{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T17:28:36Z","timestamp":1774978116471,"version":"3.50.1"},"reference-count":48,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2021,12,12]],"date-time":"2021-12-12T00:00:00Z","timestamp":1639267200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010653","name":"Masaryk University","doi-asserted-by":"publisher","award":["project MUNI\/A\/1608\/2020"],"award-info":[{"award-number":["project MUNI\/A\/1608\/2020"]}],"id":[{"id":"10.13039\/501100010653","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Ministry of Health, Czech Republic","award":["conceptual development of research organization (65269705), grant number NIG0219"],"award-info":[{"award-number":["conceptual development of research organization (65269705), grant number NIG0219"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Cardiovascular rehabilitation (CR) is an effective secondary preventive model of care. However, the use of CR is insufficient, and the reasons for this are not well-characterized in East-Central Europe. This prospective observational study psychometrically validated the recently translated Cardiac Rehabilitation Barriers Scale for the Czech language (CRBS-CZE) and identified the main CR barriers. Consecutive cardiac in\/out-patients were approached from January 2020 for 18 months, of whom 186 (89.9%) consented. In addition to sociodemographic characteristics, participants completed the 21-item CRBS-CZE (response options 1\u20135, with higher scores representing greater barriers), and their CR utilization was tracked. Forty-five (24.2%) participants enrolled in CR, of whom 42 completed the CRBS a second time thereafter. Factor analysis revealed four factors, consistent with other CRBS translations. Internal reliability was acceptable for all but one factor (Cronbach\u2019s alpha range = 0.44\u20130.77). Mean total barrier scores were significantly higher in non-enrollers (p &lt; 0.001), decreased from first and second administration in these enrollers (p &lt; 0.001), and were lower in CR completers (p &lt; 0.001), supporting criterion validity. There were also significant differences in barrier scores by education, geography, tobacco use, among other variables, further supporting validity. The biggest barriers to enrolment were distance, work responsibilities, lack of time, transportation problems, and comorbidities; and the greatest barriers to adherence were distance and travel. Several items were considered irrelevant at first and second administration. Other barriers included wearing a mask during the COVID-19 pandemic. The study demonstrated sufficient validity and reliability of CRBS-CZE, which supports its use in future research.<\/jats:p>","DOI":"10.3390\/ijerph182413113","type":"journal-article","created":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T01:28:11Z","timestamp":1639358891000},"page":"13113","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Validity and Reliability of the Cardiac Rehabilitation Barriers Scale in the Czech Republic (CRBS-CZE): Determination of Key Barriers in East-Central Europe"],"prefix":"10.3390","volume":"18","author":[{"given":"Petr","family":"Winnige","sequence":"first","affiliation":[{"name":"Department of Public Health, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic"},{"name":"Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katerina","family":"Filakova","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jakub","family":"Hnatiak","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic"},{"name":"Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filip","family":"Dosbaba","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Otakar","family":"Bocek","sequence":"additional","affiliation":[{"name":"Department of Internal Cardiology Medicine, University Hospital Brno, 62500 Brno, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8012-0325","authenticated-orcid":false,"given":"Garyfallia","family":"Pepera","sequence":"additional","affiliation":[{"name":"Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, 35100 Lamia, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2557-5508","authenticated-orcid":false,"given":"Jannis","family":"Papathanasiou","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Allergology & Physiotherapy, Faculty of Dental Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria"},{"name":"Department of Kinesitherapy, Faculty of Public Health, Medical University of Sofia, 1431 Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2147-1541","authenticated-orcid":false,"given":"Ladislav","family":"Batalik","sequence":"additional","affiliation":[{"name":"Department of Public Health, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic"},{"name":"Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7063-3610","authenticated-orcid":false,"given":"Sherry L.","family":"Grace","sequence":"additional","affiliation":[{"name":"Faculty of Health, York University & KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON M3J 1P3, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,12]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2021, January 30). Noncommunicable Diseases Country Profiles. Available online: https:\/\/www.who.int\/nmh\/publications\/ncd-profiles-2018\/en\/."},{"key":"ref_2","unstructured":"\u00dastav Zdravotnick\u00fdch Informac\u00ed a Statistiky \u010cR (2021, January 30). Zdravotnick\u00e1 Ro\u010denka \u010cesk\u00e9 Republiky. Available online: https:\/\/www.uzis.cz\/res\/f\/008280\/zdrroccz-2018.pdf."},{"key":"ref_3","unstructured":"\u010cesk\u00fd Statistick\u00fd \u00da\u0159ad (2021, January 30). V\u00fdsledky Zdravotnick\u00fdch \u00da\u010dt\u016f \u010cR 2010\u20132018. Available online: https:\/\/www.czso.cz\/documents\/10180\/122362658\/26000520.pdf\/ce8cd21a-9317-4b04-8e5d-441be5ea0c8b?version=1.1."},{"key":"ref_4","unstructured":"World Health Organization (2021, January 30). Cardiovascular Diseases. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cardiovascular-diseases-(cvds)."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jacc.2015.10.044","article-title":"Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease Cochrane Systematic Review and Meta-Analysis","volume":"67","author":"Anderson","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1136\/heartjnl-2012-303055","article-title":"Cardiorespiratory fitness changes in patients receiving comprehensive outpatient cardiac rehabilitation in the UK: A multicentre study","volume":"99","author":"Sandercock","year":"2013","journal-title":"Heart"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"5015","DOI":"10.12659\/MSM.917362","article-title":"Effects of Exercise-Based Cardiac Rehabilitation in Patients with Acute Coronary Syndrome: A Meta-Analysis","volume":"25","author":"Ji","year":"2019","journal-title":"Med. Sci. Monit."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Babu, A.S., Lopez-Jimenez, F., Thomas, R.J., Isaranuwatchai, W., Herdy, A.H., Hoch, J.S., and Grace, S.L. (2016). Advocacy for Outpatient Cardiac Rehabilitation Globally. BMC Health Serv. Res., 16.","DOI":"10.1186\/s12913-016-1658-1"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1177\/1741826711409326","article-title":"Participating in Cardiac Rehabilitation: A Systematic Review and Meta-synthesis of Qualitative Data","volume":"19","author":"Neubeck","year":"2012","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/j.ahj.2012.08.020","article-title":"A Qualitative Systematic Review of Influences on Attendance at Cardiac Rehabilitation Programs After Referral","volume":"164","author":"Clark","year":"2012","journal-title":"Am. Heart J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.gheart.2016.09.004","article-title":"Availability, Use, and Barriers to Cardiac Rehabilitation in LMIC","volume":"12","author":"Ragupathi","year":"2017","journal-title":"Glob. Heart."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1016\/j.cjca.2016.01.036","article-title":"Sex Differences in Cardiac Rehabilitation Adherence: A Meta-analysis","volume":"32","author":"Oosenbrug","year":"2016","journal-title":"Can. J. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.1001\/jamainternmed.2015.3819","article-title":"Participation in Cardiac Rehabilitation Programs Among Older Patients After Acute Myocardial Infarction","volume":"175","author":"Doll","year":"2015","journal-title":"JAMA Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.ijcard.2016.08.120","article-title":"Participation and Adherence to Cardiac Rehabilitation Programs. A systematic review","volume":"223","author":"Raposeiras","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1177\/2047487312447846","article-title":"Factors Influencing Referral to Cardiac Rehabilitation and Secondary Prevention Programs: A Systematic Review","volume":"20","author":"Clark","year":"2013","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1177\/2047487319838221","article-title":"Exercise Training in Women with Cardiovascular Disease: Differential Response and Barriers\u2014Review and Perspective","volume":"28","author":"Witvrouwen","year":"2019","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/MD.0000000000019546","article-title":"Translation and Validation of the Cardiac Rehabilitation Barriers Scale in the Czech Republic (CRBS-CZE): Protocol to Determine the Key Barriers in East-Central Europe","volume":"99","author":"Winnige","year":"2020","journal-title":"Medicine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1177\/0269215511410579","article-title":"Psychometric Validation of the Cardiac Rehabilitation Barriers Scale","volume":"26","author":"Shanmugasegaram","year":"2012","journal-title":"Clin. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1177\/2047487312460484","article-title":"Aerobic Exercise Intensity Assessment and Prescription in Cardiac Rehabilitation: A Joint Position Statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation","volume":"20","author":"Mezzani","year":"2013","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2315","DOI":"10.1093\/eurheartj\/ehw106","article-title":"ESC Scientific Document Group. 2016 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the Special Contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR)","volume":"37","author":"Piepoli","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_21","unstructured":"Heart Foundation (2021, December 05). A Pathway to Cardiac Recovery Standardised Program Content for Phase II Cardiac Rehabilitation. Available online: https:\/\/globalcardiacrehab.com\/resources\/Documents\/CardRehabModules_COMBINED_FINAL.pdf."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Taylor, R.S., Dalal, H.M., and McDonagh, S.T.J. (2021). The Role of Cardiac Rehabilitation in Improving Cardiovascular Outcomes. Nat. Rev. Cardiol.","DOI":"10.1038\/s41569-021-00611-7"},{"key":"ref_23","unstructured":"Hatcher, L. (1994). A Step-by-Step Approach to Using the SAS System for Factor Analysis and Structural Equation Modeling, SAS Institute Inc."},{"key":"ref_24","unstructured":"Nunnally, J.C. (1978). Psychometric Theory, McGraw-Hill. [2nd ed.]."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e021356","DOI":"10.1161\/JAHA.120.021356","article-title":"Dose of Cardiac Rehabilitation Reduces Mortality and Morbidity: A Population-based Study","volume":"10","author":"Grace","year":"2021","journal-title":"JAHA"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e64","DOI":"10.1097\/jnr.0000000000000328","article-title":"Translation, Adaptation and Validation of the Malay Version of the Cardiac Rehabilitation Barriers Scale","volume":"28","author":"Chai","year":"2020","journal-title":"J. Nurs. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1590\/S0066-782X2012005000025","article-title":"Development and Validation of the Brazilian Portuguese Version of the Cardiac Rehabilitation Barriers Scale","volume":"98","author":"Ghisi","year":"2012","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_28","first-page":"1","article-title":"Translation, Cross-Cultural Adaptation, and Psychometric Validation of the Chinese\/Mandarin Cardiac Rehabilitation Barriers Scale (CRBS-C\/M)","volume":"9","author":"Liu","year":"2021","journal-title":"Rehabil. Res. Pract."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e034552","DOI":"10.1136\/bmjopen-2019-034552","article-title":"Cross-cultural Adaptation and Psychometric Validation of the Persian version of the Cardiac Rehabilitation Barriers Scale (CRBS-P)","volume":"10","author":"Ghanbari","year":"2020","journal-title":"BMJ Open"},{"key":"ref_30","first-page":"858","article-title":"Translation, Cross-cultural Adaptation and Psychometric Validation of the Korean-Language Cardiac Rehabilitation Barriers Scale (CRBS-K)","volume":"10","author":"Baek","year":"2017","journal-title":"BMJ Open"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"J\u00e1come Hort\u00faa, A.M., Angarita-Fonseca, A., Villamizar Jaimes, C.J., Mart\u00ednez Mar\u00edn, R.d.P., Dutra de Souza, H.C., de Paula Facioli, T., and S\u00e1nchez-Delgado, J.C. (2021). Reliability of the Scale of Barriers for Cardiac Rehabilitation in the Colombian Population. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18084351"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1089\/jwh.2007.0753","article-title":"A Multisite Examination of Sex Differences in Cardiac Rehabilitation Barriers by Participation Status","volume":"18","author":"Grace","year":"2009","journal-title":"J. Womens Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1177\/2047487317726623","article-title":"Kardiovize Brno 2030, A Prospective Cardiovascular Health Study in Central Europe: Methods, Baseline Findings and Future Directions","volume":"25","author":"Movsisyan","year":"2018","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.pcad.2017.08.007","article-title":"A Review of Cardiac Rehabilitation Delivery Around the World","volume":"60","author":"Pesah","year":"2017","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.eclinm.2019.06.006","article-title":"Cardiac Rehabilitation Availability and Density around the Globe","volume":"13","author":"Supervia","year":"2019","journal-title":"EClinicalMedicine"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1476-072X-9-27","article-title":"Drive Time to Cardiac Rehabilitation: At What Point Does it Affect Utilization?","volume":"9","author":"Brual","year":"2010","journal-title":"Int. J. Health Geogr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1001\/archinte.1992.00400170113021","article-title":"Predictors of Cardiac Rehabilitation Participation in Older Coronary Patients","volume":"152","author":"Ades","year":"1992","journal-title":"Arch. Intern. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2110","DOI":"10.1093\/ptj\/pzaa159","article-title":"Perceptions of Kinesiophobia in Relation to Physical Activity and Exercise After Myocardial Infarction: A Qualitative Study","volume":"100","author":"Caldenius","year":"2020","journal-title":"Phys. Ther."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Grace, S.L., Kotseva, K., and Whooley, M.A. (2021). Cardiac Rehabilitation: Under-utilized Globally. Curr. Cardiol. Rep., 23.","DOI":"10.1007\/s11886-021-01543-x"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1097\/HCR.0b013e31829b6e81","article-title":"A Comparison of Barriers to Use of Home- versus Site-based Cardiac Rehabilitation","volume":"33","author":"Shanmugasegaram","year":"2013","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1080\/09593985.2019.1620388","article-title":"Barriers to Participation in Center-based Cardiac Rehabilitation Programs and Patients\u2019 Attitudes Toward Home-based Cardiac Rehabilitation Programs","volume":"37","author":"Bakhshayeh","year":"2021","journal-title":"Physiother. Theory Pract."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Taylor, R.S., Dalal, H., Jolly, K., Zawada, A., Dean, S.G., Cowie, A., and Norton, R.J. (2015). Home-based vs. centre-based cardiac rehabilitation. Cochrane Database Syst. Rev., 18.","DOI":"10.1002\/14651858.CD007130.pub3"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1161\/CIR.0000000000000663","article-title":"Home-Based Cardiac Rehabilitation: A Scientific Statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology","volume":"140","author":"Thomas","year":"2019","journal-title":"Circulation"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e19556","DOI":"10.1097\/MD.0000000000019556","article-title":"Benefits and Effectiveness of Using a Wrist Heart Rate Monitor as a Telerehabilitation Device in Cardiac Patients: A Randomized Controlled Trial","volume":"99","author":"Batalik","year":"2020","journal-title":"Medicine"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"807","DOI":"10.23736\/S1973-9087.21.06653-3","article-title":"Long-term exercise effects after cardiac telerehabilitation in patients with coronary artery disease: 1-year follow-up results of the randomized study","volume":"57","author":"Batalik","year":"2021","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Batalik, L., Pepera, G., Papathanasiou, J., Rutkowski, S., L\u00ed\u0161ka, D., Batalikova, K., Hartman, M., Fel\u0161\u0151ci, M., and Dosbaba, F. (2021). Is the Training Intensity in Phase Two Cardiovascular Rehabilitation Different in Telehealth versus Outpatient Rehabilitation?. J. Clin. Med., 10.","DOI":"10.3390\/jcm10184069"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1016\/j.apmr.2020.06.004","article-title":"Cardiac Rehabilitation During Quarantine in COVID-19 Pandemic: Challenges for Center-Based Programs","volume":"101","author":"Besnier","year":"2020","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1177\/2047487320939671","article-title":"The Future is Now: A Call for Action for Cardiac Telerehabilitation in the COVID-19 Pandemic from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology","volume":"28","author":"Scherrenberg","year":"2020","journal-title":"Eur. J. Prev. Cardiol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/24\/13113\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:46:04Z","timestamp":1760168764000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/24\/13113"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,12]]},"references-count":48,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["ijerph182413113"],"URL":"https:\/\/doi.org\/10.3390\/ijerph182413113","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,12]]}}}