Date of Completion
Summer 2026
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
First Advisor
Dr. Lydia Forsythe
Second Advisor
Dr. Corinne Cochran
Third Advisor
Dr. Angela Morehead
Abstract
Problem: Peripheral artery disease (PAD) is a leading cause of cardiovascular morbidity, mortality, and lower extremity amputation. At a Level 1 veterans medical center, the absence of a standardized screening and referral process contributed to delayed identification of symptomatic PAD and underutilization of supervised exercise therapy (SET). Between August 2024 and July 2025, only four veterans completed SET despite a large high-risk population, demonstrating a significant gap in evidence-based recommendations and clinical practice.
Aim of the Project: The aim of this project was to improve patient outcomes by standardizing screening for symptomatic PAD using the Walking Impairment Questionnaire (WIQ) to identify functional limitations and timely referral to SET.
Review of the Evidence: A review of the evidence supported the WIQ as a valid, reliable, patient-reported outcome measure (PROM) that correlates with objective assessments of walking impairment and provides an efficient and cost-effective alternative to performance-based testing. Early identification of symptomatic PAD facilitates timely referral to SET, improving functional status, quality of life, and disease management.
Project Design: The project design was guided by the Plan-Do-Study-Act (PDSA) framework and the OhioHealth Change Management (OHCM) model to support implementation, workflow refinement, stakeholder engagement, and sustainability.
Intervention: The intervention, an Excel-based WIQ screening tool, was integrated into the outpatient vascular surgery clinic nursing workflow. A registered nurse screened all eligible new patients. Providers reviewed results, delivered PAD education, recommended SET when clinically appropriate, and documented referrals in the electronic health record.
Significant Findings/Outcomes: Thirty-two screenings were completed on 30 patients, achieving 100% screening of all eligible veterans. Fourteen patients had a positive screening; however, most had advanced vascular disease that disqualified them from SET participation. All clinically eligible patients were referred to SET. Documentation compliance and overall program utilization remained below project goals.
Implications for Nursing: Standardized nurse-led WIQ screening enhanced identification of symptomatic PAD and demonstrated the value of integrating PROMs into clinical workflows. Future implementation in the primary care setting may facilitate earlier detection, improve the use of evidence-based interventions, and enhance patient outcomes.
Recommended Citation
Doyle, Lisa, "Implementing the Walking Impairment Questionnaire for Peripheral Artery Disease Screening and Referral" (2026). Doctor of Nursing Practice (DNP) Scholarly Project. 67.
https://fuse.franklin.edu/dnp-project/67
Rights
Copyright, all rights reserved
Included in
Other Nursing Commons, Other Rehabilitation and Therapy Commons, Population Health Commons
