Date
Item
1. Enter the date and time your RLs symptoms started.
datetime
Item
2. How severe were your RLS symptoms at the time you took the dose of study medication?
text
Code List
2. How severe were your RLS symptoms at the time you took the dose of study medication?
Did your RLS symptoms disrupt your routine evening activity?
Item
3. Did your RLS symptoms disrupt your routine evening activity?
boolean
Item
4. How severe were your RLS symptoms 2 hours after taking the study medication?
text
Code List
4. How severe were your RLS symptoms 2 hours after taking the study medication?
CL Item
I was asleep at 2 hours after taking the last dose (1)
Item
5. Overall, how would you describe the change in your RLS symptoms after dosing last night?
text
Code List
5. Overall, how would you describe the change in your RLS symptoms after dosing last night?
CL Item
Very much improved (Complete symptom relief) (1)
CL Item
Much improved (Good symptom relief) (2)
CL Item
Minimally improved (Some symptom relief) (3)
CL Item
Minimally worse (Symptoms minimally worse) (5)
CL Item
Much worse (Symptoms much worse) (6)
CL Item
Very much worse (Symptoms very much worse) (7)
Sleep affected by RLS symptoms?
Item
6. Overall, did your RLS symptoms affect your sleep last night?
boolean
Specification of RLS symptoms affecting sleep
Item
If yes, did your RLS symptoms prevent you from falling asleep or staying asleep last night?
boolean
Date study medication taken
Item
Date study medication taken
date
Time study medication taken
Item
Time study medication taken
time