The impact of restless legs syndrome on physical functioning in a community-dwelling population of middle-aged and elderly people.
OBJECTIVE
To investigate whether restless legs syndrome (RLS) is associated with impaired physical functioning using subjective and objective assessments.


METHODS
From 2006-2013, 5,960 participants (mean age 67.2; 57.5% females) of the prospective population-based Rotterdam Study, aged 45 years and over, were cross-sectionally investigated for presence of restless legs syndrome using a questionnaire. Physical functioning was assessed subjectively with the Stanford Health Assessment Questionnaire (basic activities of daily living) and the Instrumental Activities of Daily living scale (instrumental activities of daily living). Additionally, physical functioning was assessed objectively by quantifying fine motor performance with the Purdue Pegboard Test and by quantifying gait with an electronic walkway.


RESULTS
Restless legs syndrome was present in 13.7% of the participants. Persons with restless legs had more impairment in basic (difference in score 0.65, 95% CI 0.41;0.90) and instrumental activities of daily living (difference in score 0.28, 95% CI 0.09;0.48) than persons without restless legs. This association was strongest when symptoms were present two or more times a week (basic activities of daily living score difference 1.69, 95% CI 1.28;2.09). The association between restless legs syndrome and activities of daily living attenuated after adjusting for sleep quality or depressive symptoms. There was no association with the Purdue Pegboard Test score nor with gait.


CONCLUSIONS
Individuals with restless legs syndrome experienced significantly more impairment in activities of daily function than persons without restless legs. This seemed to be (partly) mediated by poor sleep quality and depressive symptoms. No association was found with objectively assessed physical functioning.
Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Rens
R
Hanewinckel
Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Ana
A
Maksimovic
Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Vincent J A
VJ
Verlinden
Department of Neuroscience, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Jos N
JN
van der Geest
Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Albert
A
Hofman
Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Pieter A
PA
van Doorn
Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Agnita J W
AJ
Boon
Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Henning
H
Tiemeier
Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. Electronic address: m.a.ikram@erasmusmc.nl.
M Arfan
MA
Ikram
D000203:Activities of Daily Living; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology; D009426:Netherlands; D011788:Quality of Life; D012111:Residence Characteristics; D012148:Restless Legs Syndrome / Q000150:complications* / Q000503:physiopathology* / Q000523:psychology; D011795:Surveys and Questionnaires
Activities of daily living; Epidemiology; Physical functioning; Quality of life; Restless legs syndrome; Sleep quality