Movement Disorders Including essential tremor, dystonia and Restless Leg Syndrome (RLS).


advertisement
Reply
 
Thread Tools Display Modes
Old 09-27-2006, 09:36 AM #1
The Godfather's Avatar
The Godfather The Godfather is offline
ex Member
 
Join Date: Aug 2006
Location: New York
Posts: 93
15 yr Member
The Godfather The Godfather is offline
ex Member
The Godfather's Avatar
 
Join Date: Aug 2006
Location: New York
Posts: 93
15 yr Member
Default Restless legs Syndrome - Symptom questionnaire

The following is a self assessment symptom questionnaire prepared by the International Restless Legs Syndrome Study Group.

The scores for each question are either 4 (which is the worst), 3, 2, 1 or 0 (which is the mildest).

Adding up the total score will give you the severity of the Restless Legs Syndrome :

Mild (if your total score 1-10)
Moderate (if your total score is 11-20)
Severe (if your total score is 21-30)
Very severe (if your total is score 31-40)


In the past week…

1. Overall, how would you rate the RLS discomfort in your legs or arms?

4 - Very severe
3 - Severe
2 - Moderate
1 - Mild
0 - None


2. Overall, how would you rate the need to move around because of your RLS symptoms?

4 - Very severe
3 - Severe
2 - Moderate
1 - Mild
0 - None


3. Overall, how much relief of your RLS arm or leg discomfort did you get from moving around?

4 - No relief
3 - Mild relief
2 - Moderate relief
1 - Either complete or almost complete relief
0 - No RLS symptoms to be relieved


4. How severe was your sleep disturbance due to your RLS symptoms?

4 - Very severe
3 - Severe
2 - Moderate
1 - Mild
0 - None


5. How severe was your tiredness or sleepiness during the day due to your RLS symptoms?

4 - Very severe
3 - Severe
2 - Moderate
1 - Mild
0 - None


6. How severe was your RLS as a whole?

4 - Very severe
3 - Severe
2 - Moderate
1 - Mild
0 - None


7. How often did you get RLS symptoms?

4 - From 6 to 7 days per week
3 - From 4 to 5 days per week
2 - From 2 to 3 days per week
1 - Only 1 day per week
0 - Not at all in the past week


8. When you had RLS symptoms, how severe were they on average ?

4 - Very severe (8 hours or more per 24 hour)
3 - Severe (3 to 8 hours per 24 hour)
2 - Moderate (1 to 3 hours per 24 hour)
1 - Mild (less than 1 hour per 24 hour)
0 - None


9. Overall, how severe was the impact of your RLS symptoms on your ability to carry out your daily affairs, for example carrying out a satisfactory family, home, social, school or work.

4 - Very severe
3 - Severe
2 - Moderate
1 - Mild
0 - None


10. How severe was your mood disturbance due to your RLS symptoms - for example angry, depressed, sad, anxious or irritable?

4 - Very severe
3 - Severe
2 - Moderate
1 - Mild
0 - None

Last edited by The Godfather; 09-27-2006 at 10:51 AM.
The Godfather is offline   Reply With QuoteReply With Quote

advertisement
Reply


Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off



All times are GMT -5. The time now is 06:18 PM.

Powered by vBulletin • Copyright ©2000 - 2024, Jelsoft Enterprises Ltd.

vBulletin Optimisation provided by vB Optimise v2.7.1 (Lite) - vBulletin Mods & Addons Copyright © 2024 DragonByte Technologies Ltd.
 

NeuroTalk Forums

Helping support those with neurological and related conditions.

 

The material on this site is for informational purposes only,
and is not a substitute for medical advice, diagnosis or treatment
provided by a qualified health care provider.


Always consult your doctor before trying anything you read here.