{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T07:25:50Z","timestamp":1785914750361,"version":"3.56.0"},"reference-count":50,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,2,24]],"date-time":"2023-02-24T00:00:00Z","timestamp":1677196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Cardiac Rehabilitation (CR) is a secondary prevention intervention proven to improve quality of life, yet with low participation. The Cardiac Rehabilitation Barriers Scale (CRBS) was developed to assess multi-level barriers to participation. This study aimed at the translation, and cross-cultural adaptation of the CRBS into the Greek language (CRBS-GR), followed by psychometric validation. Some 110 post-angioplasty patients with coronary artery disease (88.2% men, age 65.3 \u00b1 10.2 years) answered the CRBS-GR. Factor analysis was performed to obtain the CRBS-GR subscales\/factors. The internal consistency and 3-week test\u2013retest reliability was evaluated using Cronbach\u2019s alpha (\u03b1) and intraclass correlation coefficient (ICC), respectively. Construct validity was tested via convergent and divergent validity. Concurrent validity was assessed with the Hospital Anxiety and Depression Scale (HADS). Translation and adaptation resulted in 21 items similar to the original version. Face validity and acceptability were supported. Construct validity assessment revealed four subscales\/factors, with acceptable overall reliability (\u03b1 = 0.70) and subscale internal consistency for all but one factor (\u03b1 range = 0.56\u20130.74). The 3-week test-retest reliability was 0.96. Concurrent validity assessment demonstrated a small to moderate correlation of the CRBS-GR with the HADS. The greatest barriers were the distance from the rehabilitation center, the costs, the lack of information about CR, and already exercising at home. The CRBS-GR is a reliable and valid tool for identifying CR barriers among Greek-speaking patients.<\/jats:p>","DOI":"10.3390\/ijerph20054064","type":"journal-article","created":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T02:22:16Z","timestamp":1677464536000},"page":"4064","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Translation, Cross-Cultural Adaptation and Psychometric Validation of the Greek Version of the Cardiac Rehabilitation Barriers Scale (CRBS-GR): What Are the Barriers in South-East Europe?"],"prefix":"10.3390","volume":"20","author":[{"given":"Varsamo","family":"Antoniou","sequence":"first","affiliation":[{"name":"Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, GR-35100 Lamia, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Pasias","sequence":"additional","affiliation":[{"name":"Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, GR-35100 Lamia, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nektarios","family":"Loukidis","sequence":"additional","affiliation":[{"name":"Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, GR-35100 Lamia, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5599-4044","authenticated-orcid":false,"given":"Kalliopi K.","family":"Exarchou-Kouveli","sequence":"additional","affiliation":[{"name":"Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, GR-35100 Lamia, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8583-153X","authenticated-orcid":false,"given":"Demosthenes B.","family":"Panagiotakos","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, GR-17671 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7063-3610","authenticated-orcid":false,"given":"Sherry L.","family":"Grace","sequence":"additional","affiliation":[{"name":"School of Kinesiology and Health Science, Faculty of Health, York University, \u03a4oronto, ON M3J 1P3, Canada"},{"name":"KITE Research Institute and Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON M5G 2A2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8012-0325","authenticated-orcid":false,"given":"Garyfallia","family":"Pepera","sequence":"additional","affiliation":[{"name":"Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, GR-35100 Lamia, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1177\/2047487319827453","article-title":"Cardiac rehabilitation availability and delivery in Europe: How does it differ by region and compare with other high-income countries?: Endorsed by the European association of preventive cardiology","volume":"26","author":"Abreu","year":"2019","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/S0167-5273(15)31026-3","article-title":"Global burden of CVD: Focus on secondary prevention of cardiovascular disease","volume":"201","author":"Bansilal","year":"2015","journal-title":"Int. J. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1038\/s41569-021-00607-3","article-title":"Epidemiology of cardiovascular disease in Europe","volume":"19","author":"Townsend","year":"2022","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_4","unstructured":"Elstat (2022, August 11). Deaths\/2019. Available online: https:\/\/www.statistics.gr\/en\/statistics\/-\/publication\/SPO09\/2019."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: A systematic analysis for the global burden of disease study 2019","volume":"396","author":"Vos","year":"2020","journal-title":"Lancet"},{"key":"ref_6","unstructured":"European Heart Network, and ESC (European Society of Cardiology) (2022, October 22). Fighting Cardiovascular Disease\u2014A Blueprint for EU Action, Brussels. Available online: File:\/\/\/C:\/Users\/User\/Downloads\/05748%20CVD%20plan_digital%20edition.pdf."},{"key":"ref_7","unstructured":"WHO (2022, November 12). Cardiovascular Diseases. Available online: https:\/\/www.who.int\/health-topics\/cardiovascular-diseases#tab=tab_1."},{"key":"ref_8","first-page":"2047487320913379","article-title":"Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the secondary prevention and rehabilitation section of the European association of preventive cardiology","volume":"28","author":"Ambrosetti","year":"2020","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the task force for cardiovascular disease prevention in clinical practice with representatives of the European society of cardiology and 12 medical societies with the special contribution of the European association of preventive cardiology (EAPC)","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1756","DOI":"10.1177\/2047487320905719","article-title":"Effectiveness of comprehensive cardiac rehabilitation in coronary artery disease patients treated according to contemporary evidence based medicine: Update of the cardiac rehabilitation outcome study (CROS-II)","volume":"27","author":"Salzwedel","year":"2020","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"R713","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":"JACC"},{"key":"ref_12","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_13","doi-asserted-by":"crossref","unstructured":"Antoniou, V., Davos, C.H., Kapreli, E., Batalik, L., Panagiotakos, D.B., and Pepera, G. (2022). Effectiveness of home-based cardiac rehabilitation, using wearable sensors, as a multicomponent, cutting-edge intervention: A systematic review and meta-analysis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11133772"},{"key":"ref_14","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_15","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_16","first-page":"CD007131","article-title":"Interventions to promote patient utilisation of cardiac rehabilitation","volume":"2019","author":"Chaves","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s43044-021-00156-7","article-title":"Cardiac rehabilitation via telerehabilitation in COVID-19 pandemic situation","volume":"73","author":"Sari","year":"2021","journal-title":"Egypt Heart J."},{"key":"ref_18","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_19","first-page":"270","article-title":"Exercise-based cardiac rehabilitation programs in the era of COVID-19: A critical review","volume":"22","author":"Stefanakis","year":"2021","journal-title":"Rev. Cardiovasc. Med. Spec. Issue Card. Rehabil."},{"key":"ref_20","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_21","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1177\/2047487318825350","article-title":"Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: Results from the European society of cardiology ESC-EORP EUROASPIRE V registry","volume":"26","author":"Kotseva","year":"2019","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_22","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":"2011","journal-title":"Clin. Rehabil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1016\/S0895-4356(98)00082-1","article-title":"Translating health status questionnaires and evaluating their quality: The IQOLA project approach","volume":"51","author":"Bullinger","year":"1998","journal-title":"J. Clin. Epidem."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1080\/15305058.2017.1398166","article-title":"ITC guidelines for translating and adapting tests (second edition)","volume":"18","author":"Bartram","year":"2018","journal-title":"Int. J. Test"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.1001\/jama.2013.281053","article-title":"World medical association declaration of Helsinki: Ethical principles for medical research involving human subjects","volume":"310","author":"Association","year":"2013","journal-title":"JAMA"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/S0140-6736(86)90837-8","article-title":"Statistical methods for assessing agreement between two methods of clinical measurement","volume":"327","author":"Altman","year":"1986","journal-title":"Lancet"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1744-859X-7-4","article-title":"Hospital anxiety and depression scale (HADS): Validation in a Greek general hospital sample","volume":"7","author":"Michopoulos","year":"2008","journal-title":"Ann. Gen. Psychiatry"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e059945","DOI":"10.1136\/bmjopen-2021-059945","article-title":"Efficacy, efficiency and safety of a cardiac telerehabilitation programme using wearable sensors in patients with coronary heart disease: The TELEWEAR-CR study protocol","volume":"12","author":"Antoniou","year":"2022","journal-title":"BMJ Open"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1365-2753.2010.01434.x","article-title":"Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: A clear and user-friendly guideline","volume":"17","author":"Sousa","year":"2011","journal-title":"J. Eval. Clin. Pract."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.jclinepi.2010.02.006","article-title":"The COSMIN study reached aninternational consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes","volume":"63","author":"Mokkink","year":"2010","journal-title":"J. Clin. Epidemiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1177\/001316446002000116","article-title":"The application of electronic computers to factor analysis","volume":"20","author":"Kaiser","year":"1960","journal-title":"Educ. Psychol. Meas."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1207\/s15327906mbr0102_10","article-title":"The scree test for the number of factors","volume":"1","author":"Cattell","year":"1966","journal-title":"Multivar. Behav. Res."},{"key":"ref_34","unstructured":"Reymont, R., and Joreskog, K. (1993). Applied Factor Analysis in the Natural Sciences, Cambridge University."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1136\/bmj.314.7080.572","article-title":"Cronbach\u2019s alpha","volume":"314","author":"Bland","year":"1997","journal-title":"BMJ Clin. Res. Ed."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Streiner, D.L., Norman, G.R., and Cairney, J. (2014). Health Measurement Scales. A Practical Guide to Their Development and Use, Oxford University Press. [4th ed.].","DOI":"10.1093\/med\/9780199685219.001.0001"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/BF02289447","article-title":"A rationale and test for the number of factors in factor analysis","volume":"30","author":"Horn","year":"1965","journal-title":"Psychometrika"},{"key":"ref_38","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_39","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":"Mirzaei","year":"2020","journal-title":"BMJ Open"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Winnige, P., Filakova, K., Hnatiak, J., Dosbaba, F., Bocek, O., Pepera, G., Papathanasiou, J., Batalik, L., and 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. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182413113"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"59","DOI":"10.26657\/gulhane.00055","article-title":"Validity and reliability of the Turkish version of \u201ccardiac rehabilitation barriers scale\u201d","volume":"61","author":"Yagci","year":"2019","journal-title":"Gul. Med. J."},{"key":"ref_42","first-page":"5511426","article-title":"Translation, cross-cultural adaptation, and psychometric validation of the Chinese\/Mandarin cardiac rehabilitation barriers scale (CRBS-C\/M)","volume":"2021","author":"Liu","year":"2021","journal-title":"Rehabil. Res. Pract."},{"key":"ref_43","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":"Arquivos Brasileiros Cardiologia"},{"key":"ref_44","first-page":"858","article-title":"Translation, cross-cultural adaptation and psychometric validation of the Korean-language cardiac rehabilitation barriers scale (CRBS-K)","volume":"41","author":"Baek","year":"2017","journal-title":"Arm"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.hrtlng.2022.04.016","article-title":"Safety of home-based cardiac rehabilitation: A systematic review","volume":"55","author":"Stefanakis","year":"2022","journal-title":"Heart Lung J. Crit. Care"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e2228720","DOI":"10.1001\/jamanetworkopen.2022.28720","article-title":"Comparison of home-based vs. center-based cardiac rehabilitation in hospitalization, medication adherence, and risk factor control among patients with cardiovascular disease","volume":"5","author":"Reynolds","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1177\/2047487317710803","article-title":"Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: Results of the FIT@Home study","volume":"24","author":"Kraal","year":"2017","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Batalik, L., Filakova, K., Sladeckova, M., Dosbaba, F., SU, J.J., and Pepera, G. (2023). The cost-effectiveness of telehealth exercise-based cardiac rehabilitation intervention: A systematic review. Eur. J. Phys. Rehabil. Med., 59.","DOI":"10.23736\/S1973-9087.23.07773-0"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.ijcard.2022.08.055","article-title":"Cardiac telerehabilitation improves lipid profile in the long term: Insights and implications","volume":"367","author":"Batalik","year":"2022","journal-title":"Int. J. Cardiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1093\/eurjpc\/zwab106","article-title":"Effectiveness of home-based cardiac telerehabilitation as an alternative to Phase 2 cardiac rehabilitation of coronary heart disease: A systematic review and meta-analysis","volume":"29","author":"Ramachandran","year":"2021","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\/20\/5\/4064\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:41:26Z","timestamp":1760121686000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/5\/4064"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,24]]},"references-count":50,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["ijerph20054064"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20054064","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,24]]}}}