RESET-RLS: Reviewing Safe and Effective (De)Prescribing Strategies in RLS

About the project

About the Project Applications are invited for a PhD studentship investigating the safe and effective use of medicines in Restless Legs Syndrome (RLS), with a particular focus on prescribing and deprescribing in patients who experience treatment-related complications such as augmentation. Project Overview RLS is a common neurological condition characterised by an urge to move the legs, typically accompanied by uncomfortable sensations that worsen at rest and during the evening or night. As a result, RLS is closely linked to disrupted sleep, reduced quality of life, and significant impacts on physical and mental health. Pharmacological treatments play an important role in the management of RLS, particularly in individuals with moderate to severe symptoms. However, the long-term use of some medicines can be associated with complications, most notably augmentation—a phenomenon in which symptoms become more severe, occur earlier in the day, and may spread to other parts of the body. Augmentation can be distressing for patients and challenging for clinicians to manage. This project will explore how prescribing and deprescribing decisions are made in RLS, particularly in the context of augmentation, and how these processes can be optimised to improve patient outcomes. Research Focus The focus of this PhD is on understanding and improving the use of medicines in Restless Legs Syndrome (RLS) where treatment-related complications arise. While the exact direction of the research will be developed with the successful candidate, the project will centre on prescribing and deprescribing practices for patients experiencing augmentation. Key areas of interest may include: How clinicians recognise and respond to augmentation in RLS Approaches to adjusting, reducing, or stopping medicines Patient experiences of treatment escalation, change, or withdrawal Challenges and uncertainties in clinical decision-making Strategies to balance symptom control with long-term safety Feasibility and acceptability of principles of prescribing The project will aim to generate insights that can support safer and more consistent approaches to managing complex treatment pathways in RLS. Mixed Methods Approach This PhD will adopt a mixed methods design, combining quantitative and qualitative approaches to provide a comprehensive understanding of prescribing and deprescribing in RLS. Quantitative components may include analysis of prescribing patterns, treatment pathways, or clinical outcomes, helping to identify variation and trends in practice. Qualitative methods—such as interviews or focus groups—will explore the experiences and perspectives of both patients and healthcare professionals, particularly in relation to augmentation and medication changes. The integration of these approaches will allow the research to capture both the measurable aspects of care and the lived realities of those involved, providing a more complete understanding of the challenges and opportunities in this area. This work would be foundational for the development of pilot and feasibility studies to support the testing of (de)prescribing principles. Research Design The project is expected to involve several interconnected phases, which may include: Exploring current clinical practices in prescribing and deprescribing for RLS Investigating patient experiences of augmentation and treatment changes Reviewing and synthesising existing evidence in this area Developing practical, evidence-informed principles to support clinical care Designing pilot and feasibility studies to explore (de)prescribing principles The design will remain flexible, enabling the candidate to refine specific research questions and approaches in collaboration with the supervisory team. Training and Environment The successful candidate will join a supportive research environment with expertise spanning clinical pharmacy, behavioural science, and neurological care. There will be opportunities to engage with clinicians, researchers, and patient groups, ensuring that the research remains grounded in real-world practice. Training will be provided in mixed methods research, including both qualitative and quantitative techniques, alongside opportunities to develop skills in analysis, academic writing, and dissemination. Impact and Significance This project addresses a recognised challenge in the management of RLS. Augmentation represents a significant complication of treatment, yet there is limited clarity on how best to manage medicines when it occurs. By focusing on prescribing and deprescribing practices, this research has the potential to: Improve understanding of how augmentation is managed in practice Support more consistent and evidence-informed decision-making Enhance patient experiences during treatment changes Contribute to safer and more effective use of medicines in RLS Provide pilot and feasibility studies for onward work to evaluate and validate (de)prescribing protocols in augmented RLS More broadly, the findings may have relevance to other areas of healthcare where long-term medicine use requires careful review and adjustment. Candidate Profile We welcome applications from candidates with a background in pharmacy, medicine, public health, psychology, or a related discipline. An interest in sleep health, neurology, or medicines optimisation is desirable. The project is well suited to individuals who are motivated, curious, and interested in addressing complex clinical challenges through research. Summary RESET-RLS offers an opportunity to undertake focused, impactful research on prescribing and deprescribing in RLS, particularly in the context of augmentation. Through a mixed methods approach and strong engagement with stakeholders, the project will contribute to improving how medicines are used and managed in this important area of sleep and neurological health.

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