1.1. Background and rationale
loss of social networks, comorbidity, Willis-Ekbom disease, WED, anxiety, sleep disorders, RLS/WED, neurological disorder, inflammation, autoimmune diseases, metabolic diseases, depressive, polyneuropathy, RLS-, RLS, depression, cardiac and renal diseases, sleep-related
DISORDER, WILLIS-EKBOM DISEASE, NEUROLOGICAL DISORDER, PARKINSON DISEASE, DIABETES MELLITUS, AUTOIMMUNE DISEASES, NEURODEGENERATIVE DISEASES, INFLAMMATION, DISEASE, METABOLIC DISEASES, DISORDERS, RESTLESS LEGS SYNDROME (RLS), WED, IRON DEFICIENCY, MULTIPLE SCLEROSIS, POLYNEUROPATHY, COLD, DISEASES
Restless legs syndrome (RLS), also known as Willis-Ekbom disease (WED), is a common neurological disorder characterized by agonizing sensations in the legs, occurrence at rest, and compelling urge to move the legs (or arms or sometimes other body parts).RLS symptoms of any frequency and severity occur in 5% to 10% of the general population in Western industrialized countries.RLS affects and interacts with many comorbidities, and may lead to missed work, loss of social networks, and even early retirement.Patients with RLS also show more anxiety and depression symptoms, psychopathological symptoms, and lower well-being than control subjects without sleep disorders. There is a relationship between RLS severity, anxiety, and depressive symptoms. Under psychological stress, RLS/WED symptoms are more severe.RLS is a complex disorder in which predisposing genetic factors, environmental factors, and comorbidities contribute to the expression of the disorder. Patients with a high burden of comorbidity have a consistently higher prevalence of RLS than healthy individuals do. Additionally, an increasing number of publications have reported associations between RLS and multiple diseases, including metabolic diseases (diabetes mellitus and iron deficiency), cardiac and renal diseases, autoimmune diseases (e.g., multiple sclerosis), polyneuropathy, neurodegenerative diseases (e.g., Parkinson disease), and illnesses associated with inflammation and depression.In many cases, RLS remains incurable; therefore, available treatments focus on alleviating the symptoms of the disease.Dopamine agonists may also lead to impulse control disorders in up to 12.4% of patients taking the dopamine agonist Pramipexole).Effective non-drug symptom reduction in RLS would be clinically helpful and relevant because RLS-medications with potential side effects, such as augmentation, could be avoided or reduced. State of the art reviews on RLSFor the treatment of mild and intermittent forms of RLS, clinical guidelines often recommend relaxation methods and other non-pharmacological therapies.Up to 65% of RLS patients regularly use complementary medical interventions to relieve their symptoms and improve well-being.Hydrotherapy according to Kneipp and acupressure are methods of complementary and integrative medicine that can be performed by the patients themselves and at a low cost. To date, no randomized controlled trials have examined the effectiveness, safety, and feasibility of self-administered acupressure and hydrotherapy according to Kneipp in patients with RLS.Two systematic reviews in 2019 and 2021 showed that acupuncture was significantly superior to control interventions for RLS in terms of severity and reported significant clinical effects.In a pilot study on the efficacy of acupressure in dialysis patients with RLS, a reduction in RLS severity was reported.Hydrotherapy according to Sebastian Kneipp (1821–1897) is characterized by serial, mostly cold-water applications (e.g., affusions, compresses, washes) and has been known in German-speaking countries since the 19There are indications that cold water applications can reduce RLS symptoms in pregnant women,Self-administered acupressure and hydrotherapy, according to the German non-medical naturopath and priest Sebastian Kneipp, showed little to no side effects.As there is good evidence for the effectiveness of acupuncture in patients with RLS, and some pilot studies have shown that acupressure and cold applications can reduce RLS- and sleep-related symptoms, we hypothesized that self-administered acupressure and Kneipp hydrotherapy with cold affusions could be a potential therapeutic option for patients with RLS.