Quality of life in restless legs syndrome: A systematic review of clinical trials and a critical review of instruments

Restless legs syndrome (RLS) is a neurological movement disorder characterized by sensory symptoms and motor disturbances. While the underlying cause remains unknown, it is suggested that 20–25% of people with RLS are affected seriously enough to require pharmacological treatment. Dopamine agonists (DAs) are the most common treatment and act by increasing the low levels of dopamine to which RLS is often attributed. A growing literature highlights the debilitating and distressing nature of this condition from the patient's perspective. While sleep problems are most commonly reported, the impact of RLS on quality of life (QOL) is wide ranging, affecting relationships with partners, sex life, family life, social life, leisure activities, friendships, everyday activities, concentration, travel, career/work, sleep, and health.

We conducted a systematic review of clinical trials in which DAs have been evaluated in terms of RLS-specific QOL, i.e. their impact on the QOL of people with RLS, and critically reviewed the development history and measurement properties of RLS-specific QOL instruments.

A systematic search using terms synonymous with RLS, DAs and QOL was conducted using Scopus software, which includes MEDLINE, PsycINFO, EMBASE, and CINAHL. Our search covered publications from 2000 (prior to which RLS-specific QOL measures did not exist) to August 2009. Trials were included in our review if they evaluated DAs for the treatment of adults with RLS and reported evaluation using an RLS-specific QOL measure. We also ran citation searches to identify papers reporting the development history and measurement properties of the identified RLS-specific QOL instruments.

Three measures of RLS-specific QOL have been developed in recent years and are reviewed here: the Restless Legs Syndrome Quality of Life (RLSQOL) questionnaire, the Restless Legs Syndrome Quality of Life Instrument (RLS-QLI), and the Quality of Life Restless Legs Syndrome (QOL-RLS) measure. Critical review indicates that each has limitations (particularly in terms of published developmental history and content validity). Eleven trials of DAs were identified that included assessment of RLS-specific QOL (nine using the RLSQOL and two using the QOL-RLS). In all studies, significant improvements in RLS-specific QOL were observed, although these were mostly short term (12 weeks) and large placebo effects were also noted.

In people with RLS, the use of DAs has been shown to improve RLS-specific QOL. Longer-term, large-scale studies may be needed to confirm these findings and demonstrate statistically significant improvements in RLS-specific QOL at lower doses. Further development of the RLS-specific QOL measures is needed to ensure that the full impact of RLS (and the full benefit of new treatments) on aspects of life identified as important to individuals is captured in future studies.

The health-related quality of life of overweight and obese adolescents - a study measuring body mass index and adolescent-reported perceptions

Objective. To determine whether the health-related quality of life (HRQOL) of overweight and obese adolescents is significantly lower than that of their healthy weight counterparts, and if so, whether any demographic trends exist and the relative contribution of each HRQOL dimension.

Methods. Cross-sectional analysis of 2,890 students participating in the Pacific Obesity Prevention in Communities Project, Australia. HRQOL was measured using the Pediatric Quality of Life Inventory (PedsQL) adolescent module. Adolescent height and weight were measured by trained field workers and weight categories assigned according to the International Obesity Task Force BMI cut-off points for adolescents. Multivariate linear regression analyses were undertaken to estimate the mean differences in HRQOL scores between (i) overweight and healthy weight, and (ii) obese and healthy weight adolescents, whilst adjusting for gender, age and socioeconomic status quartile.

Results. The sample had a mean age of 14.6 years (range 11–18), 56.2% boys, 20.2% overweight and 6.3% obese. Higher weight status categories were associated with lower HRQOL scores (mean PedsQL scores: healthy weight: 79.1, overweight: 77.7 and obese: 73.7). Relative to the healthy weight group, and after adjustments, overweight and obese adolescents reported 1.44 (p = 0.005) and 5.55 (p < 0.001) lower HRQOL summary scores, respectively. Overweight adolescents reported significantly lower scores in physical and social functioning, whilst obese adolescents reported significantly lower scores in the same dimensions plus emotional functioning. Girls and younger (< 15 years) adolescents reported greater mean negative HRQOL differences associated with excess weight.

Conclusions. Overweight and obesity in adolescents are associated with significantly lower HRQOL scores.

Utility-based quality of life of overweight and obese adolescents

Objective : To explore the relationship between overweight/obesity and utility in adolescents.

Methods : Data were collected from 2890 adolescents attending 13 secondary schools in the state of Victoria, Australia. The Assessment of Quality of Life 6-Dimension (AQoL-6D) questionnaire was used to measure individual utility. Adolescent's height and weight were measured and weight status categories assigned according to the World Health Organization adolescent growth standards. Multivariate linear regression analyses were undertaken for the whole population and subpopulations of boys and girls to estimate the mean differences in utility scores between 1) overweight and healthy weight and 2) obese and healthy weight adolescents, while controlling for demographic and socioeconomic status variables.

Results : The mean age of adolescents was 14.6 years, 56.2% were boys, 22.2% were overweight, and 9.4% were obese. The mean utility of healthy weight adolescents was 0.860. After adjustments, the overweight and obese groups reported significantly lower mean utility scores (differences: −0.018 and −0.059, respectively, relative to the healthy weight group). This can be interpreted as equivalent to a stated willingness to sacrifice 1.8% and 5.9% of a life in perfect health or 2.3% and 6.8% of a life at healthy weight. A significant utility difference associated with overweight was only experienced by girls (−0.039, P = 0.003). Both sexes experienced significant utility differences associated with obesity, but the magnitude was double for girls (−0.084, P < 0.001) relative to boys (−0.041, P = 0.022).

Conclusion : Utility is lower among overweight and more so among obese adolescents.