Guest guest Posted March 31, 1999 Report Share Posted March 31, 1999 Group this is the last time you will have to make changes. Please do not answer the questions now after I make final corrections it will be sent out next week for your answers. Thank you again for your time. I am hoping this will help us in a small way to find something to help us cope. Please answer this week so I can complete the survey on time Thank you again for your help Rodney 65 NEPA 1 Name 2 Age 3 Age at first symptoms of RLS 4 Age when diagnosed with RLS 5 Who diagnosed RLS a doctor or yourself 6 How many doctors did you see before you were diagnosed with RLS 7 Do the doctors know enough or very little about RLS 8 Based on a scale of 1 (least) to 10 (best) how well does your doctor deal with you 9 Were your first treatments effective 10 Approximately how many medications have you tried 11 Did any work well 12 Is it still working 13 Are you still on this medication 14 What are you taking now 15 What worked best 16 Based on a scale of 1 (least) to 10 (best) how well does this work for you 17 Do you use non prescription treatment 18 Does this work for you 19 Based on a scale of 1 (least) to 10 (best) how well does this work for you 20 What are you taking 21 Have you tried a combination of medications 22 Does anyone else in your immediate family have RLS 23 What are their relation to you 24 What parts of your body are bothered most 25 What parts of your body are bothered least 26 Did you have any trauma before your RLS: i.e. operation, accident 27 Do you have pain with your RLS 28 Does your medication relieve your pain and RLS 29 (Female) Did you have RLS during pregnancy 30 (Female) Did it stay 31 (Female) Does your menstrual cycle effect your RLS 32 Have you found an exercise that helps 33 How long does it help 34 Is there any thing that you have used that is still working 35 How much faith do you put into what other people are taking 36 Do you follow your doctors orders faithfully 37 Do you experiment with combinations of medication 38 Are you depressed 39 How often 40 Would you use a experimental drug 41 Would you use a specialized diet 42 Can you see your self living with this the rest of your life 43 Would you support research for RLS 44 Do you drink socially or every day 45 Do you drink a lot of coffee 46 Do you smoke and how much 47 Do you consider your self over weight 48 Do you take medication for other problems 49 Did you change your life style after RLS how drastic 50 Have you ever had chicken pox 51 Have you ever shingles 52 When you have a acute illness is RLS better or worse 53 How important is the support group to you 54 Would you be willing to participate in medical trials 55 Describe your quality of life Quote Link to comment Share on other sites More sharing options...
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