The International Restless Leg Scale

RESTLESS LEGS SYNDROME RATING SCALE
Ask the patient to rate his or her symptoms for the following 10 questions. The patient, not the examiner, should make the ratings, but the examiner should be available to clarify any misunderstandings the patient may have about the questions. The examiner should mark the patient’s answers on the form. Point values are in parentheses after each answer.

Please rate your average symptoms during the preceding week
Overall, how would you rate the restless legs syndrome (RLS) discomfort in your legs or arms?*

0 = None1 = Mild2 = Moderate3 = Severe4 = Very Severe
Overall, how severe was your RLS as a whole?*

0 = None1 = Mild2 = Moderate3 = Severe4 = Very Severe
Overall, how would you rate the need to move around because of your RLS symptoms?*

0 = None1 = Mild2 = Moderate3 = Severe4 = Very Severe
How often did you have RLS symptoms?*

0 = Never1 = Occasionally; one day or less2 = Sometimes; two to three days3 = Often; four to five days4 = Very often; six to seven days
Overall, how much relief of your RLS arm or leg discomfort did you get from moving around?*

0 = No RLS symptoms; question does not apply1 = Complete or almost complete relief2 = Moderate relief3 = Mild relief4 = No relief
When you had RLS symptoms, how severe were they onan average day?*

0 = None1 = Mild; less than one hour per 24 hours2 = Moderate; one to three hours per 24 hours3 = Severe; three to eight hours per 24 hours4 = Very severe; at least eight hours per 24 hours
Overall, how severe was your sleep disturbance because of your RLS symptoms?*

0 = None1 = Mild2 = Moderate3 = Severe4 = Very Severe
Overall, how severe was the impact of your RLS symptoms on your ability to carry out your daily affairs (for example carrying out a satisfactory family, home, social, school, or work life)?*

0 = None1 = Mild2 = Moderate3 = Severe4 = Very Severe
How severe was your tiredness or sleepiness because of your RLS symptoms?*

0 = None1 = Mild2 = Moderate3 = Severe4 = Very Severe
How severe was your mood disturbance because ofyour RLS symptoms (for example, angry, depressed, sad, anxious, or irritable)?*

0 = None1 = Mild2 = Moderate3 = Severe4 = Very Severe
Total Score:
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RESTLESS LEGS SYNDROME RATING SCALE