Cardiac rehabilitation barriers in the Czech Republic: Determination of key barriers in East-Central Europe
Authors: Winnige P , Batalik L , Filakova K , Hnatiak J , Dosbaba F 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): the Ministry of Health, Czech Republic - conceptual development of research organization (65269705)
Background
Cardiovascular diseases are leading causes of morbidity and mortality worldwide, including in Central Europe. Cardiac rehabilitation (CR) represents an efficient secondary prevention model, but it is highly underutilised. Barriers to CR in the Czech Republic (and in Central Europe) are not well-characterised, and therefore we present a study to define these barriers.
Purpose
Through this study, a reliable and valid means of assessing patient"s CR barriers will be established. Results will be used to identify ways to help patients overcome barriers to CR and potentially contribute to improving CR utilisation in this region.
Methods
This is a multi-method study. First, in 2019, we professionally translated and cross-culturally validated the Cardiac Rehabilitation Barriers Scale to Czech (CRBS-CZE), and piloting it in 50 cardiac patients. A prospective study was undertaken to psychometrically-validate the CRBS-CZE, where patients eligible for phase II/outpatient CR were recruited. The internal reliability of the scale was assessed with Cronbach"s alpha.
In total, 143 eligible patients (target of 200-300 patients) in the University Hospital Brno was approached from January 2020 for one year. Consenting participants were informed about the CR program and their sociodemographic (age, sex, highest educational attainment, work status, travel time), clinical characteristics (diagnosis, anthropometrics, blood pressure, lipids levels, diabetes), heart-healthy behaviours (level of physical activity, tobacco use, harmful use of alcohol), and the CRBS-CZE administered.
Mean CRBS-CZE scores (21-items/barriers, five-point Likert scale) were analysed to determine key barriers in this setting. To test construct validity, differences in CRBS-CZE total scores were compared by patient characteristics outlined above, using a t-test and Pearson"s correlation. Patient"s enrollment, adherence, and completion of the CR program (% of 24 prescribed sessions attended) were tracked.
Results (preliminary)
The CRBS-CZE had good internal consistency (Cronbach’s alpha = .74). Mean total perceived barriers were significantly greater among non-enrollers (2.1, SD = .57) than CR enrollers (1.8, SD = .53), and among rural (2.2, SD = .54) than urban inhabitants (1.7, SD = .46) (p &lt; .05). The long distance from CR facilities (mean commuting time about 50 mins), a little free time, and the transportation problems were identified as the greatest barriers. From all eligible patients, 19.6% entered and 10.5% completed the CR program. The mean completion rate was 70.6%. The main limitations of the study were a small number of participants and the COVID-19 pandemic.

Conclusion
The CRBS-CZE has shown adequate validity and reliability, which supports its use in future studies. Results also point to suboptimal CR availability in the Czech Republic. This finding, especially in the pandemic situation, promotes the need for CR alternatives like home-based programs and telerehabilitation.