Validation of the Physician Attitudes toward Cardiac Rehabilitation and Referral (PACRR) Scale

Methods: Data were retrospectively analysed from three cohorts administering the PACRR, a 19-item scale. The first cohort consisted of 185 cardiologists or family physicians; the second of 51 of the same, and the third of 97 cardiologists. Internal consistency was assessed by Cronbach's alpha, factor structure by confirmatory factor analysis, construct validity by significant differences in PACRR scores by physician specialty, and criterion validity by testing for significant differences in PACRR scores by referral.

Results: Cronbach’s alpha was 0.81, 0.71, and 0.69 in each of the three cohorts, respectively. Factor analysis in the latter two cohorts revealed four factors: referral norms, preference to manage patients independently of cardiac rehabilitation (CR), perceptions of program quality, and referral processes. Construct validity was established in the first cohort, as significant differences in PACRR scores were found by physician specialty. Criterion validity was supported by significant differences in mean scores by referral in each cohort. Physicians rated bad experiences with CR programs, poor program quality, skepticism of CR benefits and lack of familiarity with local programs as the most important factors that affected their referral to CR.

Conclusions: In conclusion, the PACRR scale was demonstrated to have good reliability and validity.