Do You Have Restless Leg Syndrome QUIZ

 

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The Subjective Restless Leg Syndrome Questionnaire

Take the Quiz below to help discover if you have Restless Leg Syndrome

* 1. How would you rate the discomfort in your legs?
(4) Very Severe
(3) Severe
(2) Moderate
(1) Mild
(0) None in the past week
* 2. How would you rate the need to move around with your leg symptoms?
(4) Very Severe
(3) Severe
(2) Moderate
(1) Mild
(0) None in the Past Week
* 3. How much relief of your 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 leg symptoms?
(4) Very Severe
(3) Severe
(2) Moderate
(1) Mild
(0) None in the past week
* 5. How severe was your tiredness or sleepiness during the day due to your leg symptoms?
(4) Very Severe
(3) Severe
(2) Moderate
(1) Mild
(0) None in the past week
* 6. How severe was your leg symptoms as a whole?
(4) Very Severe
(3) Severe
(2) Moderate
(1) Mild
(0) None in the past week
* 7. How often did you get leg symptoms?
(4) Very often (6 to 7 days in 1 week)
(3) Often (4 to 5 days in 1 week)
(2) Sometimes (2 to 3 days in 1 week)
(1) Occasionally (1 day in 1 week)
(0) Never in th epast week
* 8. When you had leg symptoms, how severe were they on average?
(4) Very severe (8 hours or more per 24 hours)
(3) Severe (3 to 8 hours per 24 hours)
(2) Moderate (1 to 3 hours per 24 hours)
(1) Mild (less than 1 hour per 24 hours)
(0) None in th epast week
* 9. Overall, how severe was the impact of your leg symptoms on your ability to carry out you daily affairs, for example carrying out a satisfactory family, social, school or work life?
(4) Very severe
(3) Severe
(2) Moderate
(1) Mild
(0) None in the past week
* 10. How severe was your mood disturbance due to your leg symptoms for example angry, depressed, sad, anxious or irritable?
(4) Very Severe
(3) Severe
(2) Moderate
(1) Mild
(0) None in the past week
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