Psychometrics of Persian Version of the Restless Legs Syndrome Quality of Life Questionnaire (RLS-QoL): A Cross-Sectional Study

Psychometrics of Persian Version of the Restless Legs Syndrome Quality of Life Questionnaire (RLS-QoL): A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychometrics of Persian Version of the Restless Legs Syndrome Quality of Life Questionnaire (RLS-QoL): A Cross-Sectional Study Marjan Shamspour, Farzaneh Jahanbakhsh, Asghar Tavan, Mana Aminai, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6688710/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Restless legs syndrome is a common condition associated with a decrease in the quality of life of affected individuals. Considering the responsiveness of the Restless Legs Syndrome Quality of Life Questionnaire (RLS-QoL) in clinical and research interventions in various countries, we translated it into Persian and examined its validity and reliability. Methods The present study was cross-sectional and conducted on a sample of a hundred patients with restless legs syndrome. Initially, the Johns Hopkins questionnaire was translated into Persian and then into English by another person and sent for final approval to the questionnaire's creator. Fifteen psychiatry and sleep experts reviewed the tool's formal and content validity. For concurrent validity assessment, this questionnaire and the SF-36 and IRLSS questionnaires were completed simultaneously by patients with this syndrome. Spearman's correlation coefficient between the scores of these questionnaires was calculated. Results The results showed that this questionnaire is valid. Spearman correlation test results showed a significant relationship between RLS-QoL, SF-36, and IRLSS questionnaire results and indicated that this questionnaire is suitable for assessing patients' quality of life. The Cronbach's alpha score for the Persian version of the RLS-QoL questionnaire in the study population was reported as 0.89. Conclusion The results of the present study demonstrated that the Persian version of the RLS-QoL questionnaire is valid and reliable and can be used as a valid tool in clinical, research, and post-treatment follow-up trials. Clinical trial number: Not applicable Restless legs syndrome quality of life Restless Legs Syndrome Quality of Life Questionnaire Introduction Restless Legs Syndrome (RLS) is a common condition characterised by uncomfortable limb sensations that prompt an irresistible urge to move the legs. Symptoms worsen at rest and improve with movement, often disrupting sleep, especially in the evening and at night. In order to diagnose RLS, it is crucial to differentiate it from other medical conditions like myalgia, venous stasis, leg edema, arthritis, and leg cramps. Factors such as family history, positive response to dopaminergic treatments, and sleep disturbances linked to RLS aid in confirming the diagnosis. This syndrome is also common in children and adolescents, but the prevalence increases with age and varies based on age, gender, ethnicity, and geographical regions (Masuko, 2008; Facheris, 2010). Restless Legs Syndrome (RLS) affects around 10% of the general population, with a higher prevalence in women than men. A survey on RLS's impact on quality of life found that over half of individuals experienced mood disturbances, nearly half reported fatigue, and over 40% mentioned disruptions to daily activities. Alongside these effects, symptoms such as depression, concentration difficulties, restlessness, pain, and tingling in the lower limbs may also occur (Facheris, 2010). Even though this syndrome is widely common, it does not receive adequate attention from the medical community and primary healthcare services. As a result, these patients are not diagnosed on time and consequently do not receive appropriate treatment. The quality of life of individuals with this syndrome can be significantly affected by sleep disturbances, decreased work performance, disruption in daily activities, emotional status, sexual interests, and fatigue. Unemployment, work-related issues, and the associated costs of reducing the quality of life impose a significant economic burden on society (Facheris, 2010). Additionally, it can lead to depression, increased risk of suicide, fatigue, reduced concentration, daily sleepiness, and anxiety (Facheris, 2010; Silber et al., 2021 ; Mungan et al., 2016 ; Becker, 2006 ). Specific and validated questionnaires must be used to assess the quality of life in patients with Restless Legs Syndrome effectively. A study by Arthur S. Walters and colleagues analysed five questionnaires associated with RLS patients' quality of life: RLS-Quality of Life-Abetz (RLS-QoL-Abetz), RLS-Quality of Life Instrument (RLS-QLI), RLS-QoL-Kohnen, Post Sleep Questionnaire for RLS (PSQ), and the RLS-Next Day Impact Questionnaire. These questionnaires have been validated and are suitable for clinical evaluation, post-treatment follow-up, and research studies in the target population. Tools for evaluating Restless Legs Syndrome were assessed based on applicability in patients, usage by researchers/clinicians, and validation quality. The tools were classified as recommended, suggested, or listed. The RLS-QoL tool, validated by Linda Abetz, was the only one to meet all criteria. It is recommended for cross-sectional studies and monitoring symptom changes during treatment (Walters et al., 2014). The RLS-QoL tool consists of 18 questions assessing the impact of Restless Legs Syndrome on various aspects of life. Lower scores indicate a lower quality of life. It is statistically robust, responsive to treatment effects, and available in multiple languages. It is widely used in research and clinical trials and has demonstrated utility across diverse settings. Considering the above points and the lack of a valid Persian version of this questionnaire, the current study was designed and conducted to evaluate the validity and reliability of the Persian version of this questionnaire. Due to the responsiveness of this tool in clinical and research interventions in different countries and cultures, this tool has been translated into Persian, with questions translated in a way that is in line with the Iranian culture and Persian language rules to ensure the preservation of the original tool's content and to make it transparent and understandable for the target group. Methods This study conducted a cross-sectional analysis of patients diagnosed with Restless Legs Syndrome (RLS) based on the diagnostic criteria outlined by the international RLS study group. During formal and content validity evaluation, feedback was gathered from 15 psychiatrists and sleep medicine fellows regarding the questionnaire items. A minimum sample size of 90 participants, five times the estimated number of items, was determined. Eventually, 100 RLS patients seeking care at psychiatric clinics in Kerman in 2023 were included in the study. The sampling approach for formal and content validity stages was purposeful and conducted by psychiatrists and sleep medicine fellows, while for concurrent validity, it was straightforward and accessible. Standard descriptive analyses utilising SPSS 25 and Excel 2016 were applied to assess formal and content validity based on specified formulas. Descriptive statistical methods like mean, standard deviation, tables, and graphs were utilised for data interpretation. The study's inclusion criteria comprised individuals aged 18 and above who could communicate effectively and were willing to participate. Exclusion criteria involved a history of specific illnesses such as myopathies, knee osteoarthritis, rheumatoid arthritis, Parkinson's disease, peripheral neuropathy, radiculopathy, prior lower limb surgery, thyroid disorders, sleep apnea, pregnancy, and the use of medications that could induce or worsen RLS symptoms, such as certain antidepressants and antipsychotics. In the first stage, two proficient individuals translated the RLS-QoL questionnaire from English to Persian. Then, the two translations were reconciled to reach a consensus. In the second stage, respondents expressed their opinions on the items' aesthetic value in measuring the tool's desired structure and assessment goals for formal validity. For this purpose, 15 psychiatry and sleep fellowship experts evaluated the items and selected one of the options (not important, slightly important, moderately important, relatively important, or highly important). To assess content validity, both the Content Validity Ratio (CVR) and the Content Validity Index (CVI) were computed. The Lawshe table was employed to determine the CVR (Table 1 ). Expert specialists in the specific field of the test content were consulted to assign each question to the three-category Likert scale: "Essential item," "Useful item but not essential," and "Item not necessary," facilitating the calculation of this index. Then, based on the formula below, the content validity ratio has been calculated. CVR= (N e - N/2)/ (N/2) N e = the number of panellists indicating essential, N = the total number of panellists Table 1 Minimum CVR Values in Minimum Required One-Sided Tests for Lawshe Agreement for Content Validity The minimum acceptable amount based on the number of expert scorers CVR Value Number of Experts CVR Value Number of Experts 0.42 20 0.59 11 0.37 25 0.56 12 0.33 30 0.54 13 0.31 35 0.51 14 0.29 40 0.49 15 The Waltz and Basel method was utilised to calculate CVI. In this way, experts have defined each item's "relevance," "clarity," and "simplicity" based on a 4-part Likert spectrumItems that have achieved an I-CVI score higher than 79% are considered suitable for detection. Items that have obtained an I-CVI score between 70% and 79% are considered questionable and have been revised and reviewed. Items that have obtained an I-CVI score of less than 70% are considered unacceptable and have been removed. To calculate S-CVI, which is considered the tool's overall validity, the formula CVI/Avg (Scale-CVI/Average) was reported. In fact, S-CVI/Avg represents the average of all I-CVI scores of the entire tool. After entering the experts' opinions into an Excel file and defining the formula, the tool's overall validity was calculated. Kappa calculates the level of agreement for relevance and irrelevance and considers this. Naturally, this calculation only reflects the overall agreement of evaluators. It does not pay much special attention to the relevance of items to the tool as an important criterion of content validity. (K* value = less than 0.59 is weak, K* value = from 0.60 to 0.74 is good, and K* value = above 0.74 is excellent). In this study, after entering the experts' opinions into an Excel file and defining a formula, the corrected kappa level for each item was calculated, and decisions were made based on the above classification. To examine the concurrent criterion validity, eligible individuals completed the IRLSS and SF-36 questionnaires alongside the RLS_QoL questionnaire. Subsequently, the scores from the criterion questionnaires were computed. The Spearman correlation coefficient was then determined between the scores of these questionnaires and the Persian version of the RLS_QoL questionnaire. The adequacy of criterion validity assessment was determined based on the significance of the questionnaire scores (p < 0.05). Additional details regarding these questionnaires are offered. To assess the instrument's reliability, Cronbach's Alpha test was employed. This test measures the consistency among a set of items that gauge a particular construct. In the present study, after completing the participants' questionnaires, the Cronbach's Alpha value for the entire instrument and each item was calculated using SPSS version 25 software. Four questionnaires were used to collect data: Demographic Information Questionnaire: This includes age, gender, education level, occupation, history of underlying diseases, and history of drug and substance use. SF36 Questionnaire: The internal consistency of the Persian version of this questionnaire indicates a reliable standard in each of its eight domains (Cronbach α coefficients ranged from 0.77 to 0.90, except for the vitality scale, which had α = 0.65). The tool's convergent validity, assessing item correlations, is satisfactory (ranging from 0.58 to 0.95). The questionnaire's two main components are the Mental Component Summary (MCS) and the Physical Component Summary (PCS). This scoring method can facilitate the assessment of areas related to restless leg syndrome, which predominantly affects MCS (Abetz et al, 2005 ; Montazeri et al, 2005 ; Asghari Moghaddam & Faghehi, 2003 ). International Restless Legs Syndrome Severity Questionnaire (IRLSS): The Persian version of this questionnaire also indicates good validity and reliability (95%). This tool is scored between 0 and 40, where higher scores indicate greater severity of restless leg syndrome (Molahosseini et al., 2005 ). RLS-QoL Questionnaire: Linda Abetz's study, in particular, showcased strong validity and reliability (α = 0.92). Scores on this questionnaire range from 0 to 100, with 0 representing a poor quality of life and 100 indicating a high quality of life. The questionnaire comprises both categorised and numerical items. A composite score can also be calculated based on categorised items 1–5, 7–10, and 13 (Walters et al., 2003 ; Kubo et al., 2016 ). Results In the present study conducted on 100 patients with primary RLS, the participants in the age range of 22–60 years had a mean age and standard deviation of 37.83 ± 7.87. The demographic characteristics of the participants were as follows: out of 100 participants with RLS, 70 were females, and 30 were males. Among the participants in the present study, 18% were single, 79% were married, and 3% were in other categories. 34% of the participants in the study had no university education, while 66% mentioned having a university education. Regarding occupational status, 12% were unemployed, 62% had government jobs, and 26% had non-governmental jobs. Validity determination of the instrument: The research conducted both qualitative and quantitative formal validation of the instrument. Qualitatively, feedback was gathered from 15 specialists to assess the relevance, relationships, ambiguities, misunderstandings, and complexity of concepts. Quantitatively, an Excel file with specific formulas evaluated item significance and impact on scoring, with all items achieving a score above 1.5, indicating strong quantitative validity. The items, their new codes, and the impact scores obtained from each item in the stage of quantitative formal validity are presented in Table 2 . Content validity determination of the instrument: A combination of quantitative and qualitative approaches was employed to determine content validity. Through qualitative analysis, psychiatry and sleep fellowship specialists assessed aspects like linguistic accuracy, use of suitable terminology, and proper item placement. Feedback from these experts and input from the research team guided adjustments to the instrument as needed. The content validity ratio and content validity index were utilised for quantitative assessment. Determining the content validity ratio: In this phase, the items derived from earlier study stages were included in a questionnaire distributed to 15 psychiatry and sleep fellowship experts. Any items scoring below 0.51 were to be eliminated from the instrument. As indicated in Table 2 , all items in this phase achieved higher scores and were considered appropriate regarding content validity ratio. Determining the content validity index: To evaluate the Scale Content Validity Index (S-CVI), 15 psychiatry and sleep fellowship experts were tasked with evaluating each item's relevance. Based on theoretical and practical definitions of the concept and its dimensions, they were required to select one of the following options: 1—Not relevant, 2—Somewhat relevant, 3—Relevant, and 4—Highly relevant. The questionnaire prepared for this stage is provided in the appendix. The Item Content Validity Index (I-CVI) and Scale Content Validity Index (S-CVI) scores were calculated. Items with an I-CVI score above 79% are considered suitable, while items with an I-CVI score between 70% and 79% are questionable and require revision. Items with an I-CVI score below 69% are unacceptable and are removed. As shown in Table 2 , all items had appropriate content validity index scores. In this stage, the overall content validity (S-CVI) was also assessed using the S-CVI/Ave test, which yielded a value of 0.89 in the current study. In conclusion, since all items demonstrated suitable formal and content validity, they proceeded to the next stage for concurrent validity and reliability assessment of the instrument. Table 2 Results obtained from quantitative face validity, content validity, and item content validity index Quantitative Face Validity Content Validity Content Validity Index Item code Item F S II-Score result CVR RES I-CBI Pc K* result Item1 During the past 4 weeks, how disturbing has the restlessness in your legs been? Never Slight amount Somewhat Quite a lot Very much 1.1 4.8 5.3 Suitable 0.86 0.93 4.57 0.93 Valid Item2 To what extent has leg restlessness hindered your presence in social evening and night activities during the last 4 weeks? Never Slight amount Occasionally Most of the time Always 1 4.6 4.6 Suitable 1 0.457 0.93 0.457 0.93 Valid Item3 How much has leg restlessness caused you difficulty waking up in the morning over the past 4 weeks? Never Slight amount Somewhat Quite a lot Very much 0.9 4.1 3.7 Suitable 0.6 0 0.86 0 0.86 Valid Item4 How many times during the past 4 weeks have you been late to work or morning appointments due to leg restlessness? Never Slight amount Somewhat Most of the time Always 0.8 4.1 3.3 Suitable 0.6 4.5 0.93 4.5 0.93 Valid Item5 During the past 4 weeks, how often have you been late to work or morning appointments due to leg restlessness? Choose: Never, Slight amount, Somewhat, Most of the time, Always 0.9 4.3 3.9 Suitable 0.73 3 1 3 1 Valid Item6 How many days in the past 4 weeks have you been late to work or morning appointments due to leg restlessness? Write the number of days. 0.8 4 3.2 Suitable 0.73 4.5 0.93 4.5 0.93 Valid Item7 How many times have you had trouble concentrating during the evenings in the past 4 weeks? Never Slight amount Sometimes Most of the time Always 0.9 4 3.6 Suitable 0.73 0 0.86 0 0.86 Valid Item8 How many times have you had trouble concentrating during the nights in the past 4 weeks? Never Slight amount Sometimes Most of the time Always 0.9 3.9 3.5 Suitable 0.6 0 0.8 0 0.79 Valid Item9 How much has your decision-making ability been affected by sleep problems in the past 4 weeks? Choose: Never, Slight amount, Sometimes, Most of the time, Always 0.9 4.1 3.7 Suitable 0.6 0 0.8 0 0.79 Valid Item10 How many times in the past 4 weeks have you cancelled trips that lasted more than 2 hours? Choose: Never, Slight amount, Sometimes, Most of the time, Always 0.7 4 2.8 Suitable 0.6 0 0.8 0 0.79 Valid Item11 How interested have you been in engaging in sexual activity during the past 4 weeks? Never, Slight amount, Somewhat, A lot, Very much, Prefer not to answer 0.8 3.8 3 Suitable 0.6 0 0.8 0 0.79 Valid Item12 To what extent has leg restlessness caused disturbances or reductions in your sexual activity in the past 4 weeks? Never, Slight amount, Somewhat, A lot, Very much, Prefer not to answer 1 4.3 4.3 Suitable 0.73 3 1 3 1 Valid Item13 How much has leg restlessness in the past four weeks disrupted your ability to perform daily activities? Never, Slight amount, Somewhat, A lot, Very much. 1.1 4.6 4.6 Suitable 0.6 3 1 3 1 Valid Item14 Are you currently going to work? (Full-time, Part-time, Self-employed, Unemployed, Volunteer) Yes (If your answer is yes, please continue to answer questions 18 − 15) No, thanks for completing the questionnaire (due to my restless legs) No, thanks for completing the questionnaire (due to other reasons) 1 4.2 4.2 Suitable 0.6 0 0.86 0 0.86 Valid Item15 How many times has leg restlessness made working a full day difficult for you in the past 4 weeks? Never, Slight amount, Sometimes, Most of the time, Always 1.1 4.7 4.7 Suitable 0.86 4.5 0.93 4.5 0.93 Valid Item16 How many days in the past 4 weeks have you worked less than desired due to leg restlessness? 0.8 4 4 Suitable 0.86 0 0.8 0 0.79 Valid Item17 On average, how many hours a day have you worked in the past 4 weeks? 0.8 3.8 3.8 Suitable 0.6 0 0.8 0 0.79 Valid Item18 On the days when you worked less than desired due to leg restlessness on average, how many hours less did you work each day? 1 4 4 Suitable 0.73 4.5 0.93 4.5 0.93 Valid F = Frequency S = Suitable Determining Concurrent Validity: The Spearman correlation coefficient test was utilised to examine the concurrent validity by comparing the total scores of the RLS-QoL questionnaire with those of the IRLSS and SF-36 questionnaires, which served as reference measures. The results are summarised in Table 3 . The Spearman correlation analysis showed a significant negative association between the Restless Legs Syndrome Severity Questionnaire scores and the Restless Legs Syndrome Quality of Life Questionnaire. Higher severity of Restless Legs Syndrome was linked to lower quality of life as per the RLS-QoL questionnaire. Strong correlation coefficients with other questionnaires and satisfactory concurrent validity indicate that the RLS-QoL questionnaire is suitable for assessing the quality of life in individuals with Restless Legs Syndrome. Table 3 Results of the SPEARMAN Correlation Test correlation Spearman's rho RLS-QoL SF-36 SF-36 and RLS-QoL questioners RLS_QOl Correlation coefficient 1.000 0.438 Sig. 0 0 N 97 94 SF_36 Correlation coefficient 0.438 1.000 Sig. 0 0 N 94 97 IRLSS and RLS-QoL questioners RLS_QOl Correlation coefficient 1.000 -0.647 Sig. 0 0 N 97 97 IRLSS Correlation coefficient -0.647 1.000 Sig. 0 0 N 97 100 In this study, the participants had an average RLS-QoL life quality score of 69.55 and an average IRLSS score of 17.63, with variances of 218.317 and 48.275, respectively. The minimum and maximum life quality scores for individuals with Restless Legs Syndrome were 31.67 and 96.67, while for the IRLSS tool, the minimum and maximum severity scores were 4 and 35, respectively. Analysis using the Kruskal-Wallis test revealed significant differences in the participants' average scores based on their occupation. Specifically, unemployed individuals had higher scores in restless legs syndrome severity. Moreover, individuals with government jobs showed higher average scores in the SF-36 and RLS-QoL life quality tools, although this difference was not statistically significant. There was no significant association between participants' demographic characteristics and the scores obtained from the study tools. Additionally, responses to questions 6, 16, and 18 were collected from the participants, with questions 16 and 18 specifically focused on employed individuals. In item 6, around 66% of the participants mentioned one day or more, with approximately 45% mentioning more than 3 days, which includes a significant percentage of patients. In item 16, about 62% of the participants mentioned one day or more, and 7% mentioned 5 days or more of working less than desired, which are notable numbers. In the item, around 70% of the participants mentioned one hour or more, which includes a high percentage of patients. Reliability Assessment of the Tool: To evaluate the tool's reliability, the researchers conducted the Cronbach's alpha test, employing a sample of 100 patients diagnosed with Restless Legs Syndrome. The Persian version of the RLS-QoL questionnaire achieved a Cronbach's alpha score of 0.89 in the study population, signifying the tool's strong reliability. Discussion In the present study conducted on 100 patients with Restless Legs Syndrome aged 22–60, the average age of the patients was 37.83 ± 7.87 years, and 70% were female. Most of the participants in the current study were female, which is consistent with other studies. In the study by Linda Ibtaz and colleagues in 2005, which was conducted on 85 adults with Restless Legs Syndrome (36.5% male), aged 26–87 years, the average age was 62.4 ± 14 years (Abetz, 2005). In another study conducted in 2012 to validate the Indian version of the mentioned questionnaire, the participants included 34 individuals with RLS (64.7% female) with an average age of 38.6 years and 29 individuals as the control group (62.1% female) with an average age of 39.58 years (Vishwakarma, 2012). In the 2015 Turkish version validation study, 201 individuals with Restless Legs Syndrome (RLS) took part, mainly females (166). The affected patients had an average age of 47 years. Furthermore, a control group of 43 individuals was part of the study, with 26 females (average age 40.77) and 17 males (average age 49.8). The study had a predominant representation of female participants (Güler & Nesrin Turan, 2015 ). Women have a higher prevalence of Restless Legs Syndrome, possibly due to factors like pregnancy, childbirth, menopause, iron deficiency, and related health conditions. Women with RLS are more likely to have accompanying diseases like migraines, depression, and anxiety disorders, possibly influenced by RLS and the medications used to treat these conditions (Seeman, 2020 ). In our study, secondary cases of Restless Legs Syndrome mentioned were excluded, yet most participants were women. In primary RLS, even with low iron levels in the blood, localised iron deficiency in the brains of affected individuals plays a role, considering that iron is a co-factor of enzymes involved in dopamine synthesis and dopamine receptor function. Another factor is estrogen level fluctuations. Estrogen level fluctuations (not absolute estrogen levels) affect dopamine and glutamate transmission in the brain, which can justify the vulnerability of women to RLS (Seeman, 2020 ). The study investigated the impact of Restless Legs Syndrome on individuals who were late for morning appointments and on employed individuals who worked less than desired. About 66% of affected individuals were late for work or morning appointments at least once, with around half of them being late for more than 3 days in the past 4 weeks due to RLS. Approximately 62% of affected individuals worked less than desired for at least one day, significantly impacting occupational status. Unemployed participants scored higher in RLS severity questionnaires. Quality of life scores for participants with government jobs were higher, although not statistically significant. Another study in the US found that, on average, patients experienced a one-day decrease in work productivity per week due to RLS (Allen, 2011). In a 2015 study by Durgin T in the US on the human and economic burden of Restless Legs Syndrome, work productivity was assessed using the Work Productivity and Activity Impairment-General Health tool. The research revealed a significant decrease in work productivity and a decline in the likelihood of workforce participation due to RLS. This productivity decline included days of absence from work and subpar performance on days individuals were present. The study also found that higher severity of RLS correlated with greater reductions in work productivity (Durgin, 2015). Our study's average RLS-QoL Summary scale score was 69.55, ranging from 31.67 to 96.67. Participants' average score on the IRLSS tool was 17.63, ranging from 4 to 35. In Linda Abetz's study, participants were classified into mild, moderate, and severe groups based on the severity assessment tool. There were 24 individuals in the mild group, 29 in the moderate group, and 23 in the severe group (Abetz et al., 2005 ). The average RLS-QoL Summary scale score for these groups was 84.48, 62.93, and 37.47, respectively. In line with the findings of the Linda Abetz study, our research also demonstrated that as the severity of restless legs syndrome increased, the quality of life of those affected decreased. When validating the Hindi version of the specified questionnaire (Vishwakarma, 2012), individuals with this syndrome had an average RLS-QoL score of 29.8. Similarly, in the validation of the Turkish version (Güler S, Nesrin Turan, 2015 ), the average RLS-QoL score for participants with RLS and the control group was reported as 44.80 ± 17.27 and 93.49 ± 9.73, respectively, aligning with the results of our study. The results of this study indicated good internal consistency of the tool, with a Cronbach's alpha of 0.89 in the Persian version, which is in line with previous studies. In the Linda Abetz study, Cronbach's alpha was reported as 0.92, and the test-retest reliability after two weeks was 0.84 (Abetz et al., 2005 ). Regarding the reliability assessment of the Turkish version of this tool, Cronbach's alpha was reported as 0.975 (Güler & Nesrin Turan, 2015 ), and for the Hindi version, it was reported as 0.85 (Vishwakarma et al., 2012 ). In our study, this tool was evaluated with SF-36 and IRLSS questionnaires for concurrent validity assessment, and a significant correlation was observed between them. In Linda Abetz's study, the tool showed a notable correlation with the SF-36 Mental Components Scale (MCS), with only question 17 correlating significantly with the SF-36 Physical Components Scale (PCS). In our study, the Persian version significantly correlated with the SF-36 tool. Additionally, when compared with the IRLS-PV questionnaire, higher severity in IRLS-PV was associated with poorer RLS-QoL scores (Abetz et., 2005). In the Turkish version (Güler & Nesrin Turan, 2015 ), this tool significantly correlated with the ISI and IRLSSG questionnaires. In the Hindi version (Vishwakarma et al., 2012 ), a significant correlation was observed with the ISI questionnaire in patients with sleep disorders. However, the Hindi version did not show a significant correlation with the IRLSSG tool, and in the Turkish version, the observed correlation needed to be stronger. The probable reason for this discrepancy may be the difference in the duration of symptoms, as IRLSSG considers the symptoms over the past week. Conclusion The findings of this study indicated that the Persian adaptation of the RLS-QoL questionnaire demonstrates suitable face validity, content validity, concurrent validity, and strong reliability. Moreover, it is user-friendly, requiring only about 10 minutes to complete. Its succinct nature effectively captures key facets of life influenced by Restless Legs Syndrome. Given these attributes, this questionnaire holds promise as a valid instrument in research, clinical trials, and post-treatment monitoring. Limitations: In children with RLS, cognitive disorders, ADHD, sleepwalking, night terrors, and other issues may be present (Facheris et al., 2010 ). Therefore, similar to adults, it is necessary to investigate and treat secondary RLS issues in children. This tool has been evaluated in individuals above 18 years of age, and its application in children and adolescents should be studied. The questionnaire has been translated into Persian, and understanding it may be difficult for the Iranian population to speak languages other than Persian. Therefore, it is recommended that translations be made and validated in other common languages in Iran. Test-Retest examination was not conducted in our study, and it is essential to consider in future studies. Abbreviations ADHD Attention deficit hyperactivity disorder RLS-QoL Restless legs syndrome-Quality of life CVR Content validity ratio CVI Content validity index MSC Mental component summary PCS Physical component summary IRLSS International restless legs syndrome severity Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of Kerman University of Medical Sciences with the ethics code IR.KMU.AH.REC.1401.216, in accordance with the declaration of Helsinki. All participants are required to provide written informed consent before inrolment. Consent for publication Not applicable. Availablity of data and material Data and materials will we available upon reasonable requests to corresponding authors. Competing interests The authors declare no competing interests. Fundings This research did not receive any specific grant from funding agencies in the public commercial or not for profit sectors Author contributions: MSH : concept , definition of intellectual content , clinical studies FJ : design , litterature search AT : data analysis , statistical analysis MA : manuscript prepartion , manuscript editing RP :guarantor , manuscript review , data acquisition , clinical studies , literature search Acknowledgement: We are thankful to MAPI research trust for allowing us to use the instruments used in this study. We would like to sincerely thank the patients who participated in this study for their valuable cooperation . References Abetz L, Vallow SM, Kirsch J, Allen RP, Washburn T, Earley CJ. (2005). Validation of the restless legs syndrome quality of life questionnaire. Value in Health, 8 (2), 157 – 67. 10.1111/j.1524-4733.2005.03010 . x. Allen RP, Bharmal M, Calloway M. Prevalence and disease burden of primary restless legs syndrome: results of a general population survey in the United States. Mov Disord. 2011;26(1):114–20. Asghari Moghaddam M, Faghehi S. Validity of the sf-36 health survey questionnaire in two Iranian samples. Clin Psychol Personality. 2003;1(1):1–10. Becker PM. The biopsychosocial effects of restless legs syndrome (RLS). Neuropsychiatric disease treatment. 2006;2(4):505–12. Durgin T, Witt EA, Fishman J. The humanistic and economic burden of restless legs syndrome. PLoS ONE. 2015;10(10):e0140632. 10.1371/journal.pone.0140632 . Facheris MF, Hicks AA, Pramstaller PP, Pichler I. Update on the management of restless legs syndrome: existing and emerging treatment options. Nat Sci Sleep. 2010;2:199–212. Walters AS, LeBrocq C, Dhar A, Hening W, Rosen R, Allen RP, Trenkwalder C. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med. 2003;4(2):121–32. Güler S, Nesrin Turan F. Turkish version of the Johns Hopkins Restless Legs Syndrome Quality of Life Questionnaire (RLS-QoL): validity and reliability study. Quality Life Research. 2015;24(11):2789–94. 10.1007/s11136-015-1003-x . Kubo K, Sugawara N, Kaneda A, Takahashi I, Nakamura K, Nakaji S. Relationship between quality of life and restless legs syndrome among a community-dwelling population in Japan. Neuropsychiatr Dis Treat. 2016;12(12):809–15. 10.2147/NDT.S102089 . Masuko AH, Carvalho LB, Machado MA, Morais JF, Prado LB, Prado GF. Translation and validation into the Brazilian Portuguese of the restless legs syndrome rating scale of the International Restless Legs Syndrome Study Group. Arq Neuropsiquiatr. 2008;66:832–6. Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The short form health survey (SF-36). Translation and validation study of the Iranian version. Qual Life Res. 2005;14(3):875–82. 10.1007/s11136-004-1014-5 . Mungan S, Ozcan M, Orhan G, Titiz A, Arli B, Koseoglu S. Clinical and polysomnographic features of patients with Restless Legs Syndrome. J Pak Med Assoc. 2016;66(5):568–73. Seeman MV. Why are women prone to restless legs syndrome? Int J Environ Res Public Health. 2020;17(1):368. 10.3390/ijerph17010368 . Silber MH, Buchfuhrer MJ, Earley CJ, Koo BB, Manconi M, Winkelman JW. (2021). The management of restless legs syndrome: an updated algorithm. Mayo Clinic Proceedings ; Elsevier, 96 (7), 1921–1937. Doi.org/10.1016/j.mayocp.2020.12.026 Molahosseini S, Mohammadzadeh S, Kamali P, Tavakoli Shooshtari M. Frequency of sleep disorder and restless legs syndrome in patients referring to hemodialysis units in university hospitals in Tehran in 2003. Med Sci J Islamic Azad Univesity-Tehran Med Branch. 2005;15(1):27–30. Vishwakarma K, Lahan V, Gupta R, Goel D, Dhasmana D, C., and, Sharma T. Translation and validation of restless leg syndrome quality of life questionnaire in Hindi language. Neurol India. 2012;60(50):476–80. 10.4103/0028-3886.103188 . Walters AS, Frauscher B, Allen R, Benes H, Chaudhuri KR, Garcia-Borreguero D. Review of quality-of-life instruments for the restless legs syndrome/Willis-Ekbom Disease (RLS/WED): Critique and recommendations. J Clin Sleep Med, 10 (12), 1351–7. Doi.org/10.5664/jcsm.4300 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6688710","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":477531735,"identity":"6c58ded4-e09f-4d87-8e52-73bf2e288169","order_by":0,"name":"Marjan Shamspour","email":"","orcid":"","institution":"Shahid Beheshti Hospital, Kerman University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Marjan","middleName":"","lastName":"Shamspour","suffix":""},{"id":477531736,"identity":"d1a4e043-883d-4667-9930-ffc17d1154f6","order_by":1,"name":"Farzaneh Jahanbakhsh","email":"","orcid":"","institution":"Shahid Beheshti Hospital, Kerman University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Farzaneh","middleName":"","lastName":"Jahanbakhsh","suffix":""},{"id":477531737,"identity":"0d4ab8a3-ed6b-41ca-a155-3e0aa81c2d1d","order_by":2,"name":"Asghar Tavan","email":"","orcid":"","institution":"Kerman University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Asghar","middleName":"","lastName":"Tavan","suffix":""},{"id":477531738,"identity":"053e6285-6aa1-4a2f-947d-b521c3e6cb45","order_by":3,"name":"Mana Aminai","email":"","orcid":"","institution":"Shahid Beheshti Hospital, Kerman University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mana","middleName":"","lastName":"Aminai","suffix":""},{"id":477531739,"identity":"dc2c25fa-7c5c-4b6b-91c8-5e1aedbb84bd","order_by":4,"name":"Roya pooyanfard","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYHADxgcMDGw2IEbjASK1MBsAtaSBtDSQpOUwmIlXi3l7j+HnggqbxP7ZzYyfK8rO261tPwy0pcYmGpcWmTNnjKVnnElLnHHnMLPkmXO3k7edSQRqOZaW24BDi4REjoE0b9vhxIYb+QckG9tuJ5sdAGphbDiMT4vxb5CW+TeSmX82tp1LNjv/kKAWM7AtG24kswFtOWBndoOQLTzHyqyBfjHeCNRi2XAuOcHsBtCWBHx+YW/efBsYYrLzgA672VBmZ292Pv3hgw81Nji1MDBwGDADSUeYgkQwIwGnchBgfwDSYg/j2uNWOQpGwSgYBSMVAADOfWWvj/AXGgAAAABJRU5ErkJggg==","orcid":"","institution":"Shahid Beheshti Hospital, Kerman University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Roya","middleName":"","lastName":"pooyanfard","suffix":""}],"badges":[],"createdAt":"2025-05-17 19:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6688710/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6688710/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88072664,"identity":"40f987aa-34b1-4ad8-bb66-3ce2d8fa7722","added_by":"auto","created_at":"2025-08-01 06:16:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1189483,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6688710/v1/17674831-4564-4ac0-b781-e3dbbe0fe578.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Psychometrics of Persian Version of the Restless Legs Syndrome Quality of Life Questionnaire (RLS-QoL): A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRestless Legs Syndrome (RLS) is a common condition characterised by uncomfortable limb sensations that prompt an irresistible urge to move the legs. Symptoms worsen at rest and improve with movement, often disrupting sleep, especially in the evening and at night. In order to diagnose RLS, it is crucial to differentiate it from other medical conditions like myalgia, venous stasis, leg edema, arthritis, and leg cramps. Factors such as family history, positive response to dopaminergic treatments, and sleep disturbances linked to RLS aid in confirming the diagnosis. This syndrome is also common in children and adolescents, but the prevalence increases with age and varies based on age, gender, ethnicity, and geographical regions (Masuko, 2008; Facheris, 2010).\u003c/p\u003e \u003cp\u003eRestless Legs Syndrome (RLS) affects around 10% of the general population, with a higher prevalence in women than men. A survey on RLS's impact on quality of life found that over half of individuals experienced mood disturbances, nearly half reported fatigue, and over 40% mentioned disruptions to daily activities. Alongside these effects, symptoms such as depression, concentration difficulties, restlessness, pain, and tingling in the lower limbs may also occur (Facheris, 2010). Even though this syndrome is widely common, it does not receive adequate attention from the medical community and primary healthcare services.\u003c/p\u003e \u003cp\u003eAs a result, these patients are not diagnosed on time and consequently do not receive appropriate treatment. The quality of life of individuals with this syndrome can be significantly affected by sleep disturbances, decreased work performance, disruption in daily activities, emotional status, sexual interests, and fatigue. Unemployment, work-related issues, and the associated costs of reducing the quality of life impose a significant economic burden on society (Facheris, 2010). Additionally, it can lead to depression, increased risk of suicide, fatigue, reduced concentration, daily sleepiness, and anxiety (Facheris, 2010; Silber et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Mungan et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Becker, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2006\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSpecific and validated questionnaires must be used to assess the quality of life in patients with Restless Legs Syndrome effectively. A study by Arthur S. Walters and colleagues analysed five questionnaires associated with RLS patients' quality of life: RLS-Quality of Life-Abetz (RLS-QoL-Abetz), RLS-Quality of Life Instrument (RLS-QLI), RLS-QoL-Kohnen, Post Sleep Questionnaire for RLS (PSQ), and the RLS-Next Day Impact Questionnaire. These questionnaires have been validated and are suitable for clinical evaluation, post-treatment follow-up, and research studies in the target population.\u003c/p\u003e \u003cp\u003eTools for evaluating Restless Legs Syndrome were assessed based on applicability in patients, usage by researchers/clinicians, and validation quality. The tools were classified as recommended, suggested, or listed. The RLS-QoL tool, validated by Linda Abetz, was the only one to meet all criteria. It is recommended for cross-sectional studies and monitoring symptom changes during treatment (Walters et al., 2014).\u003c/p\u003e \u003cp\u003eThe RLS-QoL tool consists of 18 questions assessing the impact of Restless Legs Syndrome on various aspects of life. Lower scores indicate a lower quality of life. It is statistically robust, responsive to treatment effects, and available in multiple languages. It is widely used in research and clinical trials and has demonstrated utility across diverse settings.\u003c/p\u003e \u003cp\u003eConsidering the above points and the lack of a valid Persian version of this questionnaire, the current study was designed and conducted to evaluate the validity and reliability of the Persian version of this questionnaire. Due to the responsiveness of this tool in clinical and research interventions in different countries and cultures, this tool has been translated into Persian, with questions translated in a way that is in line with the Iranian culture and Persian language rules to ensure the preservation of the original tool's content and to make it transparent and understandable for the target group.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study conducted a cross-sectional analysis of patients diagnosed with Restless Legs Syndrome (RLS) based on the diagnostic criteria outlined by the international RLS study group. During formal and content validity evaluation, feedback was gathered from 15 psychiatrists and sleep medicine fellows regarding the questionnaire items. A minimum sample size of 90 participants, five times the estimated number of items, was determined. Eventually, 100 RLS patients seeking care at psychiatric clinics in Kerman in 2023 were included in the study. The sampling approach for formal and content validity stages was purposeful and conducted by psychiatrists and sleep medicine fellows, while for concurrent validity, it was straightforward and accessible.\u003c/p\u003e \u003cp\u003eStandard descriptive analyses utilising SPSS 25 and Excel 2016 were applied to assess formal and content validity based on specified formulas. Descriptive statistical methods like mean, standard deviation, tables, and graphs were utilised for data interpretation.\u003c/p\u003e \u003cp\u003eThe study's inclusion criteria comprised individuals aged 18 and above who could communicate effectively and were willing to participate. Exclusion criteria involved a history of specific illnesses such as myopathies, knee osteoarthritis, rheumatoid arthritis, Parkinson's disease, peripheral neuropathy, radiculopathy, prior lower limb surgery, thyroid disorders, sleep apnea, pregnancy, and the use of medications that could induce or worsen RLS symptoms, such as certain antidepressants and antipsychotics.\u003c/p\u003e \u003cp\u003eIn the first stage, two proficient individuals translated the RLS-QoL questionnaire from English to Persian. Then, the two translations were reconciled to reach a consensus.\u003c/p\u003e \u003cp\u003eIn the second stage, respondents expressed their opinions on the items' aesthetic value in measuring the tool's desired structure and assessment goals for formal validity. For this purpose, 15 psychiatry and sleep fellowship experts evaluated the items and selected one of the options (not important, slightly important, moderately important, relatively important, or highly important).\u003c/p\u003e \u003cp\u003eTo assess content validity, both the Content Validity Ratio (CVR) and the Content Validity Index (CVI) were computed. The Lawshe table was employed to determine the CVR (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Expert specialists in the specific field of the test content were consulted to assign each question to the three-category Likert scale: \"Essential item,\" \"Useful item but not essential,\" and \"Item not necessary,\" facilitating the calculation of this index.\u003c/p\u003e \u003cp\u003eThen, based on the formula below, the content validity ratio has been calculated.\u003c/p\u003e \u003cp\u003eCVR= (N\u003csub\u003ee\u003c/sub\u003e - N/2)/ (N/2)\u003c/p\u003e \u003cp\u003eN\u003csub\u003ee =\u003c/sub\u003e the number of panellists indicating essential, N\u0026thinsp;=\u0026thinsp;the total number of panellists\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMinimum CVR Values in Minimum Required One-Sided Tests for Lawshe Agreement for Content Validity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eThe minimum acceptable amount based on the number of expert scorers\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCVR Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Experts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCVR Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber of Experts\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe Waltz and Basel method was utilised to calculate CVI. In this way, experts have defined each item's \"relevance,\" \"clarity,\" and \"simplicity\" based on a 4-part Likert spectrumItems that have achieved an I-CVI score higher than 79% are considered suitable for detection. Items that have obtained an I-CVI score between 70% and 79% are considered questionable and have been revised and reviewed. Items that have obtained an I-CVI score of less than 70% are considered unacceptable and have been removed.\u003c/p\u003e \u003cp\u003eTo calculate S-CVI, which is considered the tool's overall validity, the formula CVI/Avg (Scale-CVI/Average) was reported. In fact, S-CVI/Avg represents the average of all I-CVI scores of the entire tool. After entering the experts' opinions into an Excel file and defining the formula, the tool's overall validity was calculated.\u003c/p\u003e \u003cp\u003eKappa calculates the level of agreement for relevance and irrelevance and considers this. Naturally, this calculation only reflects the overall agreement of evaluators. It does not pay much special attention to the relevance of items to the tool as an important criterion of content validity.\u003c/p\u003e \u003cp\u003e(K* value\u0026thinsp;=\u0026thinsp;less than 0.59 is weak, K* value\u0026thinsp;=\u0026thinsp;from 0.60 to 0.74 is good, and K* value\u0026thinsp;=\u0026thinsp;above 0.74 is excellent). In this study, after entering the experts' opinions into an Excel file and defining a formula, the corrected kappa level for each item was calculated, and decisions were made based on the above classification.\u003c/p\u003e \u003cp\u003eTo examine the concurrent criterion validity, eligible individuals completed the IRLSS and SF-36 questionnaires alongside the RLS_QoL questionnaire. Subsequently, the scores from the criterion questionnaires were computed. The Spearman correlation coefficient was then determined between the scores of these questionnaires and the Persian version of the RLS_QoL questionnaire. The adequacy of criterion validity assessment was determined based on the significance of the questionnaire scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additional details regarding these questionnaires are offered.\u003c/p\u003e \u003cp\u003eTo assess the instrument's reliability, Cronbach's Alpha test was employed. This test measures the consistency among a set of items that gauge a particular construct.\u003c/p\u003e \u003cp\u003eIn the present study, after completing the participants' questionnaires, the Cronbach's Alpha value for the entire instrument and each item was calculated using SPSS version 25 software. Four questionnaires were used to collect data:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDemographic Information Questionnaire: This includes age, gender, education level, occupation, history of underlying diseases, and history of drug and substance use.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSF36 Questionnaire: The internal consistency of the Persian version of this questionnaire indicates a reliable standard in each of its eight domains (Cronbach α coefficients ranged from 0.77 to 0.90, except for the vitality scale, which had α\u0026thinsp;=\u0026thinsp;0.65). The tool's convergent validity, assessing item correlations, is satisfactory (ranging from 0.58 to 0.95). The questionnaire's two main components are the Mental Component Summary (MCS) and the Physical Component Summary (PCS). This scoring method can facilitate the assessment of areas related to restless leg syndrome, which predominantly affects MCS (Abetz et al, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Montazeri et al, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Asghari Moghaddam \u0026amp; Faghehi, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2003\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eInternational Restless Legs Syndrome Severity Questionnaire (IRLSS): The Persian version of this questionnaire also indicates good validity and reliability (95%). This tool is scored between 0 and 40, where higher scores indicate greater severity of restless leg syndrome (Molahosseini et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2005\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eRLS-QoL Questionnaire: Linda Abetz's study, in particular, showcased strong validity and reliability (α\u0026thinsp;=\u0026thinsp;0.92). Scores on this questionnaire range from 0 to 100, with 0 representing a poor quality of life and 100 indicating a high quality of life. The questionnaire comprises both categorised and numerical items. A composite score can also be calculated based on categorised items 1\u0026ndash;5, 7\u0026ndash;10, and 13 (Walters et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Kubo et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn the present study conducted on 100 patients with primary RLS, the participants in the age range of 22\u0026ndash;60 years had a mean age and standard deviation of 37.83\u0026thinsp;\u0026plusmn;\u0026thinsp;7.87. The demographic characteristics of the participants were as follows: out of 100 participants with RLS, 70 were females, and 30 were males. Among the participants in the present study, 18% were single, 79% were married, and 3% were in other categories. 34% of the participants in the study had no university education, while 66% mentioned having a university education. Regarding occupational status, 12% were unemployed, 62% had government jobs, and 26% had non-governmental jobs.\u003c/p\u003e\n\u003ch3\u003eValidity determination of the instrument:\u003c/h3\u003e\n\u003cp\u003eThe research conducted both qualitative and quantitative formal validation of the instrument. Qualitatively, feedback was gathered from 15 specialists to assess the relevance, relationships, ambiguities, misunderstandings, and complexity of concepts. Quantitatively, an Excel file with specific formulas evaluated item significance and impact on scoring, with all items achieving a score above 1.5, indicating strong quantitative validity. The items, their new codes, and the impact scores obtained from each item in the stage of quantitative formal validity are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003ch3\u003eContent validity determination of the instrument:\u003c/h3\u003e\n \u003cp\u003eA combination of quantitative and qualitative approaches was employed to determine content validity. Through qualitative analysis, psychiatry and sleep fellowship specialists assessed aspects like linguistic accuracy, use of suitable terminology, and proper item placement. Feedback from these experts and input from the research team guided adjustments to the instrument as needed. The content validity ratio and content validity index were utilised for quantitative assessment.\u003c/p\u003e\n\u003ch3\u003eDetermining the content validity ratio:\u003c/h3\u003e\n \u003cp\u003eIn this phase, the items derived from earlier study stages were included in a questionnaire distributed to 15 psychiatry and sleep fellowship experts. Any items scoring below 0.51 were to be eliminated from the instrument. As indicated in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, all items in this phase achieved higher scores and were considered appropriate regarding content validity ratio.\u003c/p\u003e\n\u003ch3\u003eDetermining the content validity index:\u003c/h3\u003e\n \u003cp\u003eTo evaluate the Scale Content Validity Index (S-CVI), 15 psychiatry and sleep fellowship experts were tasked with evaluating each item's relevance. Based on theoretical and practical definitions of the concept and its dimensions, they were required to select one of the following options: 1\u0026mdash;Not relevant, 2\u0026mdash;Somewhat relevant, 3\u0026mdash;Relevant, and 4\u0026mdash;Highly relevant. The questionnaire prepared for this stage is provided in the appendix.\u003c/p\u003e \u003cp\u003eThe Item Content Validity Index (I-CVI) and Scale Content Validity Index (S-CVI) scores were calculated. Items with an I-CVI score above 79% are considered suitable, while items with an I-CVI score between 70% and 79% are questionable and require revision. Items with an I-CVI score below 69% are unacceptable and are removed. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, all items had appropriate content validity index scores.\u003c/p\u003e \u003cp\u003eIn this stage, the overall content validity (S-CVI) was also assessed using the S-CVI/Ave test, which yielded a value of 0.89 in the current study.\u003c/p\u003e \u003cp\u003eIn conclusion, since all items demonstrated suitable formal and content validity, they proceeded to the next stage for concurrent validity and reliability assessment of the instrument.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults obtained from quantitative face validity, content validity, and item content validity index\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eQuantitative Face Validity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eContent Validity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c12\" namest=\"c9\"\u003e \u003cp\u003eContent Validity Index\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem code\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eII-Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eresult\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCVR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRES\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eI-CBI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003ePc\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eK*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eresult\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring the past 4 weeks, how disturbing has the restlessness in your legs been?\u003c/p\u003e \u003cp\u003eNever Slight amount Somewhat Quite a lot Very much\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo what extent has leg restlessness hindered your presence in social evening and night activities during the last 4 weeks?\u003c/p\u003e \u003cp\u003eNever Slight amount Occasionally Most of the time Always\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow much has leg restlessness caused you difficulty waking up in the morning over the past 4 weeks?\u003c/p\u003e \u003cp\u003eNever Slight amount Somewhat Quite a lot Very much\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow many times during the past 4 weeks have you been late to work or morning appointments due to leg restlessness?\u003c/p\u003e \u003cp\u003eNever Slight amount Somewhat Most of the time Always\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring the past 4 weeks, how often have you been late to work or morning appointments due to leg restlessness? Choose: Never, Slight amount, Somewhat, Most of the time, Always\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow many days in the past 4 weeks have you been late to work or morning appointments due to leg restlessness? Write the number of days.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow many times have you had trouble concentrating during the evenings in the past 4 weeks?\u003c/p\u003e \u003cp\u003eNever Slight amount Sometimes Most of the time Always\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow many times have you had trouble concentrating during the nights in the past 4 weeks?\u003c/p\u003e \u003cp\u003eNever Slight amount Sometimes Most of the time Always\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow much has your decision-making ability been affected by sleep problems in the past 4 weeks? Choose: Never, Slight amount, Sometimes, Most of the time, Always\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow many times in the past 4 weeks have you cancelled trips that lasted more than 2 hours? Choose: Never, Slight amount, Sometimes, Most of the time, Always\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem11\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow interested have you been in engaging in sexual activity during the past 4 weeks? Never, Slight amount, Somewhat, A lot, Very much, Prefer not to answer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo what extent has leg restlessness caused disturbances or reductions in your sexual activity in the past 4 weeks? Never, Slight amount, Somewhat, A lot, Very much, Prefer not to answer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem13\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow much has leg restlessness in the past four weeks disrupted your ability to perform daily activities? Never, Slight amount, Somewhat, A lot, Very much.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem14\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAre you currently going to work? (Full-time, Part-time, Self-employed, Unemployed, Volunteer)\u003c/p\u003e \u003cp\u003eYes (If your answer is yes, please continue to answer questions 18\u0026thinsp;\u0026minus;\u0026thinsp;15)\u003c/p\u003e \u003cp\u003eNo, thanks for completing the questionnaire (due to my restless legs)\u003c/p\u003e \u003cp\u003eNo, thanks for completing the questionnaire (due to other reasons)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem15\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow many times has leg restlessness made working a full day difficult for you in the past 4 weeks? Never, Slight amount, Sometimes, Most of the time, Always\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow many days in the past 4 weeks have you worked less than desired due to leg restlessness?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem17\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOn average, how many hours a day have you worked in the past 4 weeks?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eItem18\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOn the days when you worked less than desired due to leg restlessness on average, how many hours less did you work each day?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSuitable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eValid\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003eF\u0026thinsp;=\u0026thinsp;Frequency S\u0026thinsp;=\u0026thinsp;Suitable\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDetermining Concurrent Validity:\u003c/h2\u003e \u003cp\u003eThe Spearman correlation coefficient test was utilised to examine the concurrent validity by comparing the total scores of the RLS-QoL questionnaire with those of the IRLSS and SF-36 questionnaires, which served as reference measures. The results are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThe Spearman correlation analysis showed a significant negative association between the Restless Legs Syndrome Severity Questionnaire scores and the Restless Legs Syndrome Quality of Life Questionnaire. Higher severity of Restless Legs Syndrome was linked to lower quality of life as per the RLS-QoL questionnaire. Strong correlation coefficients with other questionnaires and satisfactory concurrent validity indicate that the RLS-QoL questionnaire is suitable for assessing the quality of life in individuals with Restless Legs Syndrome.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of the SPEARMAN Correlation Test\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecorrelation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpearman's rho\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRLS-QoL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSF-36\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eSF-36 and RLS-QoL questioners\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eRLS_QOl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCorrelation coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSF_36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCorrelation coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eIRLSS and RLS-QoL questioners\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eRLS_QOl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCorrelation coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.647\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIRLSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCorrelation coefficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.647\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn this study, the participants had an average RLS-QoL life quality score of 69.55 and an average IRLSS score of 17.63, with variances of 218.317 and 48.275, respectively. The minimum and maximum life quality scores for individuals with Restless Legs Syndrome were 31.67 and 96.67, while for the IRLSS tool, the minimum and maximum severity scores were 4 and 35, respectively.\u003c/p\u003e \u003cp\u003eAnalysis using the Kruskal-Wallis test revealed significant differences in the participants' average scores based on their occupation. Specifically, unemployed individuals had higher scores in restless legs syndrome severity. Moreover, individuals with government jobs showed higher average scores in the SF-36 and RLS-QoL life quality tools, although this difference was not statistically significant. There was no significant association between participants' demographic characteristics and the scores obtained from the study tools.\u003c/p\u003e \u003cp\u003eAdditionally, responses to questions 6, 16, and 18 were collected from the participants, with questions 16 and 18 specifically focused on employed individuals. In item 6, around 66% of the participants mentioned one day or more, with approximately 45% mentioning more than 3 days, which includes a significant percentage of patients.\u003c/p\u003e \u003cp\u003eIn item 16, about 62% of the participants mentioned one day or more, and 7% mentioned 5 days or more of working less than desired, which are notable numbers.\u003c/p\u003e \u003cp\u003eIn the item, around 70% of the participants mentioned one hour or more, which includes a high percentage of patients.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eReliability Assessment of the Tool:\u003c/h3\u003e\n \u003cp\u003eTo evaluate the tool's reliability, the researchers conducted the Cronbach's alpha test, employing a sample of 100 patients diagnosed with Restless Legs Syndrome. The Persian version of the RLS-QoL questionnaire achieved a Cronbach's alpha score of 0.89 in the study population, signifying the tool's strong reliability.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the present study conducted on 100 patients with Restless Legs Syndrome aged 22\u0026ndash;60, the average age of the patients was 37.83\u0026thinsp;\u0026plusmn;\u0026thinsp;7.87 years, and 70% were female. Most of the participants in the current study were female, which is consistent with other studies. In the study by Linda Ibtaz and colleagues in 2005, which was conducted on 85 adults with Restless Legs Syndrome (36.5% male), aged 26\u0026ndash;87 years, the average age was 62.4\u0026thinsp;\u0026plusmn;\u0026thinsp;14 years (Abetz, 2005). In another study conducted in 2012 to validate the Indian version of the mentioned questionnaire, the participants included 34 individuals with RLS (64.7% female) with an average age of 38.6 years and 29 individuals as the control group (62.1% female) with an average age of 39.58 years (Vishwakarma, 2012). In the 2015 Turkish version validation study, 201 individuals with Restless Legs Syndrome (RLS) took part, mainly females (166). The affected patients had an average age of 47 years. Furthermore, a control group of 43 individuals was part of the study, with 26 females (average age 40.77) and 17 males (average age 49.8). The study had a predominant representation of female participants (G\u0026uuml;ler \u0026amp; Nesrin Turan, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Women have a higher prevalence of Restless Legs Syndrome, possibly due to factors like pregnancy, childbirth, menopause, iron deficiency, and related health conditions. Women with RLS are more likely to have accompanying diseases like migraines, depression, and anxiety disorders, possibly influenced by RLS and the medications used to treat these conditions (Seeman, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In our study, secondary cases of Restless Legs Syndrome mentioned were excluded, yet most participants were women.\u003c/p\u003e \u003cp\u003eIn primary RLS, even with low iron levels in the blood, localised iron deficiency in the brains of affected individuals plays a role, considering that iron is a co-factor of enzymes involved in dopamine synthesis and dopamine receptor function. Another factor is estrogen level fluctuations. Estrogen level fluctuations (not absolute estrogen levels) affect dopamine and glutamate transmission in the brain, which can justify the vulnerability of women to RLS (Seeman, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe study investigated the impact of Restless Legs Syndrome on individuals who were late for morning appointments and on employed individuals who worked less than desired. About 66% of affected individuals were late for work or morning appointments at least once, with around half of them being late for more than 3 days in the past 4 weeks due to RLS. Approximately 62% of affected individuals worked less than desired for at least one day, significantly impacting occupational status. Unemployed participants scored higher in RLS severity questionnaires. Quality of life scores for participants with government jobs were higher, although not statistically significant. Another study in the US found that, on average, patients experienced a one-day decrease in work productivity per week due to RLS (Allen, 2011). In a 2015 study by Durgin T in the US on the human and economic burden of Restless Legs Syndrome, work productivity was assessed using the Work Productivity and Activity Impairment-General Health tool. The research revealed a significant decrease in work productivity and a decline in the likelihood of workforce participation due to RLS. This productivity decline included days of absence from work and subpar performance on days individuals were present. The study also found that higher severity of RLS correlated with greater reductions in work productivity (Durgin, 2015).\u003c/p\u003e \u003cp\u003eOur study's average RLS-QoL Summary scale score was 69.55, ranging from 31.67 to 96.67. Participants' average score on the IRLSS tool was 17.63, ranging from 4 to 35. In Linda Abetz's study, participants were classified into mild, moderate, and severe groups based on the severity assessment tool. There were 24 individuals in the mild group, 29 in the moderate group, and 23 in the severe group (Abetz et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). The average RLS-QoL Summary scale score for these groups was 84.48, 62.93, and 37.47, respectively. In line with the findings of the Linda Abetz study, our research also demonstrated that as the severity of restless legs syndrome increased, the quality of life of those affected decreased.\u003c/p\u003e \u003cp\u003eWhen validating the Hindi version of the specified questionnaire (Vishwakarma, 2012), individuals with this syndrome had an average RLS-QoL score of 29.8. Similarly, in the validation of the Turkish version (G\u0026uuml;ler S, Nesrin Turan, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), the average RLS-QoL score for participants with RLS and the control group was reported as 44.80\u0026thinsp;\u0026plusmn;\u0026thinsp;17.27 and 93.49\u0026thinsp;\u0026plusmn;\u0026thinsp;9.73, respectively, aligning with the results of our study. The results of this study indicated good internal consistency of the tool, with a Cronbach's alpha of 0.89 in the Persian version, which is in line with previous studies. In the Linda Abetz study, Cronbach's alpha was reported as 0.92, and the test-retest reliability after two weeks was 0.84 (Abetz et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). Regarding the reliability assessment of the Turkish version of this tool, Cronbach's alpha was reported as 0.975 (G\u0026uuml;ler \u0026amp; Nesrin Turan, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), and for the Hindi version, it was reported as 0.85 (Vishwakarma et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our study, this tool was evaluated with SF-36 and IRLSS questionnaires for concurrent validity assessment, and a significant correlation was observed between them.\u003c/p\u003e \u003cp\u003eIn Linda Abetz's study, the tool showed a notable correlation with the SF-36 Mental Components Scale (MCS), with only question 17 correlating significantly with the SF-36 Physical Components Scale (PCS). In our study, the Persian version significantly correlated with the SF-36 tool. Additionally, when compared with the IRLS-PV questionnaire, higher severity in IRLS-PV was associated with poorer RLS-QoL scores (Abetz et., 2005). In the Turkish version (G\u0026uuml;ler \u0026amp; Nesrin Turan, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), this tool significantly correlated with the ISI and IRLSSG questionnaires. In the Hindi version (Vishwakarma et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), a significant correlation was observed with the ISI questionnaire in patients with sleep disorders. However, the Hindi version did not show a significant correlation with the IRLSSG tool, and in the Turkish version, the observed correlation needed to be stronger. The probable reason for this discrepancy may be the difference in the duration of symptoms, as IRLSSG considers the symptoms over the past week.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study indicated that the Persian adaptation of the RLS-QoL questionnaire demonstrates suitable face validity, content validity, concurrent validity, and strong reliability. Moreover, it is user-friendly, requiring only about 10 minutes to complete. Its succinct nature effectively captures key facets of life influenced by Restless Legs Syndrome. Given these attributes, this questionnaire holds promise as a valid instrument in research, clinical trials, and post-treatment monitoring.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLimitations:\u003c/h2\u003e \u003cp\u003eIn children with RLS, cognitive disorders, ADHD, sleepwalking, night terrors, and other issues may be present (Facheris et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Therefore, similar to adults, it is necessary to investigate and treat secondary RLS issues in children. This tool has been evaluated in individuals above 18 years of age, and its application in children and adolescents should be studied. The questionnaire has been translated into Persian, and understanding it may be difficult for the Iranian population to speak languages other than Persian. Therefore, it is recommended that translations be made and validated in other common languages in Iran. Test-Retest examination was not conducted in our study, and it is essential to consider in future studies.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eADHD Attention deficit hyperactivity disorder\u003c/p\u003e \u003cp\u003eRLS-QoL Restless legs syndrome-Quality of life\u003c/p\u003e \u003cp\u003eCVR Content validity ratio\u003c/p\u003e \u003cp\u003eCVI Content validity index\u003c/p\u003e \u003cp\u003eMSC Mental component summary\u003c/p\u003e \u003cp\u003ePCS Physical component summary\u003c/p\u003e \u003cp\u003eIRLSS International restless legs syndrome severity\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Kerman University of Medical Sciences with the ethics code IR.KMU.AH.REC.1401.216, in accordance with the declaration of Helsinki. All participants are required to provide \u0026nbsp;written informed consent before inrolment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailablity of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData and materials will we available upon \u0026nbsp; reasonable requests to corresponding authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFundings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public commercial or not for profit sectors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMSH : concept , definition of intellectual content , \u0026nbsp;clinical studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFJ : design , litterature search\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAT : data analysis , statistical analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMA : manuscript prepartion , manuscript editing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRP :guarantor , manuscript review , data acquisition , clinical studies , literature search\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are thankful to MAPI research trust for allowing us to use the instruments used in this study. We would like to sincerely thank the patients who participated in this study for their valuable cooperation\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbetz L, Vallow SM, Kirsch J, Allen RP, Washburn T, Earley CJ. (2005). Validation of the restless legs syndrome quality of life questionnaire. \u003cem\u003eValue in Health, 8\u003c/em\u003e(2), 157\u0026thinsp;\u0026ndash;\u0026thinsp;67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1524-4733.2005.03010\u003c/span\u003e\u003cspan address=\"10.1111/j.1524-4733.2005.03010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. x.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAllen RP, Bharmal M, Calloway M. Prevalence and disease burden of primary restless legs syndrome: results of a general population survey in the United States. Mov Disord. 2011;26(1):114\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsghari Moghaddam M, Faghehi S. Validity of the sf-36 health survey questionnaire in two Iranian samples. Clin Psychol Personality. 2003;1(1):1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBecker PM. The biopsychosocial effects of restless legs syndrome (RLS). Neuropsychiatric disease treatment. 2006;2(4):505\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDurgin T, Witt EA, Fishman J. The humanistic and economic burden of restless legs syndrome. PLoS ONE. 2015;10(10):e0140632. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0140632\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0140632\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFacheris MF, Hicks AA, Pramstaller PP, Pichler I. Update on the management of restless legs syndrome: existing and emerging treatment options. Nat Sci Sleep. 2010;2:199\u0026ndash;212.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalters AS, LeBrocq C, Dhar A, Hening W, Rosen R, Allen RP, Trenkwalder C. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med. 2003;4(2):121\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eG\u0026uuml;ler S, Nesrin Turan F. Turkish version of the Johns Hopkins Restless Legs Syndrome Quality of Life Questionnaire (RLS-QoL): validity and reliability study. Quality Life Research. 2015;24(11):2789\u0026ndash;94. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11136-015-1003-x\u003c/span\u003e\u003cspan address=\"10.1007/s11136-015-1003-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKubo K, Sugawara N, Kaneda A, Takahashi I, Nakamura K, Nakaji S. Relationship between quality of life and restless legs syndrome among a community-dwelling population in Japan. Neuropsychiatr Dis Treat. 2016;12(12):809\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/NDT.S102089\u003c/span\u003e\u003cspan address=\"10.2147/NDT.S102089\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMasuko AH, Carvalho LB, Machado MA, Morais JF, Prado LB, Prado GF. Translation and validation into the Brazilian Portuguese of the restless legs syndrome rating scale of the International Restless Legs Syndrome Study Group. Arq Neuropsiquiatr. 2008;66:832\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMontazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The short form health survey (SF-36). Translation and validation study of the Iranian version. Qual Life Res. 2005;14(3):875\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11136-004-1014-5\u003c/span\u003e\u003cspan address=\"10.1007/s11136-004-1014-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMungan S, Ozcan M, Orhan G, Titiz A, Arli B, Koseoglu S. Clinical and polysomnographic features of patients with Restless Legs Syndrome. J Pak Med Assoc. 2016;66(5):568\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeeman MV. Why are women prone to restless legs syndrome? Int J Environ Res Public Health. 2020;17(1):368. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph17010368\u003c/span\u003e\u003cspan address=\"10.3390/ijerph17010368\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilber MH, Buchfuhrer MJ, Earley CJ, Koo BB, Manconi M, Winkelman JW. (2021). The management of restless legs syndrome: an updated algorithm. \u003cem\u003eMayo Clinic Proceedings\u003c/em\u003e; \u003cem\u003eElsevier, 96\u003c/em\u003e(7), 1921\u0026ndash;1937. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003eDoi.org/10.1016/j.mayocp.2020.12.026\u003c/span\u003e\u003cspan address=\"Doi.10.1016/j.mayocp.2020.12.026\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMolahosseini S, Mohammadzadeh S, Kamali P, Tavakoli Shooshtari M. Frequency of sleep disorder and restless legs syndrome in patients referring to hemodialysis units in university hospitals in Tehran in 2003. Med Sci J Islamic Azad Univesity-Tehran Med Branch. 2005;15(1):27\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVishwakarma K, Lahan V, Gupta R, Goel D, Dhasmana D, C., and, Sharma T. Translation and validation of restless leg syndrome quality of life questionnaire in Hindi language. Neurol India. 2012;60(50):476\u0026ndash;80. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/0028-3886.103188\u003c/span\u003e\u003cspan address=\"10.4103/0028-3886.103188\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalters AS, Frauscher B, Allen R, Benes H, Chaudhuri KR, Garcia-Borreguero D. Review of quality-of-life instruments for the restless legs syndrome/Willis-Ekbom Disease (RLS/WED): Critique and recommendations. J Clin Sleep Med, \u003cem\u003e10\u003c/em\u003e(12), 1351\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003eDoi.org/10.5664/jcsm.4300\u003c/span\u003e\u003cspan address=\"Doi.10.5664/jcsm.4300\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Restless legs syndrome, quality of life, Restless Legs Syndrome Quality of Life Questionnaire","lastPublishedDoi":"10.21203/rs.3.rs-6688710/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6688710/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRestless legs syndrome is a common condition associated with a decrease in the quality of life of affected individuals. Considering the responsiveness of the Restless Legs Syndrome Quality of Life Questionnaire (RLS-QoL) in clinical and research interventions in various countries, we translated it into Persian and examined its validity and reliability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study was cross-sectional and conducted on a sample of a hundred patients with restless legs syndrome. Initially, the Johns Hopkins questionnaire was translated into Persian and then into English by another person and sent for final approval to the questionnaire's creator. Fifteen psychiatry and sleep experts reviewed the tool's formal and content validity. For concurrent validity assessment, this questionnaire and the SF-36 and IRLSS questionnaires were completed simultaneously by patients with this syndrome. Spearman's correlation coefficient between the scores of these questionnaires was calculated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results showed that this questionnaire is valid. Spearman correlation test results showed a significant relationship between RLS-QoL, SF-36, and IRLSS questionnaire results and indicated that this questionnaire is suitable for assessing patients' quality of life. The Cronbach's alpha score for the Persian version of the RLS-QoL questionnaire in the study population was reported as 0.89.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of the present study demonstrated that the Persian version of the RLS-QoL questionnaire is valid and reliable and can be used as a valid tool in clinical, research, and post-treatment follow-up trials.\u003c/p\u003e\n\u003cp\u003eClinical trial number: Not applicable\u003c/p\u003e","manuscriptTitle":"Psychometrics of Persian Version of the Restless Legs Syndrome Quality of Life Questionnaire (RLS-QoL): A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-30 14:40:58","doi":"10.21203/rs.3.rs-6688710/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bb81181b-4782-4c96-b89a-0d5180e04cae","owner":[],"postedDate":"June 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-01T06:08:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-30 14:40:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6688710","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6688710","identity":"rs-6688710","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}