Abstract

Objectives: The purpose of the study was to determine the level of awareness of restless legs syndrome in individuals admitted to primary health care services.

Patients and Methods: This survey was conducted with 240 participants (99 males, 141 females; mean age: 32.6±13.1 years; range, 18 to 78 years) between July 2020 and July 2021. In the first stage of the survey, the demographic characteristics of the participants (those who admitted to primary health care services to receive health care), such as age, sex, and educational status, were examined. In the second stage, the survey questions were asked to the participants to determine the level of awareness of restless legs syndrome, and in the third stage, the participants answered the questions about the International Restless Legs Syndrome Study Group criteria to determine whether they had restless legs syndrome.

Results: Of the respondents, 37.1% answered “Yes” to the question, “Have you ever heard of restless legs syndrome?” When the participants were asked the question, “Do you know what this disorder is this rate decreased to 30.8%. The rate of the patients who answered “Yes” to all four questions of the International Restless Legs Syndrome Study Group diagnostic criteria was 28.1%.

Conclusion: Although the number of patients meeting the International Restless Legs Syndrome Study Group diagnostic criteria is high, a small number of patients have information about the disease. It is of major importance for the public health to have more information on this disorder that affects quality of life and sleep.

Introduction

Restless legs syndrome (RLS)/WillisEkbom disease is a sensorimotor disorder that particularly affects the legs.[1] The diagnosis is made based on the diagnostic criteria of the International Restless Legs Syndrome Study Group (IRLSSG).[2] The prevalence of RLS varies regionally. Its prevalence is between 5 and 12% in the European population, 1 and 8% in Central Asian countries, and less than 1% in African countries.[3] Although the disease is common, since the symptoms are not known exactly, it is rarely diagnosed.[4,5] The prevalence of RLS in Türkiye has been reported to be between 2.5 and 7%.[4,6,7] Studies related to awareness of RLS in Türkiye are lacking or limited. Hence, the purpose of our study was to determine the level of awareness of RLS in individuals admitted to primary health care services.

Patients and Methods

This survey study was conducted with 240 participants (99 males, 141 females; mean age: 32.6±13.1 years; range, 18 to 78 years) at the Kahramanmaraş Sütçü Imam University, Faculty of Medicine Department of Neurology between July 2020 and July 2021. The study population was randomly selected from individuals who applied to primary health care services in the province of Kahramanmaraş, Türkiye. In the first stage of the survey, the demographic characteristics of the patients, such as age, sex, and educational status, were recorded. In the second stage, the survey questions were asked to the participants to determine their level of awareness of RLS, and in the third stage, the participants answered the questions about IRLSSG criteria to determine whether they had RLS (Table 1). In addition, the study group was asked whether there were any members of their family previously diagnosed with RLS. Those who had dementia or severe cognitive impairment were excluded from the study.

Table 1. Essential diagnostic criteria for restless legs syndrome

Statistical analysis

All analyses were performed using the IBM SPSS version 21.0 software (IBM Corp., Armonk, NY, USA). Descriptive analyses were expressed as frequencies and percentages for categorical variables and mean±standard deviation (SD) (normally distributed data) or median for continuous variables (nonnormally distributed data). The Kolmogorov-Smirnov test and histogram analysis were used to assess the distribution of the data. Spearman’s correlation analysis was used to evaluate the association between the education level and the number of correct answers. A p value <0.05 was considered statistically significant.

Results

The sociodemographic characteristics of the participants are shown in Table 2. The most common chronic diseases were hypertension, diabetes, asthma, thalassemia, and migraine. Two participants stated that they were diagnosed with RLS, and these individuals were diagnosed by an orthopedist. Thirteen participants stated that they had a diagnosis in their family, and seven of these participants stated that they were the mother of the affected individual, two were the sibling, one was the father, and one was the grandmother. The questionnaire used to determine awareness of RLS is presented in Table 3, and other answers about awareness of RLS are demonstrated in Table 4.

Table 2. Sociodemographic characteristics of the participants

Table 3. Questionnaire to determine awareness of restless legs syndrome

Table 4. Information of participants about restless legs syndrome

Of the participants, 28.1% answered all questions with “Yes”. The sex distribution of patients who were diagnosed with RLS is given in Table 5. In the study group, 29.1% of the females were diagnosed with RLS, and this value was significantly higher than the rate of males (p=0.021).

Table 5. Distribution of people diagnosed with RLS screening test by sex

Discussion

Restless legs syndrome is a sensorimotor disorder characterized by dysesthesia or discomfort in the extremities, increased symptoms after physical inactivity, relaxation after motor activity, and symptoms worsening at night.[8] In prevalence studies using different methodologies, the rates of RLS have been reported to vary between 2.5 and 29%.[4] In addition, prevalence rates differ according to ethnicity. An important issue with this disease is the low awareness of individuals, which lowers the quality of life as the rates for seeking medical advice and treatment are reduced.

In a study conducted in the province of Ordu, Türkiye, the students at the university were interviewed based on the IRLSSG diagnostic criteria, and 18.4% of the participants met the diagnostic criteria of RLS. However, none of the students who met the criteria had sought medical advice, and none of them had been diagnosed with RLS. In addition, only 23.3% of the students diagnosed with RLS gave a positive answer when they were asked if they would seek medical advice for their complaints, even though they are highly educated. Of the students who considered seeking medical advice, the majority stated that they would admit to the department of orthopedics, and neurology was ranked number two.[9]

In the prevalence and awareness study of Hadjigeorgiou et al.[10] conducted in Greece, only 7.7% of the participants answered “Yes” when they were asked if they had heard of RLS. In the prevalence study of Helvaci Yılmaz et al.,[4] the participants who met the criteria of IRLSSG were reevaluated by two neurologists, and 39 patients were diagnosed with RLS. Of these, only 14 had suspected the disease, but they had not presented to a hospital, while seven had presented to a hospital, but they were not correctly diagnosed as they applied to the wrong department, and the rest of the patients thought that this situation was not a disease that required medical advice or there was no treatment for it.

Unlike previous studies, we conducted our study to determine the level of awareness of the society. Previous studies have mostly aimed to determine the prevalence rates. As we predicted, the awareness of the society on this disorder is quite low. Even though 80% of the participants graduated a university, only 37.1% of respondents answered “Yes” to when they were asked if they heard of RLS. This rate further decreased when the participants were asked if they knew what this disorder was. The final rate was 25.8%, which was in response to the question, “Do you know the symptoms?” Another situation that restricts patients' treatment opportunities is that the patients do not know which department to admit to since the level of knowledge about the disease is insufficient. Only 14.2% of respondents answered “Yes” when they were asked if they knew which department treats this condition.

Despite the low rates of awareness, the rate of the patients who answered “Yes” to all four questions of IRLSSG diagnostic criteria was 28.1%. In our study, the prevalence rate was found to be higher than in other studies according to the same criteria. The reason for this can be the fact that patients who participated in the questionnaire were not reevaluated in terms of RLS by any neurologic examination by another neurologist since we particularly conducted a study on awareness. In other prevalence studies, after questioning the diagnostic criteria, a neurological examination has been performed and patients have been diagnosed with RLS.[4,6] In accordance with the literature, the number of females meeting the IRLSSG diagnostic criteria was statistically higher than that of males.[11]

In conclusion, even though there are many studies focusing on determining the prevalence of RLS, the number of studies on awareness is low. In our study, we preferred the department of family medicine as we thought that the distribution of individuals would be close to that of the general population. Despite the fact that the number of patients meeting the IRLSSG diagnostic criteria was high, only a few patients had information about the disease. It is of major importance for public health to have more information on this disorder that affects the quality of life and sleep.

Citation: Tuğan Yıldız B, Tuncel Berktaş D, Taş F, Erdoğan A. The level of knowledge about restless legs syndrome in the population that apply to primary health care services. Parkinson Hast Harek Boz Derg 2022;25(2-3):35-39. doi: 10.5606/phhb.dergisi.2022.5.

The study protocol was approved by the Kahramanmaraş Sütçü Imam University Faculty of Medicine Ethics Committee (reference number: 07/20.03.2019). The study was conducted in accordance with the principles of the Declaration of Helsinki.

A written informed consent was obtained from each patient.

Data Sharing Statement:
The data that support the findings of this study are available from the corresponding author upon reasonable request.

Conceptualization: B.T.Y., D.T.B.; Formal analysis: A.E., F.T.; Writing-original draft: B.T.Y., D.T.B., F.T., A.E.; Writing-review & editing: B.T.Y., D.T.B., F.T., A.E.; Supervision: B.T.Y., D.T.B., F.T., A.E.

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

The authors received no financial support for the research and/or authorship of this article.

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