990\u20132021: a systematic analysis for the Global Burden of Disease Study 2021","volume":"403","author":"Ferrari","year":"2024","journal-title":"The Lancet"},{"key":"2025101812500179000_14.10.e090261.2","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.pcad.2016.08.004","article-title":"Cardiac Rehabilitation Delivery Model for Low-Resource Settings: An International Council of Cardiovascular Prevention and Rehabilitation Consensus Statement","volume":"59","author":"Grace","year":"2016","journal-title":"Prog Cardiovasc Dis"},{"key":"2025101812500179000_14.10.e090261.3","article-title":"Exercise-based cardiac rehabilitation for coronary heart disease","volume":"11","author":"Dibben","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"2025101812500179000_14.10.e090261.4","doi-asserted-by":"crossref","unstructured":"McDonagh ST , Dalal H , Moore S , et al . 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