“The review is defined as a broad comprehensive in depth 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of scholarly publication, unpublished printed or audio-visual materials and personal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 FOUR SECTIONS:

A. Review related to 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 regarding Rest leg syndrome

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.

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; The objective of
this study was to consolidate findings from randomized clinical trials (RCTs) examining the
impact of aromatherapy with lavender on pain associated with arteriovenous fistula (AVF)
catheter insertion and restless legs syndrome (RLS) in hemodialysis (HD) patients. the
method is used A systematic search was conducted on multiple databases, including
PubMed, Web of Science, Scopus, Cochrane, Embase, (link unavailable), and Google Scholar,
from inception to August 1, 2022. Approach for this study systematic review and meta-
analysis design, incorporating data from eleven RCT articles. The study design was a
systematic review and meta-analysis. The setting of the study was not explicitly stated, but
it appears to be a clinical or hospital setting. The sample consisted of HD patients undergoing
AVF catheter insertion. A systematic search was conducted on multiple databases. 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) (6)

Li-Hung Tsai , Chuan-Mei Chen etal (2022)Acupressure reduces the severity of restless legs
syndrome in hemodialysis patients: The objective of this study was to evaluate the effect of
acupressure on the severity of Restless Legs Syndrome (RLS) symptoms and sleep quality in
hemodialysis patients with RLS. Method used in this study cluster-randomized crossover
pilot study design. Approach is used a combination of acupressure intervention and
observation periods to assess the treatment effect. The study design was a cluster-
randomized crossover pilot study. Setting the study was conducted in a hemodialysis unit.
The sample consisted of hemodialysis patients with Restless Legs Syndrome (RLS). Sample
Size the sample size consisted of 23 patients (14 in the AC sequence and 9 in the CA
sequence).The results showed a significant treatment effect of acupressure on RLS severity
(p = 0.0013), but not on sleep quality. The study also found a significant period effect on RLS
severity (p = 0.0250) and sleep disturbance (p = 0.0021).The study suggests that acupressure
may be an effective treatment for reducing RLS severity in hemodialysis patients. (7)

N.Jahan1, A.Mehmood2,(2024) effect of Restless leg syndrome on the sleep quality of

medical students of university in rurals Sindh . Objective of this study was to assess the
prevalence and severity of Restless Legs Syndrome (RLS) among medical students. Method
used in this study is a cross-sectional design. Approach Of this study used is quantitative
approach to collect data. design was cross-sectional. Setting of the study is the study was
conducted at Bhitai Dental & Medical College, Mirpurkhas. Sample Technique a non-
probability sampling method, excluding those with trauma, infection, or recent viral
infections. The sample size consisted of 200 medical students. The results showed that RLS
was more common among male students (21.0% moderate and 12.6% severe) than females
(27.0% moderate, 21.5% mild, and 15.0% severe). The study concluded that RLS is a
significant problem among medical students, with symptoms ranging from mild to moderate
severity. (8)

Prabhjot Kaur, Surinder Jaspal, Tejinder Kaur Nursing Intervention Strategies and Their
(2024)

Effectiveness on Restless Leg Syndrome and Psycho-Social Problems in Chronic Kidney

Disease Patients. The objective of this study was to assess the effectiveness of nursing
intervention strategies on physiological and psycho-social problems among chronic kidney
disease patients. Method used A quantitative research approach with a quasi-experimental
pre-test and post-test design was used. . Approach used is quantitative research approach to
assess the effectiveness of nursing intervention strategies. The study design was quasi-
experimental with a pre-test and post-test assessment of physiological and psycho-social
problems. Setting of the study was in hospital in Punjab. Data were collected through an
interview schedule using standardized scales. Sample technique used was convenience
sampling, and the sample size consisted of 30 chronic kidney disease patients, with 15 in the
control group and 15 in the experimental group. The results showed a significant reduction
in physiological and psycho-social symptoms among the experimental group. This study
concluded that nursing intervention strategies were effective in reducing physiological and
psycho-social symptoms among chronic kidney disease patients.(9)

Shreyas Bellur Suraj Samuel Thota etal (2022) Prevalence and Predictors of Restless Leg
Syndrome in Adolescents and Young Adults of Bengaluru City, India: Objective of this study
was to assess the prevalence and predictors of Restless Leg Syndrome (RLS), poor sleep
quality, and excessive daytime sleepiness (EDS) among adolescents and young adults.
Method used in this study This was a cross-sectional observational study Approach of this
study employed a quantitative approach to collect data using a semi-structured standardized
pilot-tested questionnaire. The study design was cross-sectional observational. Setting of the
study was conducted in Pre University College, Degree College, and Higher Secondary
schools in Bengaluru, India. Data were collected using 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. Sample Technique and
Size students from Pre University College, Degree College, and Higher Secondary schools.
The sample size was 4,211 students. Results The overall prevalence (95% CI; frequency) of
students with RLS, poor sleep quality, and EDS 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. The study concluded that the prevalence of RLS, poor sleep quality, and EDS
among adolescents and young adults was higher compared to historical data from the
general population in the same city..(10)

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. The objective of this systematic review was to examine the
effectiveness of exercise interventions in managing Restless Leg Syndrome (RLS) among
hemodialysis patients. Method used in this study A systematic review of eight studies,
including randomized controlled trials and quasi-experimental studies. The study design was
a systematic review of existing studies. The setting of the studies included in the review was
not explicitly stated, but it appears to be a clinical or hospital setting. Sample technique used
was a systematic review of existing studies, and the sample size consisted of eight studies.
Result The results consistently demonstrated that both aerobic and stretching exercises
significantly reduced RLS severity and improved related outcomes, such as sleep quality,
depression, and physical performance. (11)
Pınar Akbaş , 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. The objective of this study was to investigate 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. Method used in study
randomized controlled trial (RCT) design to assess the effectiveness of progressive muscle
relaxation exercises in alleviating RLS symptoms. Approach used in study is a quantitative
approach to collect data and assess the outcome of the intervention. setting of the study
was not explicitly stated, but it appears to be a clinical or hospital setting. The sample
technique used was random sampling, and the sample size consisted of 52 pregnant women.
The results showed that progressive muscle relaxation exercises significantly alleviated RLS
intensity and symptoms, improved RLS-related quaslity of life, and enhanced sleep quality in
pregnant women with RLS. (12)

Ozge Çoban, ,Necmiye Ün Yıldırım etal (2023)Effects of Different Exercise Programs on

Symptoms, Sleep, and Quality of Life in Patients with Primary Restless Legs Syndrome.The
objective of this study was to examine the effects of aerobic exercise and stretching exercise
programs on symptom severity, sleep, and quality of life in patients with primary Restless
Legs Syndrome (RLS).Method used is A randomized controlled trial design was employed to
assess the effectiveness of aerobic exercise and stretching exercise programs. Approach
used in The study used a quantitative approach. Design of study was a randomized
controlled trial with three groups: aerobic exercise, stretching exercises, and control. setting
of the study was not explicitly stated, but it appears to be a clinical or hospital setting. The
sample technique used was random sampling, and the sample size consisted of 18 patients
with primary RLS, divided into three groups.The results showed that both aerobic exercise
and stretching exercise programs were effective in decreasing RLS symptoms, improving
subjective sleep quality, overall sleep quality, and quality of life. (13)

Narges Mohammed Syam Gehan Mohamed Desoky,(2022) effects of Progressive Muscle

Relaxation Technique on Severity of Restless Legs Syndrome Among Patients The objective
of this study was to evaluate the effects of progressive muscle relaxation on the severity of
restless legs syndrome among patients on maintenance hemodialysis. Method a quasi-
experimental (time series) research design with a control comparison group. Approach used
a quantitative approach to collect data and assess the outcome of the intervention The study
design was quasi-experimental (time series) with a control comparison group. The setting at
the hemodialysis unit, Al-Moassat University Hospital, Alexandria University. The results
showed that progressive muscle relaxation significantly decreased the severity of restless
legs syndrome in the study group, with a percent reduction of 38.89% at the 6th session and
61.11% at the 12th session.(14)

Azza Awad Algendy,ZeinabFaried Bahgat etal (2019) Effect of Muscles Stretching Exercises
on Severity of Restless Legs Syndrome of Adult Patients Undergoing Hemodialysis The
objective of this study was to assess the effect of muscle stretching exercises on the severity
of restless legs syndrome (RLS) symptoms in adult patients undergoing hemodialysis
is.Method use in A quasi-experimental design. Approach used a quantitative approach to
collect data and assess the outcome of the intervention. Design quasi-experimental. Setting
The study was conducted in the Hemodialysis department at the Students Hospital Affiliated
to Tanta University and Elmabra Hospital for Health Insurance. The results indicated a
significant improvement in the severity of RLS symptoms in the study group post-muscle
stretching exercise compared to pre-exercise. (15)

Jenifer Augustina, MG Kaviya etal (2020) Effect of transcutaneous electrical nerve

stimulation with stretching and exercises in restless leg syndrome among pregnant women.
The objective of this study was to investigate the effect of Transcutaneous Electrical Nerve
Stimulation (TENS) with stretching and exercises on restless legs syndrome among pregnant
women. Method A quasi-experimental study. Approach The study used a quantitative
approach. Design was used in this study quasi-experimental. Setting of the study was not
explicitly stated. A convenient sample of 30 pregnant women with restless legs syndrome
was selected and divided into two groups of 15 subjects each using the odd-even method of
sampling.The results showed that patients who received TENS with stretching (Group A)
demonstrated marked improvement in pain relief and functional performance compared to
patients who received massage and exercises (Group B). The study concluded that TENS with
stretching is more effective than massage and exercises in managing restless legs syndrome
among pregnant women.(16)

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: The objective
of the study was to determine the effect of superficial heat-cold application on the sleep
quality of patients with restless leg syndrome (RLS).Approach used was a systematic review
and mseta-analysis. . design of the study was a systematic review and meta-analysis. The
setting of the study was not explicitly stated. The sample size was not explicitly stated, but it
appears to be a meta-analysis of multiple studies.The selection tool used was the Cochrane
Collaboration's Risk of Bias Tool. The result of this student 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). (17)

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 the objective of the study was to determine the effect of temperature therapy
on the severity of Restless Legs Syndrome (RLS).this study approach is quantitative study The
design of the study was a systematic review and meta-analysis. The setting of the study was
not explicitly stated, but it appears to be a literature-based study. The sample technique
used was a systematic review and meta-analysis of existing studies. The size of the sample
was 177 participants from 6 included studies. The final result of the study was that
temperature therapy could mildly reduce the severity of RLS symptoms, with the highest
efficacy achieved when using higher temperatures in fewer treatment sessions, particularly
in hemodialysis patients. The meta-analysis results showed a significant reduction in RLS
severity with temperature therapy (SMD=−1.520, 95% CI: −2.122 to −0.918). (18)
Ariane Park ,Katherine Ambrogi, etal (2020)Randomized pilot trial for the efficacy of the
MMF07 foot massager and heat therapy for restless legs syndrome The objective of the
study was to evaluate the efficacy of the MMF07 foot massager and heat therapy on the
severity of Restless Legs Syndrome (RLS) Approach of this study is quantitative. The design of
the study was a pilot RCT with four treatment arms: no active intervention, foot massager,
heat therapy, and foot massager plus heat therapy. The setting of the study was not
explicitly stated, but it appears to be a clinical setting. Sample Technique used was
randomization. The size of the sample was 28 participants. The final result of the study was
that the MMF07 foot massager and heat therapy may be feasible and effective treatment
options to improve RLS symptoms. (19)

D. Review related to effectiveness of stretching exercises versus thermotherapy in rest leg

syndrome.

Hadi Jafarimanesh Katayoon Vakilian etal (2020) Effects of Warm and Cold Footbath on
Sleep Quality in Pregnant Women with Restless Legs Syndrome The objective of the 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. Approach quantitative Design. The
design of the study was a randomized, two-group design, where participants were randomly
assigned to either the hot water group or the cold water group. The setting of the study was
Arak Taleghani hospital. The sample technique used was convenience sampling. The size of
the sample was 80 pregnant women with restless legs syndrome. The final result of the
study was that both hot water and cold water immersion reduced sleep quality scores in
pregnant women with restless legs syndrome. The approch used in this study employed a
quantitative. Design was a meta-analysis of cross-sectional studies. The setting of the study
was not specified, as it was a meta-analysis of existing studies conducted in various settings.
The sample size consisted of 21 studies that matched the inclusion criteria. The final result of
the study indicated that individuals with RLS had significantly higher levels of depression and
anxiety symptoms compared to healthy controls.(20)

Tianyang An , Haiyang Sun ,etal(2024) Associations of anxiety and depression with restless
leg syndrome: a systematic review and meta-analysis The primary objective of the study was
to compare the levels of depression and anxiety among individuals with Restless Legs
Syndrome (RLS) to those of healthy controls. The approch used in study is quantitative.
Design was a meta-analysis of cross-sectional studies. The setting of the study was not
specified, as it was a meta-analysis of existing studies conducted in various settings. Data
was collected through an extensive electronic search of the PubMed, Web of Science,
EMBASE, and Cochrane Library databases from their inception dates to 20 June 2023. The
sample size consisted of 21 studies that matched the inclusion criteria. The final result of the
study indicated that individuals with RLS had significantly higher levels of depression and
anxiety symptoms compared to healthy controls.The mean difference (MD) in depressive
symptoms as measured by the Beck Depression Inventory was 6.58 (95% CI = 5.54–7.62, p <
0.01). The MD in anxiety symptoms as measured by the Beck Anxiety Inventory was 9.30
(95% CI = 7.65–10.94, p < 0.01).

.(21)
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 Restless Legs Syndrome. Methods Design: Quasi-experimental design. Participants
were 90 hemodialysis patients. Conclusion of this study are 1.Effectiveness: Stretching
exercises and massage were effective in decreasing RLS severity. 2. Comparison: Stretching
exercises were more effective than leg massage.(22)

Kubasch, Julia MD etal (2023)Hydrotherapy and acupressure in restless legs syndrome: A

randomized, controlled, 3-armed, explorative clinical trial This study aims to explore the efficacy and
feasibility of self-administered hydrotherapy and acupressure in alleviating Restless Legs Syndrome
(RLS) symptoms. Participants are randomly assigned to one of three groups. The study's open-label
design means that both participants and researchers are aware of the treatment being administered.
The study includes 51 patients with moderate to severe RLS. Statistical analysis involves descriptive
statistics and exploratory analysis to investigate the effects of hydrotherapy and acupressure on RLS.
If the study yields promising results, a larger confirmatory randomized trial will be planned.
Additionally, the study's findings will inform the development of RLS self-treatment concepts.(23)

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)

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2. 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
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