Provider Attitudes toward Cardiac Rehabilitation and Referral Scale
(by provider we mean any regulated healthcare professionals that treat patients indicated for cardiac rehab and that are eligible to refer patients; e.g., physicians, advanced practice nurses)

Find the scale here:
Ghisi, G.L.M., & Grace, S.L. (2019). Validation of the Provider Attitudes toward Cardiac Rehabilitation & Referral (PACRR) scale. Heart, Lung & Circulation;28(8):1218-1224.
AAM version of the full-text available here:
PACRR Scale (Eng.)     PACRR Scoring

PACRR-R (Eng.)      PACRR-P (Scoring)

We welcome requests to administer this scale; Kindly email me ( Please cite the above when using it. I am happy to help too (including efforts to mitigate identified clinician-level barriers), as requested.


PACRR - Chinese (courtesy Yun-Mei DING, School of Nursing, Qingdao University; link to validation publication forthcoming).

PACRR- Portuguese (citation below)

If you wish to translate the scale to another language: There may be translations available or others working on translations, and I could put you in touch. If not, there are best practices for translation, cross-cultural adaptation and validation that should be used; I could point you to some resources if requested. Ultimately, I could post your translation to this website as well, giving you credit if you agree, in case others wish to use and cite it. However, often healthcare providers are proficient in English, and therefore use of the English version is not an issue. Moreover, there is an open-ended item at the end of the scale, so that any factors specific to local context can also be captured.

PACRR Presentation:
Grace, S.L. (2023). Cardiologist’s and cardiovascular surgeon’s attitudes towards cardiac rehabilitation. Michigan Cardiac Rehabilitation Network Virtual Work Group Meeting. United States. May. [virtual].

Other PACRR Citations

  1. Grace SL, Evindar A, Abramson BL, Stewart DE. Physician management preferences for cardiac patients: factors affecting referral to cardiac
    rehabilitation. Can J Cardiol 2004;20:1101–7.
  2. Grace SL, Grewal K, Stewart DE. Factors affecting cardiac rehabilitation referral by physician specialty. J Cardiopulm Rehabil Prev 2008;28:248–52.
  3. Grace SL, Gravely-Witte S, Brual J, Monette G, Suskin N, Higginson L, et al. Contribution of patient and physician factors to CR referral: a prospective multi-level study. Nat Clin Pract Cardiovasc Med 2008;5:653–62.
  4. Grace SL, Gravely-Witte S, Brual J, Monette G, Suskin N, Higginson L, et al. Contribution of patient and physician factors to cardiac rehabilitation enrollment: a prospective multilevel study. Eur J Cardiovasc Prev Rehabil 2008;15:548–56.
  5. Cuenza LR, Gacrama EN, Tan K, Quito BJ & Ebba E. (2016). Physician factors affecting cardiac rehabilitation referral among cardiac specialists: The Philippine Heart Center CRAVE study. J Clin Prev Cardiol; 5:44-50.
  6. Okeowo, A., & Spencer, G. (2020). Implementing an educational program to increase referral rates to cardiac rehabilitation. Preventive Cardiovascular Nurses Association Annual Symposium. 2020-815-Poster.pdf (
  7. Swartz, M.C., Kelly, D.M., et al. (2022). System-level barriers and facilitators to cancer rehabilitation delivery for children with cancer. Journal of Clinical Oncology; 40(28):81.
  8. Mamataz, T., Lee, D.S., Turk-Adawi, K., Hajaj, A.*, Code, J., & Grace, S.L. (ePub; Sept 5, 2023). Factors affecting healthcare provider referral to heart function clinics: A mixed-methods study. Journal of Cardiovascular Nursing. [adapted version]
  9.  daCruz, M.M.A., Vanderlei, L.C.M., Takarashi, C., Laurino, M.J., Grace, S.L., & Ghisi, G.L.M. Translation, cultural adaptation and psychometric validation of the Portuguese version of the Provider Attitudes toward Cardiac Rehabilitation and Referral (PACRR-P) scale. (under revision; PLOS ONE).
  10. Ding, Y-M., Cui, Y., Gu, J-Y., & Grace, S.L., Translation, cultural adaptation and validation of the Provider Attitudes toward Cardiac Rehabilitation and Referral (PACRR-C) scale in Simplified Chinese. (under revision; Chronic Illness).
  11. Mamataz, T., Virani, S., McDonald, M., Edgell, H., & Grace, S.L. Heart failure clinic inclusion and exclusion criteria: Cross-sectional study of clinic and referring providers' perspectives. (under revision; BMJ Open).[adapted version]