SR.

N ITEM GUIDLINE
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1 Title “A comparative study on effectiveness of stretching exercises
versus thermotherapy on rest leg syndrome among staff nurses
in selected hospital”.
2 Introduction "It's not whether you get knocked down, it's whether you get
up"

Restless Legs Syndrome (RLS), also known as Willis-Ekbom

disease, is a neurological disorder that triggers an overwhelming
urge to move the legs, often accompanied by uncomfortable
sensations like tingling, burning, or itching. This condition can
significantly impair daily life, causing sleep disruptions, fatigue,
and decreased productivity. RLS is a common yet
underdiagnosed sensorimotor disorder that can manifest as a
compelling need to move the limbs, paired with unpleasant
sensations in the lower limbs. These sensations typically subside
with physical activity and rest. While some individuals with mild
symptoms may not require medication, others with severe
symptoms that impact daily life may need pharmacological
treatment. The treatment approach can vary depending on
symptom severity, ranging from temporary and immediate to
continuous. Given the association between RLS and various
medical conditions, such as Parkinson's disease, kidney disease,
and pregnancy, it's essential for nurses across specialties to
understand the symptoms, coping mechanisms, and treatment
principles. Nursing care plays a vital role in the diagnosis and
management of RLS, and being aware of potential adverse
effects is crucial. (1)

Restless Legs Syndrome (RLS) is a neurological disorder that

affects millions of people worldwide. It's characterized by an
uncontrollable urge to move your legs, often accompanied by
strange, unpleasant sensations deep within your legs. These
sensations typically occur during periods of rest or inactivity,
especially in the evening and at night, and can be relieved by
movement. Despite its prevalence, RLS is often misdiagnosed or
underdiagnosed. Physical examinations are usually normal, and
objective neurological signs are rare, except in cases where RLS
is secondary to another condition. Interestingly, more than half
of people with RLS have a family history of the condition,
suggesting a strong genetic component. Research suggests that
RLS symptoms are triggered by a combination of iron deficiency
and dopamine dysfunction in the brain. Community surveys
indicate that around 5-10% of people in Europe and North
America experience RLS symptoms, although many cases go
undiagnosed. This review aims to provide an overview of RLS,
including its clinical features, diagnostic criteria, and treatment
options. We'll also explore the latest research on the genetics
and pathophysiology of RLS, as well as the effectiveness of
medical treatments, such as dopamine agonists. (2)

Abeer Hassan Shamekh Naglaa Zaki Hassan etal (2022) Effect of

stretching exercises versus thermotherapy on restless legs
syndrome symptoms, pain, and quality of sleep among pregnant
women. This study the approach used is qualitative Study &
design is A quasi-experimental study. Sample for this study is of
60 pregnant women. the setting of antenatal outpatient clinic of
Maternity University Hospital. The population were 60 pregnant
women. Results: the severity of RLS symptoms declined to a
mild level among pregnant women immediately and after one
week of performing stretching exercises (53.3%, 93.3%),
compared to 6.7% and 63.3% of those who applied
thermotherapy (p=0.001, p= 0.02) (3)

NEED OF STUDY
Nurses working in intensive care units face a unique set of
challenges that can take a toll on their mental and physical well-
being. The high-stress environment and demanding nature of
their job can lead to fatigue, which can have serious
consequences on their ability to provide quality care. One of the
lesser-known consequences of fatigue among nurses is Restless
Legs Syndrome (RLS), also known as Willis-Ekbom Disease. These
sensations can occur during periods of rest or inactivity,
especially in the evening or at night. The exact causes of RLS are
still unknown, but research suggests that it may be linked to
dopamine levels, iron deficiency, and poor nutrition. Nurses
working in critical care units are particularly vulnerable to RLS
due to their demanding work schedules, prolonged standing,
and excessive use of muscles. Studies have shown that RLS can
have serious consequences on a person's quality of life,
including decreased sleep quality, increased risk of depression
and anxiety, and reduced productivity. In fact, research suggests
that approximately 25% of nursing staff suffer from RLS, which is
also associated with shift work disorder. Given the prevalence of
RLS among nurses and its potential consequences on their well-
being and job performance, it's essential to investigate the
relationship between fatigue and RLS in critical care nurses. (4)

Maryam Ameri, Seyed Mohammad Mirhosseini etal (2021)

Prevalence of Restless Legs Syndrome and Its Relationship with
Fatigue in Critical Care Nurses. Objective of This study aimed to
 investigate the prevalence of RLS and its relationship with
fatigue in critical care nurses. Population was the staff nurse. In
this study the approach used is qualitative Method. This cross-
sectional study .the sample size for this study is 200 nurses of
critical care units. The setting is Shahroud hospitals the sample
selection method use is the census sampling method. Data
collection tools included the RLS questionnaire and the
Multidimensional Fatigue Inventory. The results showed that
72% of the subjects had moderate to high RLS, and their mean
fatigue was 55.31 ± 10.53. By increasing one point in the score
of RLS and 1 year of critical care nursing experience, the fatigue
score increases by 0.3 and 0.71. Conclusions: Considering the
relationship between fatigue and RLS in critical care nurses,
supportive interventions seem necessary to reduce the effects of
these two components. (5)
3 Primary Which nursing intervention is more effective in rest leg
Research syndrome among staff nurse?
Question :-
4 Secondary
Research
Question 1 :-
(if any)
5 Secondary
Research
Question 2 :-
(if any)
6 Primary H0: - There will be no significant difference in rest leg syndrome
Hypothesis :- among staff nurses who has apply stretching exercise.
H01: - There will be no significant difference in rest leg
syndrome among staff nurses who has apply the thermotherapy.
H02: - There will be no significant difference between stretching
exercise and thermotherapy for rest leg syndrome among staff
nurses.
7 Other
Hypothesis 1:-
(if any)
8. Other
Hypothesis 2:-
(if any)
9 Review of “The review is defined as a broad comprehensive in depth
Literature :- systematically and critical review of scholarly publication,
unpublished printed or audio-visual materials and personal
communication”. -BT. Basavathappa (2000)

The review of literature is helpful to gain strong knowledge to

carry out research. For the purpose of logical sequence, the
review of literature has been organized under the following
sections.
LITERATURE REVIEW HAS THE FOLLOWING THREE SECTIONS:
A. Review related to Knowledge regarding Rest leg syndrome.
B. Review related to effectiveness of stretching exercises in rest
leg syndrome.
C. Review related to effectiveness of thermotherapy in rest leg
syndrome.
D. Review related to effectiveness of stretching exercises versus
thermotherapy in rest leg syndrome.

A. Review related to Knowledge regarding Rest leg syndrome

F Izadi, SA Mazhari etal (2024) The Effect of Aromatherapy with

Lavender on Pain of Needle Insertion and Severity of Restless
Legs Syndrome in Hemodialysis Patients; a Systematic Review
and Meta-analysis Pain experienced during the insertion of a
catheter into the arteriovenous fistula (AVF) and restless legs
syndrome(RLS)are prevalence tissues among
Hemodialysis(HD)patients. The primary objective of this
systematic review and meta-analysis was to consolidate the
findings from randomized clinical trial (RCT) studies examining
the impact of aromatherapy with lavender on the pain
associated with AVF catheter insertion and RLS in HD patients.
Methods: A systematic search was conducted on PubMed, Web
of Science,
Scopus,Cochrane,Embase,ClinicalTrials.gov,andGoogle Scholar
search engine from inception to August 1, 2022, using keywords
extracted from Medical Subject Headings, such as
“Aromatherapy”, “Lavender”, “Arteriovenous fistula”, “Pain”,
“Restless legs syndrome”, and “Hemodialysis”. Results: Finally,
eleven articles were included in this systematic review and
meta-analysis. The results showed that aromatherapy reduced
the average pain of catheter insertion in AVF compared to the
control group (Standard Mean Difference:-1.60, 95% Confidence
Interval:-2.32 to-0.87, Z=4.32, I2:90.3%, P<0.001). Also,
aromatherapy massage reduced the average severity of RLS
compared to the control group, which was statistically
significant (Weighted Mean Difference:-13.21, 95% Confidence
Interval:-17.50 to-8.91, Z=6.03, I2:93.0%, P<0.001). Also, the
subgroup analysis showed that lavender in the intervention
group significantly decreased the pain intensity compared to the
"no intervention" group (P<0.001), yet it was not significant
compared to the placebo group (P=0.12). Conclusion: In
summary, the findings indicate a notable reduction in catheter
insertion pain in AVF and relief from RLS among HD patients
through the use of lavender essential oil. As a result, future
research is encouraged to include a comparison of lavender’s
effects with those of a placebo group. (3)

Li-Hung Tsai , Chuan-Mei Chen etal (2022)Acupressure reduces

the severity of restless legs syndrome in hemodialysis patients: A
cluster randomized crossover pilot study Restless legs syndrome
(RLS), a neurological disorder, often affects sleep quality in
hemodialysis patients. This study aimed to evaluate
acupressure's effect on the severity of RLS symptoms and sleep
quality in hemodialysis patients with RLS. Methods: This study is
a cluster-randomized crossover pilot study. Patients were
randomized to two sequences: acupressure for one month and
observation for another month (AC); and observation for one
month and acupressure for another month (CA). For the four-
week acupressure intervention, patients received 36 min of
acupressure three times weekly during their hemodialysis
sessions. The acupoints were on the bilateral lower limbs,
including Zusanli (ST36), Yanglingquan (GB34), Sanyinjiao (SP6),
Xuanzhong (GB39), Chengshan (BL57), and Taichong (LR3). RLS
severity and sleep quality (measured with the Pittsburgh sleep
quality index, PSQI) were measured at baseline, month 1, and
month 2. Results: AC sequence (n ¼ 14) wassimilar to the CA
sequence (n ¼9) in terms of gender, age, education,
employment, marital status, comorbid disease, BMI, duration of
dialysis, medication for RLS and insomnia, RLS severity, and
PSQI. The general linear mixed model revealed no significant
carryover effect on RLS severity, PSQI, and the seven subscales
of PSQI. A significant treatment effect (acupressure) was only
observed in RLS severity (p ¼ 0.0013) but not in PSQI and the
seven subscales. The significant period effect was observed in
RLS severity (p ¼ 0.0250) and the subscale of sleep disturbance
(p ¼ 0.0021). (4)

N.Jahan1, A.Mehmood2,(2024) effect of Restless leg syndrome

on the sleep quality of medical students of university in rurals
Sindh stless legs syndrome (RLS) is a neurological condition
characterized by unpleasant sensations, cramps, and a gnawing
feeling, typically occurring during periods of rest or sleep.
Despite established diagnostic criteria by the International RLS
Study Group (IRLSSG), RLS remains underdiagnosed, although
its symptoms are manageable and preventable.Materials and
Methods:The study targeted medical students at Bhitai Dental &
Medical College, Mirpurkhas. A sample of 200 students was
selected, excluding those with trauma, infection, or recent viral
infections. Data collection involved administering IRLSSG
standard questionnaires after obtaining ethical review board
approval and informed consent from participants. Statistical
analysis was conducted using SPSS-25, with percentage, mean,
standard deviation, and chi-square tests to assess RLS severity
and scores.Results:Of the 200 participants, 119 were male and
81 females, with an average age of 1.26 years (SD=.544). Sleep
problems were more prevalent in males, with 21.0% having
moderate and 12.6% having severe RLS symptoms. Among
females, 27.0% had moderate, 21.5% had mild, and 15.0% had
severe RLS symptoms, while 24.5% showed no symptoms. The
statistical analysis revealed a non-significant value
(p=.296).Conclusion:The study concluded that RLS is more
common among male students than females, with symptoms
ranging from mild to moderate severity(5)

Prabhjot Kaur, Surinder Jaspal, Tejinder Kaur (2024)

Nursing Intervention Strategies and Their Effectiveness on
Restless Leg Syndrome and Psycho-Social Problems in Chronic
Kidney Disease Patients Chronic kidney disease is a global health
problem affecting 843.6 million people with 1 million deaths and
the 12th leading non-communicable cause of death worldwide.
Insomnia is a disturbing problem found in chronic kidney disease
patients, leading to physiological problems like fatigue, edema,
and restless leg syndrome most of the time. The objective of this
study was to assess the effectiveness of nursing intervention
strategies on physiological and psycho-social problems.
Materials and Methods: A quantitative research approach with
quasi-experimental pre-test and post-test design was used to
assess the effectiveness of nursing intervention strategies on
physiological and psycho-social problems among 30 chronic
kidney disease patients, 15 in control and experimental each,
admitted in a selected hospital of Punjab. Convenience sampling
was used to assign the samples, and data were collected
through an interview schedule by using standardized scales. IEC
number: 2017/08/5051. Results: The result of the study showed
that the baseline restless leg syndrome mean score was 9.67,
whereas the psycho-social problem baseline mean score was
79.80, and after post-test, the mean score was reduced to 7.67
in physiological and 66.87 in psycho-social problems in the
experimental group. Intervention was found to be effective in
reduction of physiological and psycho-social symptoms of
chronic kidney disease patients significantly (P ≤ 0.05).
Conclusions: The study showed that nursing intervention
strategies were effective in reduction of physiological and
psycho-social symptoms.(6)

Shreyas Bellur; Suraj Samuel Thota etal (2022) Prevalence and

Predictors of Restless Leg Syndrome in Adolescents and Young
Adults of Bengaluru City, India: A Cross-Sectional Study Restless
leg syndrome (RLS) is a sensorimotor disease characterized by an
urge to move the legs, often caused by uncomfortable and
unpleasant sensations in the legs. It affects the quality of sleep
which in turn affects scholastic performance in children and
predisposes them to cardiovascular diseases in the long run.
Hence, the primary aim of this study was to assess the
prevalence and predictors of RLS, poor sleep quality, and
excessive daytime sleepiness (EDS). Methods: This was a cross-
sectional observational study conducted between September
2017 and March 2020 in Bengaluru, India, including all
consenting Pre University College, Degree College, and Higher
Secondary school students. After parental consent and assent (if
applicable) was obtained, a semi-structured standardized pilot-
tested questionnaire consisting of the RLS diagnostic criteria,
Pittsburgh Sleep Quality Index (PSQI), Epworth sleepiness scale,
and questions on sleep hygiene was administered. The
prevalence was expressed as proportions and 95% confidence
intervals (95% CI). Regression analysis was done to determine
the predictors. Results: The overall prevalence (95% CI;
frequency) of students with RLS, poor sleep quality, and EDS in
our study population was 8.36% (7.54, 9.24; n = 1,544/4,211),
36.67% (35.21, 38.14; n = 1,544/4,211), and 39.87% (38.39,
41.37; n = 1,679/4,211), respectively. PSQI and Epworth score
were the significant predictors of RLS. Age, Epworth score,
knowledge score, and the number of unacceptable sleep habits
were the significant predictors of sleep quality. Female gender,
PSQI, RLS, knowledge score, and the number of unacceptable
sleep habits were the significant predictors of
EDS. Conclusions: The prevalence of RLS, those with poor sleep
quality and EDS among adolescents and young adults was higher
when compared to the historical data of general population in
the same city.(7)

B. Review related to effectiveness of stretching exercises in rest

leg syndrome.

Mohamedalamin Alnoor Altayb Ismail , Islam Daffalla etal

(2024) Efficacy of Aerobic and Stretching Exercises in Managing
Willis-Ekbom Disease (Restless Leg Syndrome) Among
Hemodialysis Patients Restless leg syndrome (RLS) is a
neurological disorder characterized by an irresistible urge to
move the legs, particularly during rest. It significantly affects the
quality of life of hemodialysis patients with high prevalence in
this population. While pharmacological treatments, especially
dopamine agonists (DAs), are commonly used, they often come
with side effects and augmentation phenomena. This systematic
review examines the effectiveness of exercise interventions in
managing RLS among hemodialysis patients. Eight studies,
including randomized controlled trials and quasi-experimental
studies, were analyzed. The interventions primarily consisted of
aerobic exercises (cycling) and stretching exercises, with
durations ranging from eight weeks to six months. The primary
outcome measure was RLS severity, assessed using validated
scales such as the International Restless Legs Syndrome Study
Group (IRLSSG) scale or the Restless Legs Syndrome
Questionnaire (RLSQ). Secondary outcomes included sleep
quality, depression, and physical performance. The results
consistently demonstrated that both aerobic and stretching
exercises significantly reduced RLS severity and improved
related outcomes. The intradialytic nature of some interventions
offered a practical approach to incorporating exercise into
patient routines. While exercise showed comparable efficacy to
DAs in reducing RLS symptoms and improving depression scores,
only DAs significantly enhanced sleep quality in one comparative
study. These findings suggest that exercise interventions may be
a viable non-pharmacological approach to managing RLS in
hemodialysis patients, potentially complementing or reducing
reliance on pharmacological treatments.(8)
Pınar Akbaş a 1, Şengül Yaman Sözbir etal(2023)The effect of
progressive muscle relaxation exercise on the intensity of
symptoms and quality of sleep and quality of life in pregnant
women with restless leg syndrome.ObjectiveThis study,
accordingly, was conducted with the purpose of investigating the
effect of progressive muscle relaxation exercise on the intensity
of restless leg syndrome (RLS) and RLS-related quality of life and
sleep in pregnant women with RLS.Methods This one-centered,
parallel randomized controlled study was conducted with 52
pregnant women. 27–28th of pregnancy, progressive muscle
relaxation exercises training was shown and they were asked to
practice them 3 times a week for 8 weeks.ResultsIt was found
that the RLS Intensity Scale and PSQI posttest mean scores of the
women in experiment group are lower on a statically significant
level than the mean scores of the women in control group
(p = 0.000 and p = 0.001). It was detected that the RLS-Qol
posttest mean scores of the women in the experiment group are
higher than the mean scores in the control group on a
statistically significant level (p = 0.000).ConclusionsIt was seen
that progressive muscle relaxation exercises alleviate RLS
intensity and symptoms and improve RLS-related quality of

life and sleep in pregnant women. (9)

Özge Çoban, ,* Necmiye Ün Yıldırım etal (2023)Effects of

Different Exercise Programs onSymptoms, Sleep, and Quality of
Life in Patients with Primary Restless Legs Syndrome Restless
legs syndrome (RLS) is a sensorimotor disorder that can have a
significantdetrimental impact on the quality of life and
sleep.Objectives Objectives: Our aim was to examine the effects
of aerobic exercise and stretching exercise programs on
symptom severity, sleep, and quality of life in patients with
primary RLS. Methods: A total of 18 patients between the ages
of 22 and 61 were randomly divided into 3 groups as
aerobicexercise, stretching exercises, and control. All exercise
programs were applied 3 times a week for 8 weeks.Evaluations
were performed before and after treatment. Symptom severity
of the patients was evaluated by the International Restless Legs
Syndrome Study Group Rating Scale, sleep was evaluated with
the Pittsburgh Sleep Quality Index and actigraphy, and quality of
life was evaluated with the John Hopkins Restless Legs
Syndrome Quality of Life Questionnaire. Recovery status of the
patients was determined using the post treatment global
change scale. ResultsResults: Aerobic exercise and the stretching
exercise program were found to be effective in decreasing
RLSsymptoms (P = 0.025, P = 0.034) and improving subjective
sleep quality (P = 0.034, P = 0.025), overall sleep quality (P <
0.001, P = 0.034), and quality of life (P = 0.009, P = 0016).
Aerobic exercises were found to be more effective in reducing
wake after sleep onset of sleep (P = 0.048), whereas stretching
exercises reduced sleep disorders (P = 0.025).Conclusion: Both
exercise approaches have been identified as highly effective
approaches in patients with RLS.The treatment can be planned
according to the choice of the available facilities, patient and
clinician preference, and the advantages of the 2 exercise
approaches. (10)

Narges Mohammed Syam(1), Gehan Mohamed Desoky2,(2022)

effects of Progressive Muscle Relaxation Technique on Severity
of Restless Legs Syndrome Among Patients on Maintenance
Hemodialysis Restless legs syndrome (RLS), is one of several
complications that patients on hemodialysis suffer from, it is a
neurological sensory motor disorder, causing sleep disturbances,
and other problems, which lead to daily functioning impairment.
Progressive muscle relaxation is one of the complementary
therapies that have been shown to provide benefits, including
relieved restless legs syndrome, reducing patients’ stress, pain
and anxiety. Aim of the study was to evaluate the effects of
progressive muscle relaxation on the severity of restless legs
syndrome among patients on maintenance hemodialysis.
Research design: A quasi experimental (time series) research
design was utilized, included control comparison group. Setting:
The research was carried out at the hemodialysis unit, Al- Moass
at Alexandria University Hospital. Subjects: A purposive sample
of 60 adult patients, diagnosed with end stage renal failure on
maintenance hemodialysis, and suffering from restless legs
syndrome were selected. They were equally divided into two
groups of 30 patients. Tools of data collection: Three tools were
used for data collection; Hemodialysis patients Structured
Interview Schedule (tool I), International Restless Legs Syndrome
Severity Rating Scale (tool II), and Restless Leg Syndrome
Assessment Sheet (tool III). Results: The severity of restless legs
syndrome significantly decreased in the study group, with a
percent reduction of 38.89% at the 6th session and 61.11% at
the12th session, such decrease was not found among the
control group patients. In addition to, there was a percent
reduction and improvement of sleep pattern, physical activities,
emotional well- being and social activities among the study
group patients after completion of 12th PMR session (46.67 %,
57.78 %, 63.33 % ,55.56 % respectively). Conclusion: Progressive
muscle relaxation technique had high statistical significant
positive effects on severity of restless legs syndrome, improving
sleep pattern, physical activity, emotional wellbeing and social
activities. Recommendations: Progressive muscle relaxation
must be implemented in the therapeutic routine management
to help alleviate the severity of restless legs syndrome
symptoms among patients on maintenance hemodialysis. (11)

Azza Awad Algendy,ZeinabFaried Bahgat etal (2019) Effect of

Muscles Stretching Exercises on Severity of Restless Legs
Syndrome of Adult Patients Undergoing Hemodialysis The
patients undergoing hemodialysis usually have several
complications including restless leg syndrome, which is a
neurological disorder characterized by uncomfortable sensation
of paraesthesia in legs that subsequently causes involuntary and
continuous movement of the lower limbs especially in night
which can lead to; sleep disorder, anxiety, fatigue, depression,
disturbance of ability to work and social isolation. Moderate
exercise may be helpful in relieving restless leg syndrome. The
aim of the study is to assess the effect of muscles stretching
exercises on severity of restless legs syndrome of adult patients
undergoing hemodialysis. A quasi-experimental design was
utilized. Sample: 40 convenience adult patients diagnosed with
renal failure and undergoing hemodialysis. Settings;
Hemodialysis department in the Students Hospital Affiliated to
Tanta University and Elmabra Hospital for Health Insurance.
Data collection: Structured interview used to elicit data which
comprises two tools; Tool 1: Health assessment tool which
include Bio- Socio-demographic characteristics data; Tool 2:
International Restless Legs Syndrome Rating Scale (IRLSRS). Data
was collected through three phases; Assessment,
implementation and evaluation phase through 20 weeks.
Results: Indicated improvement of severity of restless leg
syndrome symptoms of the study group post comparing to pre
muscle stretching exercise. Conclusion: muscles stretching
exercise plays an important role in reducing the severity of RLS
symptoms of adult patients undergoing hemodialysis.
Recommendation: Nurses has to be encouraged to help alleviate
the severity of RLS symptoms by training muscle stretching
exercises to the patients undergoing heamodialysis. (12)

Jenifer Augustina,1 MG Kaviya etal (2020)Effect of

transcutaneous electrical nerve stimulation with stretching and
exercises in restless leg syndrome among pregnant women
Restless legs syndrome also known as Willis-Ekbom disease is a
sensor motor disorder composed of an urge to move with or
without associated discomfort that occurs with inactivity and
improves with movement. The symptoms occur in leg muscles
like calves and thighs. The feet and arms also affected and it
causes the functional disability in pregnant women. Sleep
disorder is typically the biggest complication of this condition.
Unpleasant sensations are deep in the legs. Sensations appear
during periods of rest or inactivity particularly in the evening and
at night and relived by movement. Prevalence of RLS among
pregnant women ranged from 10 to 34%. Aim: The aim of the
study is to prove the effect of Transcutaneous Electrical Nerve
Stimulation (TENS) with Stretching and Exercises in restless leg
syndrome among pregnant women. Objectives: To determine
and prove the effectiveness of TENS with stretching to relive
pain and improve the functional ability in restless leg syndrome
among pregnant women. Materials and Methods: A Quasi-
experimental study was conducted on 30 subjects using
convenient sampling technique based on inclusion and exclusion
criteria. Subjects were allotted into 2 groups i.e., Group A with
15 subjects and Group B with 15 subjects using odd even
method of sampling. Experimental group will be treated with
TENS and Stretching. Control group will be treated with
exercises and massage. Result: Statistical Analysis of Post test for
pain and functional performance revealed that patients who
received Transcutaneous Electrical Nerve Stimulation (TENS)
with Stretching in Group A showed marked improvement
compared to patients who received Massage and Exercises in
Group B. Conclusion: From the result of the study it concluded
that Transcutaneous Electrical Nerve Stimulation (TENS) with
Stretching is more effective than massage and exercises in
subjects with restless leg syndrome among pregnant women(13)
C. Review related to effectiveness of thermotherapy in rest leg
syndrome.

Mohammad Mehdi Mohammadi Maryam Ahmadi

etal(2024)The Effect of Superficial Heat–Cold Application on
theSleep Quality of Patients With Restless Leg Syndrome:A
Systematic Review and Meta-Analysis. Aim: The present study
was conducted to determine the effect of the superficial heat–
cold application on the sleep quality ofpatients with restless leg
syndrome.Design: This study was a systematic review and meta-
analysis.Methods: In the present study, the electronic databases
Scopus, ProQuest, Web of Science, PubMed, SID and Google
Scholarwere searched from their inception to September 2023.
The quality of included studies was evaluated through the
CochraneCollaboration's Risk of Bias Tool, and finally, a meta-
analysis was conducted by calculating standardised mean
differences(SMDs).Results: The meta-analysis results revealed
that superficial heat–cold application improved sleep quality in
patients with RLS(SMD = 0.685, 95% CI: 0.421–0.950). The meta-
regression results showed that as the temperature increased,
the intervention wasmore effective in improving sleep quality (β
= 0.0182, 95% CI: 0.0096–0.0268, p < 0.05). Moreover, the
effectiveness of the inter-vention in improving the sleep quality
of patients with RLS reduced significantly as the duration of
intervention in each session(β = −0.031, 95% CI: −0.059 to
−0.001, p < 0.05) as well as participants' age increased (β =
−0.013, 95% CI: −0.024 to −0.001,p = 0.0259).Patient or Public
Contribution: This research showed that superficial heat–cold
application had the capability to improve thesleep quality of
patients with restless leg syndrome.(14)

Mohammad Mehdi MOHAMMADI, and Ali Akbar(2023)

Investigating the Effect of Temperature Therapy on the Severity
of Restless Legs Syndrome: Systematic Review and Meta-
Analysis Restless legs syndrome (RLS) is a sensorimotor disorder
leading to disturbance of resting, discomfort, stress, and
impaired daytime activity in the sufferers. The present
systematic review and meta-analysis was conducted to
determine the effect of temperature therapy on the severity of
RLS.Methods: The electronic databases of Google Scholar,
ProQuest, Scopus, PubMed, Web of Science, and State Inpatient
Databases (SID) were searched from inception to August 2022.
The Cochrane Collaboration’s Risk of Bias Tool was used to check
the quality of included studies. Meta-analysis was performed by
calculating standardized mean differences (SMDs), using random
effects model, and running Comprehensive Meta-Analysis (CMA)
software version Results: The included studies (n=6) comprised
177 participants, whose mean age was 49.85 years old. The
results of the meta-analysis showed temperature therapy could
reduce the severity of RLS (SMD=−1.520, 95% CI: −2.122 to
−0.918). Regarding the source of heterogeneity, meta-regression
results indicated the efficacy of the intervention in reducing the
severity of RLS enhanced significantly by increasing the duration
of the intervention in each session (β=−0.039, 95% CI −0.076 to
−0.002, P<0.001). The results also showed increasing the
duration (β=−0.039, 95% CI −0.076 to −0.002, P<0.001) and the
temperature of the intervention in each session (β=−0.016, 95%
CI −0.028 to −0.003, P<0.05) significantly enhanced the efficacy
of the intervention in reducing the severity of RLS. The results
also indicated that, among patients with underlying clinical
conditions, the effectiveness of temperature therapy was higher
in hemodialysis patients (β=−2.006, 95% CI −2.736 to
−1.276, P<0.05). The present study findings suggested
temperature therapy could mildly reduce the severity of RLS
symptoms. It was also found that the highest efficacy of this
intervention could be achieved when the higher temperature
was used in fewer treatment sessions in hemodialysis patients.
Based on our findings, this intervention can be included in the
care plan of patients with RLS considering the settings described
to achieve the highest efficacy.(15)

Ariane Park ,Katherine Ambrogi, etal (2020)Randomized pilot

trial for the efficacy of the MMF07 foot massager and heat
therapy for restless legs syndrome
Restless Legs Syndrome (RLS) is a sensorimotor condition with a
wide range of severity. Symptoms negatively affect sleep and
quality of life. Pharmacologic options are not universally
effective and side effects are common. Objective data regarding
non-pharmacologic treatment is limited. The study objective
was to evaluate the efficacy of the MMF07 foot massager and
heat therapy on the severity of RLS symptoms.Methods in this
pilot randomized controlled trial, twenty-eight patients with
diagnosed, bothersome RLS were randomized to four treatment
arms: no active intervention (n = 7), foot massager (n = 8), heat
therapy (n = 6), and foot massager plus heat therapy (n = 7).
Participants completed the RLS Severity Scale, RLS Quality of Life
questionnaire, and the Medical Outcomes Study Sleep scale at
the baseline visit and at the 4-week follow up visit.ResultsFour
weeks post randomization, participants in the massager group
had significant improvement in the RLS severity score (average
difference: -9.0, 95% CI: -16.3, -1.7, p = 0.017) and sleep scale
(average difference: -22.0, 95% CI: -36.5, -7.5, p = 0.005)
compared to the no intervention group. The heat alone group
had a significant improvement in the sleep scale compared to
the no-intervention group (average difference: -17.4, 95% CI: -
32.5, -2.3, p = 0.026). Quality of life improved in the massage
only group compared to control (average difference 25.3, 95%
CI: -2.4, 53.0, p = 0.072).Conclusions Results suggest that the
MMF07 foot massage device and heat therapy may be feasible
and effective treatment options to improve RSL symptoms.(16)

Hadi Jafarimanesh Katayoon Vakilian etal (2020)Effects of

Warm and Cold Footbath on Sleep Quality in Pregnant Women
with Restless Legs Syndrome Sleep disorders are one of the most
common problems during pregnancy and the presence of
Restless legs syndrome in pregnancy can further impair sleep
quality The purpose of this study was to compare the effect of
two methods of cold and warm water immersion on sleep
quality of pregnant women with restless legs syndrome.
Methods: This randomized clinical trial study was performed on
80 pregnant women with restless legs syndrome referred to Arak
Taleghani hospital in 2019. The samples were selected by
convenience method and were randomly divided into two
groups: hot water (group 1) and cold (group 2). Group 1 was
asked to soak their feet in cold water 20 to 25°c every night for
10 minutes and for 2 weeks. Group 2 was asked to soak their
feet in warm water 40 to 45°c every night for 10 minutes and for
2 weeks. Sleep quality was measured between the two groups
and at the beginning and end of the study by Pittzburgh Sleep
Quality Questionnaire. Data were analyzed by SPSS software
(version 23) and Chi-square, independent t-test and paired t-
test. p < 0.05 was considered statistically significant.
Results: Sleep quality in hot water group before and after the
intervention was 7.42 ± 2.46 and 4.91± 2.17, respectively (P =
0.001); in cold water before and after the intervention was 6.50
± 2.56 and 4.47 ±1.86, respectively. There was no statistically
significant difference between the sleep quality scores of the
two groups after the study (p = 0.329).
Conclusion: Intervention with hot water and cold water reduced
the quality of sleep score in pregnant women. As a result, the
mentioned interventions can be used to improve the sleep
quality of pregnant women who are not able to use medical
interventions due to their side effects(17)

D. Review related to effectiveness of stretching exercises versus

thermotherapy in rest leg syndrome.

Tianyang An , Haiyang Sun ,etal(2024)

 Associations of anxiety and depression with restless leg
syndrome: a systematic review and meta-analysis The levels of
anxiety and depression among patients with restless leg
syndrome (RLS) are controversial. The aim of this systematic
review and meta-analysis was to compare the levels of
depression and anxiety among individuals with RLS with those of
healthy controls. Methods: We conducted an extensive
electronic search of the PubMed, Web of Science, EMBASE, and
Cochrane Library databases from their inception dates to 20
June 2023. Studies presenting data on depression and anxiety in
individuals with RLS were included, and a comprehensive meta-
analysis was performed. Twenty-one studies matched the
inclusion criteria. Significantly more depressive symptoms were
present in the individuals with RLS than in those without RLS, as
measured by the Beck Depression Inventory [mean difference
(MD) = 6.58, 95% confidence interval (CI) = 5.54–7.62, p < 0.01;
heterogeneity I2 = 0%, p = 0.99]. Similarly, the results from the
Beck Anxiety Inventory indicated that there were significantly
more pronounced anxiety symptoms in the individuals with RLS
than in those without RLS (MD = 9.30, 95%CI = 7.65–10.94, p <
0.01; heterogeneity I2 = 0%, p = 0.92). The other anxiety and
depression scales also yielded statistically significant results.
Significant heterogeneity was observed in the Hamilton
Depression Rating Scale and Hamilton Anxiety Rating Scale, with
the primary contributing factor probably being the scoring
criteria of the scales. This meta-analysis found that the levels of
depression and anxiety symptoms were significantly higher in
individuals with RLS than in their healthy counterparts.(18)

Aljasani, Samaa Ali Zhamis; Abed, Rajaa Ibrahim etal (2023)

Comparison of stretching exercises and leg massage on the
severity of restless legs syndrome for hemodialysis patients.
Background: Restless legs syndrome is a neurologic condition
resulting in an irresistible urge to move legs. Restless legs
syndrome affects sleep quality and can cause daytime
sleepiness, low energy, irritability, and depression. Lifestyle
changes such as doing regular daily stretching exercises and leg
massage may reduce the severity of the syndrome. Methods: A
quasi-experimental design was used to conduct a study that
started on October 2022 on 90 hemodialysis patients in
hemodialysis centers in Wasit and Thi-Qar to compare the
effectiveness of stretching exercises and massage on the
severity of restless legs syndrome among hemodialysis patients
using the International Restless Legs Syndrome Study Group
rating scale. Data were analyzed using Friedman, Kruskal Wallis,
and Mann-Whitney U Test with IBM's Statistical Package for the
Social Science (SPSS) statistic software. Results: The study found
there was a significant difference in the severity of restless legs
syndrome when comparing the severity before the
interventions, at the end of the first week, and at the end of the
second week (P-value=<0.001) among both the stretching
exercises and leg massage groups. Conclusion: stretching
exercises and massage were effective in decreasing the severity
of restless legs syndrome, with stretching exercises being more
effective.(19)

Kubasch, Julia MD etal (2023)Hydrotherapy and acupressure in

restless legs syndrome: A randomized, controlled, 3-armed,
explorative clinical trial Restless legs syndrome (RLS) is a
common neurological disease that has a significant impact on
daily activities and quality of life, for which there is often no
satisfactory therapy. Complementary medicine, such as
acupressure and hydrotherapy, is used to treat patients with RLS;
however, the clinical evidence is unclear. This study aims to
investigate the effects and feasibility of self-administered
hydrotherapy and acupressure in patients with RLS.This is a
randomized, controlled, open-label, exploratory, clinical study
with 3 parallel arms, comparing both self-applied hydrotherapy
(according to the German non-medical naturopath Sebastian
Kneipp) and acupressure in addition to routine care in
comparison to routine care alone (waiting list control) in patients
with RLS. Fifty-one patients with at least moderate restless-legs
syndrome will be randomized. Patients in the hydrotherapy
group will be trained in the self-application of cold knee/lower
leg affusions twice daily for 6 weeks. The acupressure group will
be trained in the self-application of 6-point-acupressure therapy
once daily for 6 weeks. Both interventions take approximately 20
minutes daily. The 6-week mandatory study intervention phase,
which is in addition to the patient preexisting routine care
treatment, is followed by a 6-week follow-up phase with
optional interventions. The waitlist group will not receive any
study intervention in addition to their routine care before the
end of week 12. Outcome parameters including RLS-severity,
disease and health-related quality of life (RLS-QoL, SF-12),
Hospital Anxiety and Depression Score in German version,
general self-efficacy scale, and study intervention safety will be
measured at baseline and after 6 and 12 weeks. The statistical
analyses will be descriptive and exploratory.In the case of
clinically relevant therapeutic effects, feasibility, and therapeutic
safety, the results will be the basis for planning a future
confirmatory randomized trial and for helping to develop further
RLS self-treatment concepts.(20)

Abeer Hassan Shamekh Naglaa Zaki Hassan etal (2022) Effect of

stretching exercises versus thermotherapy on restless legs
syndrome symptoms, pain, and quality of sleep among pregnant
women
Restless legs syndrome (RLS) is a sensorymotor disorder
affecting up to one in three pregnant women, which peaks
during the third trimester and is linked to poor pregnancy
outcomes. Symptoms typically worsen during a period of
inactivity, especially at night, resulting in sleep disruption or
deprivation. This study aimed to compare the effects of
stretching exercises versus thermotherapy on RLS symptoms
and sleep quality among pregnant women. Study design: A
quasi-experimental study was carried out at the antenatal
outpatient clinic of Maternity University Hospital. A sample of 60
pregnant women was randomly assigned to two groups. One
group was instructed to perform leg stretching exercises daily
for one week, and the other group applied thermotherapy. They
rated their RLS symptoms, pain level, and sleep quality at
baseline and after receiving interventions. Results: the severity
of RLS symptoms declined to a mild level among pregnant
women immediately and after one week of performing
stretching exercises (53.3%, 93.3%), compared to 6.7% and
63.3% of those who applied thermotherapy (p=0.001, p= 0.02).
After applying stretching exercise, 33.3% and 46.7% of pregnant
women reported mild pain immediately after and one week
later, compared to 10% and 73.3% of those who received
thermotherapy application at their second and third pain
assessment (p = 0.028, p = 0.035). One week after interventions,
93.3% of the stretching exercise group had good sleep quality,
compared to 73.3% of the thermotherapy group (p=0.038).
Conclusion: Both leg-stretching exercise and warm water
thermotherapy have been proven to be effective, simple, and
inexpensive interventions that alleviate RLS symptoms and pain
among pregnant women. However, leg stretching exercise
showed a superior effect. Since the daily application of the
interventions for seven days helped the pregnant women to be
mitigated such a great source of discomfort, they exhibited
better sleep quality. Integrating non-pharmacological nursing for
pregnant women with RLS for obtaining subtle and cumulative
effects as well as maximizing symptom relief is recommended.
(21)

Mahbobeh Ghasemi Nahid Rejeh (2021) Aromatherapy

Massage vs. Foot Reflexology on the Severity of Restless Legs
Syndrome in Female Patients Undergoing Hemodialysis is study
aimed to compare the effects of reflexology and aromatherapy
massage on the severity of restless legs syndrome (RLS) in 105
female patients undergoing hemodialysis. A randomized
placebo-controlled clinical trial was conducted in a hemodialysis
center with 48 beds in a high turnover hospital in an urban area
of Iran. Intervention groups received reflexology (n = 35) and
aromatherapy massage using lavender essential oil (n = 35) for
24 sessions, and the placebo group (n = 35) received simple foot
massage. The restless legs syndrome rating scale was used to
assess RLS severity in the groups before the intervention and
after 4 and 8 weeks of the interventions. Results obtained by the
mixed model analysis 3 * 3 (3 groups * 3 times) revealed the
significant effect of time, group, and the time–group
interrelationship (p = 0.001). Aromatherapy massage reduced
the RLS severity, but reflexology did not appear to cause any
significant reduction in it. Therefore, we suggest that
aromatherapy massage be incorporated into routine care for
relieving the ailment and suffering of patients undergoing
hemodialysis.(22)

Hadi Jafarimanesh a, Katayon Vakilian(2020 ) Thermo-therapy

and cryotherapy to decrease the symptoms of restless leg
syndrome during the pregnancy: A randomized clinical trial
Restless legs syndrome (RLS) is a common sensory-motor
disorder among the pregnant women. The aim of this study is to
compare the impacts of two methods of immersion of legs in
cold and warm water on the RLS symptoms among the pregnant
women.Methods
This randomized clinical trial was conducted on 80 pregnant
women with RLS who referred to Taleghani educational-therapy
center. After obtaining their informed consent, they were
selected by accessible method and randomly allocated into
group 1 (warm water) and group 2 (cold water). Group 1 were
asked to put their legs in cold water for 10 min every night for 2
weeks. The group 2 put their legs in warm water under the same
condition. The severity of RLS was measured before and after
the study. Data analysis was conducted using descriptive as well
as the analytical statistics such as Chi-square, independent T
test, pair T test, Mann-Whitney U, Wilcoxon and covariance.
Results After intervention, mean RLS of the cold water group
was11.02 ± 4.93; while this mean was 13.50 ± 4.74 in the warm
water group. The difference between the two groups was
significant (p = 0.017). Results also revealed that the severity of
RLS symptoms at the end of the treatment was different from
the beginning of the research in both groups (p = 0.001). The
intervention with both warm and cold water declined the RLS
symptoms among pregnant women. Conclusion The warm and
cold water can be used for this purpose depending on the
women’s preference. However, this article recommends the cold
 water for more reducing of symptoms.(23)

10 Primary • To assess the level of rest leg syndrome among staff nurses at
Objectives selected hospital of the city.
• To evaluate the effect of stretching exercise on rest leg
syndrome among staff nurses at selected hospital of the city.
• To evaluate the of the thermotherapy on rest leg syndrome
effect of staff nurses at selected hospital of the city.
11 Other • To compare the effectiveness of stretching exercise versus
Objectives 1:- thermotherapy on rest leg syndrome among staff nurses at
(if any) selected hospital of the city.
• To associate the effectiveness of stretching exercise on rest leg
syndrome among staff nurses at selected demographic variables.
• To associate the effectiveness of thermotherapy on rest leg
syndrome among staff nurses at selected demographic variables.
12 Other
Objectives 2:-
(if any)

13 Methodology : METHODOLOGY
- 1.Population – staff nurse
2. Research approach – Quantitative research approach.
3. Type of research design- Quasi experimental pre-test post-
test design.
Groups Before Intervention After
intervention intervention
Experimental O1 X1 O2
group-I
Experimental O1 X2 O2
group-II

Experimental group I – stretching exercise

Experimental group II – thermotherapy
O1- Before intervention assessment of rest leg syndrome
O2- After intervention assessment of rest leg syndrome
X1- stretching exercise
X2- thermotherapy

4. Setting of the study - A study will be conducted at selected

hospital
5. Study population- staff nurses with rest leg syndrome.
6. Sampling technique: - Non-probability Purposive sampling
technique
7. Sample Size:
Cochran formula for sample size:
2
z pq
Cochran formula for sample size n= 2
d

n =65

For a two group study the total sample size would be

n=2 X n

n=130

.
7. STUDY VARIABLES
Independent variables: - stretching exercise and thermotherapy
Dependent variable: - leg rest syndrome staff nurse
Socio-demographic Variables:- Age, Gender, Marital status, year
work experience ,Work shift ,Department, physical activity,
caffeine.

A) Inclusion Criteria:
1. Staff nurse who have a confirmed diagnosis of RLS based on
clinical evaluation.
2. Staff nurse who has be registered nurses working in the
hospital, as the study focuses on their specific role
3. staff nurse who have willing to participate.
B) Exclusion Criteria:
1. staff nurse who are suffering from neurological disorder.
2. staff nurse using pain relief medication.
3.staff nurse who have already attended similar type of study.

OPERATIONAL DEFINITIONS
1. Comparative
According to oxford Dictionary, one that compares with another
especially on equal footing.
In this study it refers to compare stretching exercise and
thermotherapy to find which is most effective to reducing the
rest leg syndrome.
2. Effectiveness:
According to Cambridge Dictionary, the ability to be successful
and produce the intended results.
In this study it refers to the changes in the rest leg syndrome
brought out by the stretching exercise and thermotherapy.
3. Rest Leg Syndrome:
According to medical dictionary it is the neurological condition in
which is characterized by an irresistible urge to move the legs,
usually accompanied by uncomfortable sensations, typically
occurring while resting or lying down, and finding relief with
movement.
In this study rest leg syndrome is having pain and disturbed
sleeping pattern.
4. stretching exercise
According to Cambridge Dictionary physical exercise that involve
expanding and flexing muscle or tendons to improve flexibility,
range of motion, and muscle control.
In this study application of stretching exercise complex over the
rest leg syndrome for 30 minutes per day for one week.
5. thermotherapy:
According to Cambridge Dictionary a treatment that involves
applying heat to the body to improve the symptoms of rest leg
syndrome. It can be used to treat pain and quality of sleep and is
often used to relieve pain associated with muscle stiffness.
In this study application of thermotherapy over the rest leg
syndrome with at temperature 43–47 C° for 20 minutes for 7
days.
6. staff nurse:
According to the Oxford English Dictionary A staff nurse is a
registered nurse who works in a medical facility, taking care of
patients and managing their conditions.
In this study staff nurse is a registered nurse employed in a
hospital who experiences an overwhelming urge to move their
legs

APPROPRIATE STUDY INSTRUMENT/DATA COLLECTION TOOL

PART 1: DEMOGRAPHIC DATA SECTION
SECTION A: Demographic data:
PART 2: Tool
SECTION A : RLS Rating Scale.
METHODS OF DATA COLLECTION RELEVANT OF OBJECTIVE
Step 1- Permission will be obtain from Ethical committee
Step 2- Prior to data collection, permission will obtain from
concern authority of hospital.
Step 3- Subject will be selected according to the selection
criteria of the study.
Step 4- Consent will be obtain from the participant.
Step 5- The investigator will assess the pre-test and will give
intervention.
Step 6- After seven days post-test be done.
APPROPRIATE DATA MANAGEMENT AND ANALYSIS
PROCEDURE:
1. Tool validation will be obtained from experts.
2. Pilot study will be conducted before proceeding for main
study.
3. Data will be collected.
 4. Anonymity and confidentiality will be maintained throughout.
5. Assess the effectiveness of stretching exercise
6. Assess the effectiveness of thermotherapy.
7. Comparison will be done to find the effectiveness of
stretching exercise and Thermotherapy on Rest leg syndrome.
8. Numbering and coding will be done.
9. Master sheet will be prepared for data management and
analysis.
APPROPRIATE DATA ANALYSIS
Descriptive statistics: Frequency and percentage, mean, median,
mode, standard deviation and mean percentage.
Inferential statistics: Unpaired T-test and chi-square test
14. Reference 1.Shamekh AH, Hassan NZ, Rashwan ZI, Fathalla NF. Effect of
Style :- stretching exercises versus thermotherapy on restless legs
syndrome symptoms, pain, and quality of sleep among pregnant
women. International Journal of Health Sciences.
2022;6(S6):11204-20.)
2. Ameri M, Mirhosseini S, Basirinezhad MH, Ebrahimi H.
Prevalence of restless legs syndrome and its relationship with
fatigue in critical care nurses. Indian Journal of Critical Care
Medicine: Peer-reviewed, Official Publication of Indian Society of
Critical Care Medicine. 2021 Nov;25(11):1275.
3. Izadi F, Mazhari SA, Najafi M, Ashoobi MT, Sarafi M, Karkhah S,
Vajargah PG, Takasi P, Firooz M, Hosseini SJ, Ozen N. The Effect of
aromatherapy with lavender on pain of needle insertion and
severity of restless legs syndrome in hemodialysis patients; a
systematic review and meta-analysis. Archives of academic
emergency medicine. 2023 Nov 5;12(1):e4.
4. Tsai LH, Chen CM, Lin LM, Tsai CC, Han Y, See LC. Acupressure
reduces the severity of restless legs syndrome in hemodialysis
patients: A cluster-randomized crossover pilot study. biomedical
journal. 2022 Jun 1;45(3):533-41.
5. N.JAHAN , Mehmood A, Khan N, Khan F. Effect of Restless leg
syndrome on the sleep quality of medical students of university
in rural Sindh. International Annals of Health Sciences. 2024 Aug
7;1(2).
6. Kaur P, Jaspal S, Kaur T. Nursing Intervention Strategies and
Their Effectiveness on Restless Leg Syndrome and Psycho-Social
Problems in Chronic Kidney Disease Patients. Indian Journal of
Community Medicine. 2024 Mar 1;49(2):367-74.
7. Bellur S, Thota SS, Raj JP, Kallarakal TK, Nadig R. Prevalence
and Predictors of Restless Leg Syndrome in Adolescents and
Young Adults of Bengaluru City, India: A Cross-Sectional Study.
Neuroepidemiology. 2022 Jun 7;56(4):298-305.
8. Ismail MA, Daffalla I, Singh T, Siddique QR, Almadhoun MK,
Irfan R, Saqib M, Haris M, Khan Z, Fernandes JG, Iqbal A. Efficacy
of Aerobic and Stretching Exercises in Managing Willis-Ekbom
Disease (Restless Leg Syndrome) Among Hemodialysis Patients.
Cureus. 2024 Oct 14;16(10):e71470
9.Akbaş P, Sözbir ŞY. The effect of progressive muscle relaxation
exercise on the intensity of symptoms and quality of sleep and
quality of life in pregnant women with restless leg syndrome.
Patient Education and Counseling. 2023 Aug 1;113:107768).
10. Çoban Ö, Ün Yıldırım N, Yaşa ME, Sonkaya AR. Effects of
Different Exercise Programs on Symptoms, Sleep, and Quality of
Life in Patients with Primary Restless Legs Syndrome. Movement
Disorders Clinical Practice. 2023 Sep;10(9):1349-59.
11. Mohammed Syam N, Mohamed Desoky G, Ahmed Mohamed
Eldesoky H. Effects of progressive muscle relaxation technique
on severity of restless legs syndrome among patients on
maintenance hemodialysis. Egyptian Journal of Health Care.
2022 Sep 1;13(3):102-20
12. Bahgat AA, Algendy A. Effect of muscles stretching exercises
on severity of restless legs syndrome of adult patients
undergoing hemodialysis. Journal of Health, Medicine and
Nursing. An International Peer-reviewed Journal. 2019 Nov
30;68.
13. Augustina SJ, Kaviya MG, Indrani D. Effect of transcutaneous
electrical nerve stimulation with stretching and exercises in
restless leg syndrome among pregnant women. Obstet Gynecol
Int J. 2020;11(2):101-5.
14. Mohammadi MM, Ahmadi M, Vaisi Raygani AA. The Effect of
Superficial Heat–Cold Application on the Sleep Quality of
Patients With Restless Leg Syndrome: A Systematic Review and
Meta‐Analysis. Nursing Open. 2024 Nov;11(11):e70080.
15. Mohammadi MM, Raygani AA. Investigating the Effect of
Temperature Therapy on the Severity of Restless Legs Syndrome:
Systematic Review and Meta-Analysis. Clinical Medicine &
Research. 2023 Dec 1;21(4):216-25.
16. Park A, Ambrogi K, Hade EM. Randomized pilot trial for the
efficacy of the MMF07 foot massager and heat therapy for
restless legs syndrome. PLoS One. 2020 Apr 2;15(4):e0230951.
17. Jafarimanesh H, Vakilian K, Mobasseri S. Effects of warm and
cold footbath on sleep quality in pregnant women with restless
legs syndrome. The Iranian Journal of Obstetrics, Gynecology
and Infertility. 2020 Aug 22;23(6):51-60.)
18. An T, Sun H, Yuan L, Wu X, Lu B. Associations of anxiety and
depression with restless leg syndrome: a systematic review and
meta-analysis. Frontiers in Neurology. 2024 Mar 18;15:1366839
19. Aljasani SA, Abed RI. Comparison of stretching exercises and
leg massage on the severity of restless legs syndrome for
hemodialysis patients. Revista Latino americana de Hipertension.
2023 Nov 1;18(6).
20. Kubasch J, Ortiz M, Binting S, King R, Dietzel J, Nögel R,
 Hummelsberger J, Willich SN, Brinkhaus B, Teut M, Siewert J.
Hydrotherapy and acupressure in restless legs syndrome: A
randomized, controlled, 3-armed, explorative clinical trial.
Medicine. 2023 Jun 30;102(26):e34046.
21. Shamekh AH, Hassan NZ, Rashwan ZI, Fathalla NF. Effect of
stretching exercises versus thermotherapy on restless legs
syndrome symptoms, pain, and quality of sleep among pregnant
women. International Journal of Health Sciences.
2022;6(S6):11204-20.
22. Ghasemi M, Rejeh N, Bahrami T, Heravi-Karimooi M, Tadrisi
SD, Vaismoradi M. Aromatherapy massage vs. Foot reflexology
on the severity of restless legs syndrome in female patients
undergoing hemodialysis. Geriatrics. 2021 Oct 11;6(4):99.
23. Jafarimanesh H, Vakilian K, Mobasseri S. Thermo-therapy and
cryotherapy to decrease the symptoms of restless leg syndrome
during the pregnancy: A randomized clinical trial.
Complementary therapies in medicine. 2020 May 1;50:102409.
15. Timeline/Gantt Kindly refer the Annexure No. 3
Chart :-
16. Annexures ANNEXURE: - 1
Part I. Demographic variable
Part II. Rest leg syndrome (International Restless Legs Syndrome
Study Group Rating Scale)
ANNEXURE: - 2
Pain Assessment scale
ANNEXURE: - 3
CONSENT FORM
A. Participants consent form in English and Marathi.
ANNEXURE: - 4
Gantt chart

Annexure no.1
Part I. Demographic variables Instruction to the participant: this questionnaire is used to
assess the demographic status. Please read the statement given below and give your
response against statement in appropriate columns.
PART 1: DEMOGRAPHIC DATA SECTION.

1 Age
< 30 years
30-40 years
>40 years
2 Gender
Male
 Female
3 Marital status
Single
Married
Divorced
Widowed
4 year work experience
< 5 year
5-10 years
>10 years
5 Work shift
General shift
Rotational shift
6. Department
ICU
OPD
General ward
Emergency
7 physical activity
Sedentary
Moderate
Active
8 Caffeine
Low
Moderate
High

PART 2:.
SECTION A: RLS Rating Scale. (International Restless Legs Syndrome Study Group Rating
Scale)

1 How would you rate the RLS in your leg and arms
Very severe
Severe
Moderate
Mild
None
2 How would you rate the need to move around because of your RLS symptoms
Very severe
Severe
Moderate
Mild
None
3. How much relief of your RLS arms or leg are discomfort did you get from moving
 around
No relief
Mild relief
Moderate relief
Either complete or almost complete relief
No RLS symptoms relief
4. How severe was your sleep disturbance due to RLS symptoms.
Very severe
Severe
Moderate
Mild
None
5. How severe was your tiredness or sleeping during the day due to RLS symptoms.
Very severe
Severe
Moderate
Mild
None
6. How severe was your RLS as a hole
Very severe
Severe
Moderate
Mild
None
7. How often did you get RLS symptoms
Very often (this means 6 to 7 days a week)
Often(this means 4 to 5 days a week)
Sometimes(this means 2 to 3 days a week)
Occasionally(this means 1 days a week)
Never

8. When you had RLS symptoms how sever was were they on average
Very severe (this means 8 hours per 24 hours day)
Severe(this means 3 to 8 hours per 24 hours day)
Moderate (this means 1 to 3 hours per 24 hours day)
Mild (this means 1 hours per 24 hours day)
None
9. Overall how severe was the impact of your RLS symptoms on your ability to carry
your daily affairs for example carrying out a satisfactory, family, home ,social ,school
Very severe
Severe
Moderate
Mild
None
10 How severe was your mood disturbance due to RLS symptoms for example angry,
. depressed ,sad, anxious or irritable?
Very severe
 Severe
Moderate
Mild
None

ANNEXURE.2. CONSENT FORM

Participants consent form in English.
INFORMED CONSENT
I understand that I am being asked to participate in a research study conducted by
M.Sc. (N) student of ------------------------Nursing College, ------------------, will evaluate.
( A comparative study on effectiveness of stretching exercises versus thermotherapy
on rest leg syndrome among staff nurses in selected hospital). If I agree to participate
in the study, I will be interviewed. The interview may be recorded and will take place
in privacy. No identifying information will be included when the interview is
transcribed. I understand that there are no risks associated with this study. I realize
that the knowledge gained from this study may help either me or other people in the
future. I realize that my participation in this study is entirely voluntary, and I may
withdraw from the study at any time I wish. If I decide to discontinue my
participation in this study, I will continue to be treated in the usual and customary
fashion. I understand that all study data will be kept confidential. However, this
information may be used in nursing publication or presentations. If I need to, I can
contact M.Sc. (N) student of --------------------------- Nursing College, ---------------------
any time during the study. The study has been explained to me. I have read and
understood this consent form, all of my questions have been answered, and I agree
to participate. I understand that I will be given a copy of this signed consent form.
------------------------------
Signature of Participant Date

------------------------------
Signature of Investigator . Date
सूचित संमती
मला समजले आहे की मला M.Sc ने आयोजित केलेल्या संशोधन अभ्यासात भाग
घेण्यास सांगितले जात आहे. (N) ------------------------ नर्सिंग कॉलेजचे
विद्यार्थी, ------------------ , मूल्यमापन करेल. (निवडलेल्या हॉस्पिटलमधील
स्टाफ नर्सेसमध्ये विश्रांती लेग सिंड्रोमवर थर्मोथेरपी विरुद्ध
स्ट्रेचिंग व्यायामाच्या परिणामकारकतेचा तुलनात्मक अभ्यास). मी
अभ्यासात सहभागी होण्यास सहमत असल्यास, माझी मुलाखत घेतली जाईल. मुलाखत
रेकॉर्ड केली जाऊ शकते आणि गोपनीयतेत होईल. कोणतीही ओळख माहिती देणार
नाही मुलाखत असेल तेव्हा समाविष्ट करा
लिप्यंतरण मला समजते की या अभ्यासाशी संबंधित कोणतेही धोके नाहीत.
मला जाणवते की या अभ्यासातून मिळालेले ज्ञान मला किंवा इतर लोकांना मदत
करू शकते
भविष्यात या अभ्यासात माझा सहभाग पूर्णपणे ऐच्छिक आहे हे मला जाणवते आणि
मी करू शकतो
मला पाहिजे तेव्हा अभ्यासातून माघार घ्या. मी यात माझा सहभाग बंद
करण्याचा निर्णय घेतल्यास
अभ्यास करा, मला नेहमीच्या आणि प्रथागत पद्धतीने वागवले जाईल.
मी समजतो की सर्व अभ्यास डेटा गोपनीय ठेवला जाईल. मात्र, ही माहिती
नर्सिंग प्रकाशन किंवा सादरीकरणांमध्ये वापरले जाऊ शकते. मला आवश्यक
असल्यास, मी M.Sc. शी संपर्क साधू शकतो. (N)
--------------------------- नर्सिंग कॉलेजचे विद्यार्थी, ------------------ ---
अभ्यासादरम्यान कधीही.
अभ्यास मला समजावून सांगितला आहे. मी हा संमती फॉर्म वाचला आणि समजला आहे,
माझ्या सर्व प्रश्नांची उत्तरे दिली गेली आहेत आणि मी सहभागी होण्यास
सहमत आहे. मी समजतो की मी असेन
या स्वाक्षरी केलेल्या संमती फॉर्मची एक प्रत दिली.
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1.Literature 12
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2.Problem 2
selection & wee
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3.Research 3
methodolog da
y Workshop y
4. Synopsis 8
developme wee
nt & k
Presentatio
n for ethical
clearance
5.Tool 4
validity, we
reliability, e
Pilot Study
6. Pilot 4
Study we
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n & Data ks
Collection
7.Data 4
Presentatio we
n &Analysis e
Ks
8.Dissertati 4
on wee
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9. MUHS 1
dissertation wee
Submission k