Australasian Multiple Sclerosis Network of Care Multiple Sclerosis Network of Care Australia

A Voice for People Affected by MS


 
  Issues, Needs and Expectations

CCSVI Australia

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Quick Reference Guide News Headlines What is Multiple Sclerosis? CCSVI Research Database         
       
Issues This area of the Road Map brings together 8 inter-related areas of Multiple Sclerosis research. It highlights nb:
 1. MS Needs, Issues and Expectations  5. Trends in MS progression, Lifestyle & Pharmaceutical reviews
 2. The 'top 20' common issues experienced by pwMS  6. The Demographics of Australian MS populations
 3. The significance of Chronic Fatigue in the MS equation  7.  Support for activities of daily living and basic social routines
 4. Bloodflow Irregularities  8. Expectations and unique needs and opinions of people with MS

.

What are the most Common MS  Issues - A Strong Evidence Base
Wide ranging research identifies the top 20 issues reported by those living  with MS as comprising; nb:
  Chronic fatigue, Abnormal sensory symptoms, Weak legs, Temperature intolerance, Cognition, Memory, Vision, Mood, Weak arms, Numbness, Pins and needles, Concentration, Balance, Speech Depression,  Incontinence or bladder problems, Pain including headache, Frustration, Lack of coordination and Muscle stiffness head the list (in that order).  
  Depending upon a range of underlying factors (including disease progression) the cumulative impact
at an individual level can be mild, moderate or severe
 
The
Evidence
Bas
e
A study titled ‘Living With Multiple Sclerosis in New South Wales at the Beginning of the 21st Century’ summarised 20 frequent issues that impact on Care Needs. The study ranked issues according to frequency of reporting as identified by 2618 people registered with the NSW MS Society in 2001 - an estimated 70% of all people living with MS at that time in NSW. .
The significance of this study became more widely appreciated  when published in the International Journal of MS Care. While it was  previously accepted that MS 'affects everyone differently' the study outcomes indicate commonality in many of the trends/issues impacting on daily living. These trends were reinforced by subsequent international experience and a 2012 Australia wide Needs Analysis undertaken by Deakin University in collaboration with MS Research Australia. RM3400MS
An Australia Wide Perspective
The 2012 analysis involved 2,676 participants from all States and Territories, 55% of whom described their symptoms as moderate to severe. Of 22 symptoms surveyed the major symptoms (Table 7 - page 32) experienced included fatigue (93%), heat intolerance (85%), muscle weakness (78%), memory difficulties (76%) and walking difficulties (59%)   - while broadly consistent with the rankings in the foregoing 2001 analysis many category responses appear higher in the latest analysis. Not all symptoms are similarly described in each study  - for example cognitive issues (sometimes called brain fog) were not identified in these terms in the 2012 statistical data but attracted a 58% response in 2001
 Closing Knowledge Gaps
While vascular associations with multiple sclerosis have been long known it is only in relatively recent times that researchers are finding that more than 80% of those with MS screened for CCSVI conditions have irregular bloodflow. There is a rapidly growing body of evidence (examples) that the re-establishment of normal bloodflow can give rise to significant and enduring relief from all of the foregoing symptoms/issues. More about this research.
   
In Summary Table 1 - The 20 health related issues/symptoms identified by Australians with Multiple Sclerosis
While these rankings/issues may be indicative of other countries distance from the equator is a significant variable
.   To find out more about "pre CCSVI" understandings click on the Ranking or the MS Issue title .
 
 * references research whereby vascular (CCSVI) treatment likely provides ongoing relief - click on * to access evidence base.

To research ongoing developments click on the prevalence percentage %.
Ranking * MS Issue  % Ranking * MS Issue %
1 *   Fatigue 87   11 *   Pins and needles 40
2 *   Abnormal sensory symptoms 72 12 *   Concentration 40
3 *   Weak legs 71   13 *   Balance problems 35
4 *   Temperature intolerance 68   14 *     Speech problems 27
5 *   Cognitive problems 58   15 *    Depression 26
6 *    Memory problems 51 16 *   Incontinence/bladder problems 25
7 *    Visual problems 49   17 *    Pain, including headache  24
8 *   Mood problems 46 18 *   Frustration 21
9 *   Weak arms 44 19 *    Lack of coordination 18
10 *     Numbness 41   20 *   Muscle stiffness 14
  Research demonstrates that in significant numbers of cases (across all MS sub types) relief from most of the foregoing symptoms is obtained through treating underlying vascular disorders.  

About MS Fatigue
Extensive population studies identify between 85% and 93% of those with MS as experiencing chronic fatigue. Of these a significant majority (89%) identify fatigue as having a medium to high impact on activities of daily living.  The cause has not been  clear with a range of suggested treatment options. In October 2015 the long term outcomes of treating vascular irregularities (experienced by more than 80% of those with M) identified a 98.5% improvement in fatigue - find out more about MS fatigue
Background Information
Fatigue is defined (2009) by the Fatigue Management Panel of the Multiple Sclerosis Council on Clinical Practice Guidelines as: "A subjective lack of physical and/or mental energy that is perceived by the individual or caregiver to interfere with usual and desired activities".
In February 2012 the Multiple Sclerosis International Federation (MSIF) published the results of a survey (involving 10,090 people in 101 countries) about the incidence and impact of fatigue experienced by pwMS. The survey outcomes replicate and expand upon 2001 research by the (then) Multiple Sclerosis Society of NSW, Australia involving 2618 pwMS in NSW.  
86% of respondents to the MSIF survey identified fatigue as one of their three main symptoms of MS.   Fatigue was described by respondents in the following terms  "Arms, legs, my entire body feels weighed down with lead", "Overwhelming, constant, debilitating, identity destroying", "My brain won't work and my legs feel heavy", "Fatigue is my worst symptom. The rest, I can deal with. But being so exhausted all the time is what brings me down". Many recognised the impact of fatigue on those around them, with more than half saying that their family, friends or colleagues were impacted by their fatigue - watch a short video about MS fatigue..
Respondents were asked to rate how much fatigue affected eight different "life areas" (from 1=no impact to 5=extreme impact). For work and leisure/hobbies, the majority ranked the impact of fatigue as 5. Other life areas (home life, social life, sexual life, mental health and physical health) had a majority ranking of 4, while family life had a 3. When combined together, the results show a peak at a ranking of 4.  Nearly half of respondents did not feel that the people around them understood the effect of MS fatigue. However, when asked specifically about their healthcare professionals, 37% reported that fatigue was well understood and 44% reported that at least some of the professionals involved in their care had some understanding of the impact of fatigue. Researchers concluded. "This result supports the need for further research into the treatment and management of this particular symptom".

Underlying Factors - Including Vascular Health and Lifestyle Choices
Given that vascular imbalances, including an inability to properly deal with inflammation, can contribute to disease progression, it makes good sense to also adopt lifestyle choices that enhance vascular health - rather than place additional pressure on what, for many, may already be a compromised vascular system.
Distance from Equator  - The Sunshine Influence
While it is long known that vascular disorders are more prevalent in colder climates, recent large scale population studies (52,000 people with MS) have also established that distance from the equator is associated with a higher prevalence of MS as well as a more rapid rate of MS progression. This research indicates that sunlight may protect against multiple sclerosis whereby when our skin is exposed to the sun a compound (not vitamin D) - called nitric oxide - is released in our blood vessels which in turn lowers blood pressure by causing blood vessels to widen.
Research also suggests that sunshine related vitamin D acts directly on endothelial cells to prevent vascular leak and this may help explain the clinical correlations between low serum vitamin D levels and the many human diseases with well-described vascular dysfunction phenotypes. More about these developments.
Chronic Infections
There is also ongoing research relating to the potential for chronic infections and gut bacteria as precursors for inflammatory processes contributing to vascular breakdown - more on this topic.
Lifestyle Choices - An Overview
Proper nutrition, appropriate exercise and effective sleep also readily spring to mind as lifestyle choices influencing vascular health. 
By way of example, people with multiple sclerosis who for one year followed a plant-based diet very low in saturated fat had much less MS-related fatigue at the end of that year — and significantly less fatigue than a control group of people with MS who didn't follow the diet, according to a 2014 Oregon Health & Science University study. The study was the first randomized-controlled trial to examine the potential benefits of the low fat diet on the management of MS.
The study found no significant differences between the two groups in brain lesions detected on MRI brain scans or on other measures of MS. But while the number of trial participants was relatively small, study leaders believe the significantly improved fatigue symptoms merited further and larger studies of the diet. 
In February 2015 the HOLISM Study, involving 2000 people with multiple sclerosis, showed that fatigue is markedly lower in those people with MS who adopt healthy lifestyles. It also found increased fatigue in people with MS who ate a poor diet high in saturated fats (95% more likely to be fatigued), were obese (84% more likely), or took commonly used disease-modifying medications (83% more likely), and reduced fatigue for those who exercised more (66% reduction), supplemented with vitamin D (38% reduction) and omega 3 fatty acids (37% reduction for flaxseed oil, no reduction for fish oil), consumed fish frequently (34% reduction), or drank alcohol in moderation (24% reduction). In particular, it found people with progressive types of MS experienced significant fatigue 2-3 times more commonly than those with relapsing-remitting disease.


Profile of People Living with MS - Some Trends in Disability Progression
Trends While MS is, by its nature, regarded as a progressive condition, the rate and nature of this progression depends upon the severity of underlying conditions, which can be mild, moderate or severe. For example it has been established that vascular comorbidities accelerate the progression of MS.  In general terms, studies show that:
  * Around 50% of people with MS are independently mobile after 15 years and can live normal and productive lives.
  * 21% of the overall MS population are significantly to severely impaired
  * 35% of people living with MS for between 10-20 years are significantly to severely impaired
  * Chronic MS progression occurs in around 80% of cases within 20 years
  * There are currently no "conventional" drug therapies that impact on MS progression once it reaches the chronic progression stage
  *

Betaferon based immunotherapy drugs HAVE been shown to have an impact on the frequency of relapses - more

  * Betaferon based immunotherapy drugs HAVE NOT been shown to have any impact on the rate of progression - more
  * Misdiagnosis can be an issue 
Lifetime Continuous Care

At the 20 year mark population studies show that 35% of people living with MS are significantly to severely impaired. Lifetime Continuous Care programs delivered by multi-disciplinary teams are identified as essential for those with more advanced forms of MS. More about the course of MS and prognosis.

Broader Projections
The following tables identify a range of MS populations according to projected disability levels. The projections are based upon an Access Economics 2005 study 'Acting Positively - The Strategic Implications of MS in Australia' and broader based research. An estimated 1,000 people annually are diagnosed with MS - 74% of all cases are women
MS Progression as related to Disability Levels

Click on the disability level/category to review the recommended referral pathways.

Table 2  - Overall MS population in Australia  
  Newly Diagnosed  
.Minimal 32% Moderate
 Self Managing 17%
Moderate – Support Needed 28% Significant to Severe 22%
 

  Table 3 - A snapshot of MS Progression for people people living with MS for between 10-20 years. - More about MS progression

Minimal 25%

Moderate - Little Impaired 35%

Impaired
8%

Significant to Severe 35%

 

Table 4: A snapshot of the level of mobility assistance required after 20 plus years. -  More about MS progression

Minimal - No Assistance Needed 20%

Assistance Needed - Non Wheelchair 50%

Wheelchair 30%

 

MS Demographics,  Populations and Prevalence Ratios across Australia
 
Demographics Table 5 - Source: Economic Impact of Multiple Sclerosis in Australia (2010) - Access this Report
Click on the State/Territory name to find out about regionally available support for pwMS
:
Australia NSW VIC ACT QLD SA NT TAS WA
21,283 6,268 6,637 360 3,179 1,760 49 718 2,313
  96/100,000 87/100,000 120/100,000 101/100,000 71/100,000 107/100,000 21/100,000 142/100,000 101/100,000  
These figures are somewhat lower than those provided in 2009 by the Census Bureau who identified the Australian MS population as 23,700 - Access the 2009 data.
 Given the significant subsequent Australian annual population increases and an estimated 1,000 people newly diagnosed each year the 2017 population may be considerably higher. 2016 State based MS Society estimates suggest at least a 15% overall increase since 2009..
 
MS symptoms occur more commonly in geographical areas further away from the equator compared to tropical and sub-tropical regions closer to the equator. Countries with a relatively high frequency of MS include northern United States, Canada, northern Europe, New Zealand, South Africa and southern regions of Australia. Scotland has the highest identified prevalence rate (191-251/100,000) of MS in the world. 
Isolation Factors in Australia
A wide ranging study by Access Economics (2005), titled Acting Positively - The Strategic Implications of MS in Australia observes that "people with MS are over-represented in rural and regional areas, where access to services (particularly respite) and workforce adequacy (notably medical) is poorest". Some 5 years later the Access Economics findings were echoed in a Needs Analysis of Australians with MS prepared by Deakin University in collaboration with MS Research Australia in November 2012.
 
The Needs Analysis, demonstrated that the level of satisfaction with the availability and quality of services surveyed reduced as the participant lived further from metropolitan regions, such that participants in the remote areas were least satisfied with the services, followed by rural, regional and metropolitan. Over and above the issues highlighted by Access Economics, these 'isolation factors' are exacerbated by disability level, extreme distances, poor or no public transport, minimal/inappropriate support, access to information and financial considerations. In terms of numbers and geographic factors this 'multiplier effect' appears to be most evident in NSW and, to a lesser extent, Queensland - find out more
A Missing Link - Nationally Endorsed MS Clinical  Guidelines
This situation is compounded by the fact that Australia has no National Health and Medical Research Council (NHMRC) endorsed clinical guidelines for the primary and secondary care of people with multiple sclerosis .On 25 November 2011 NHMRC re-affirmed earlier advice that "Australia has no NHMRC endorsed clinical guidelines for the primary and secondary care of people with multiple sclerosis nor is it aware of any plans for their development".
 
It went on to say "starting points' to initiate the development of such guidelines could include the State Chief Health Officers, the CEO of NHMRC or Australia's Chief Medical Officer and that funding is always an issue, so if there is a funding source, that makes it easier". With all of the resources directed to MS support/research in Australia over the years it is hard to believe that there is no uniform baseline from which the relevance and effectiveness of service delivery and associated research can best be evaluated. Whatever the future holds, pwMS deserve the comfort of knowing that guidelines of this type are in place -  more about this issue.
 

Daily Living Support It is demonstrated that QoL and health status are quite distinct concepts. An “health-related” approach to addressing QoL issues underestimates the challenges faced by pwMS with activities of daily living and basic social routines.
Support for Activities of Daily Living
Coming to terms with major, and for many, ongoing changes in one’s lifestyle has the potential to result in an increased sense of helplessness and hopelessness, low self-esteem, decreased motivation and decreased quality of life as poor health may reduce an individual’s sense of well-being. Table 6 identifies six areas of support that underpin activities of daily living and basic social routines. Not all aspects apply universally as needs vary according to disability level and personal circumstances.
Lifetime Continuous Care programs delivered by multi-disciplinary teams are identified as essential for those with advanced forms of MS.
TABLE 6 - Support for Activities of Daily Living, To find out more about support for activities of daily living click on a Category of interest

 

 Categories
Topics Encompassed - some examples
Click on a  Category for more information

 
Transport and Mobility Community Transport, Companion Card, Disabled parking, Handybar, Mobility allowance, Modified Vehicles, National public toilet map, PADP, Regional Excursion Daily (RED) tickets, Swivel Seats, Taxi Concessions, Transport Survey.
Income Support Carer Allowance, Carer Payment, Disability Support Pension, Employment Assistance, Financial Planning Assistance, Mobility allowance
Carer and Respite Support Assistance and Information, Centrelink Services, Companion Card, Consultancy Assistance - Carer Support Program, Family and Carer Support, Financial Recognition, FlexiRest, Government funded  care services, National Respite for Carers Program, Peak organisation for carers, Respite for Carers Program, Support Groups for Carers
Home Care and Support Air Conditioning, Case Management, Computers, Continence Assistance, Custom Designed Aids, Energy Rebate, Help Desk, Home Modifications, Home Care, Home Nursing, Independent Living Centres, Local Support Coordination, Mobility Aids, MS Specific Assistance,  Occupational Therapy, Physiotherapy, Support Networks, Tele Communications, Young People
Exercise, Sport and Relaxation Aquatic Exercise (Hydrotherapy), Bowen Therapy, Brain Gym, Brain Plasticity, Case studies, Common Barriers, Dietary Factors, Exercise Groups, Facial Reflexology, Feldenkrais and Body Movement, Horse Riding, Massage Therapy, Meditation, Memory Management, Naturopathy, QI Gong and healing, Reflexology, Reiki, Sailing and Boating, Side Stepping the Brain, Strength and Cardio respiratory Exercise, Vibration Therapy,
Rehabilitation Issues About Rehabilitation and MS, Brain Plasticity, Clinical Perspective to MS, Complementary Therapies, Employment Assistance,   Employment and Advocacy, International Practices, Pain Management, Rehabilitation Access in Rural and Regional Australia, Symptom Management - includes weakness, spasticity, visual problems and depression,   Workplace Modifications,  
 
To find out more about support for activities of daily living click on the foregoing Support Area Category of interest. When related to those who are not independently mobile, the above 'support sequence' often accords with priorities that need to be afforded to the development and review of individual care plans. For example, an inability to resolve transport and mobility issues, either through lack of awareness or otherwise, can have a 'domino' effect in accessing other areas of support. The cumulative and progressive nature of these 'domino' factors can lead to imbalances in matching needs, expectations and issues with appropriate support
Importance of Exercise
Even in the earliest stages of MS there is a role for physical therapy/exercise. In addition to being essential to general health and well-being, exercise is helpful in managing many MS symptoms.  There is a growing body of evidence that improvement in mobility, activities of daily living, quality of life, prevention of complications, reduction in healthcare utilization, and gains in safety and independence may be realized by a carefully planned program of exercise, functional training, and activities that address the specific needs of the individual - read more about MS and exercise
Access to Appropriate Rehabilitation
Rehabilitation in MS is a process that helps a person achieve and maintain maximal physical, psychological, social, and vocational potential, as well as quality of life consistent with physiological impairment, environment, and life goals. Achievement and maintenance of optimal function are essential in a progressive disease such as MS. Access to inpatient and outpatient rehabilitation facilities are critical and should be widely available.  Self referral to rehabilitation services should be available to every person with MS when they need them, usually when they develop any new symptom, sign, limitation on activities or other problem, or when their circumstances change. Read more about Rehabilitation


Expectations of People Living with MS - 'A Charter for MS Services' 
Rights and Expectations A good starting point in matching service delivery expectations with outcomes is for services to be delivered in ways that are consistent with the Guiding Principles for the Provision of Services to people with MS as included in the (2003) publication  'A Charter for MS Services: the voice of people affected by MS'.
 
Originally developed by the Multiple Sclerosis Society of Great Britain and Northern Island and reflected in a number of subsequent studies the Guiding Principles have broad application in all areas of service delivery to people affected by MS. Shortly after their publication the (then) NSW Multiple Sclerosis Society recommended the adoption of these standards by the MS Network of Care Australia.

The Guiding Principles are entirely consistent with the principles of Patient-centred care endorsed by all Australian Health Ministers in 2010, the United Nations Convention
on the Rights of Persons with Disabilities as ratified by Australia in 2008 and the Australian National Disability Insurance Scheme - NDIS
 

TABLE 7 - Guiding Principles for the Care and Support for People affected by MS - Abridged Summary

 

To find out more you may care to read the full text of the Guiding Principles - click here. Each Guiding Principle is influenced (either positively or negatively) by Service Providers in their approaches to service provision - this influence frequently impacts on the Quality of Life perceptions of pwMS. To assist in addressing this issue, a check list of Service Provider Guidelines, complementary to the Guiding Principles, is included elsewhere in this Road Map.

 

Recognising personal dignity. Care and Support Services should be sensitive and responsive to unique and individual needs and opinions of people with MS. Services should focus on respect for the individual and actively encompass the principles of privacy and dignity.
Maximising personal potential. In many instances it is not the MS itself that is restricting a person’s life, but the expectations and actions of others. Services should encourage people affected by MS to think about and define what they need to continue to achieve their goals and aspirations. Services need to be flexible enough to adjust to their changing circumstances and expectations. People affected by MS must be in a position to participate fully and make decisions about their support and care, with information and advice to help them make such decisions.
Involvement in planning and the provision of services The involvement of service users and carers in the planning and provision of services is a priority within the health and social care fields. Their involvement contributes to the ability of providers to deliver services that are effective and appropriate. It can foster a sense of involvement and clearer expectations of the rights and responsibilities of all concerned. Lifetime Continuous Care programs delivered by multi-disciplinary teams are identified as essential for those with advanced forms of MS. See also re NDIS (Australia).
Involvement of those who may find it difficult to participate A challenge for services wishing to involve people affected by MS is to ensure that they include those who might find it particularly difficult to participate. A decision not participate is an informed choice and should be respected as such, but for some this choice may be due to them not being given appropriate opportunities, or the process is in some way inhibiting their contribution
Finding new ways to reach those whose voices may not be heard Services need to consider new ways of reaching those whose voices are not being heard. They must also work to avoid such involvement opportunities turning into perceived obligations, particularly if they come to be seen as a condition of receipt of services.
Holistic approach to service provision Good quality service provision requires a full appreciation of each individual’s nursing, personal, social and spiritual care needs and expectations. The aim should be to maintain independence as far as possible and ensure that the best quality of life is achieved. It should take advantage of the expertise and specialist knowledge of professionals from a range of disciplines. Multi-disciplinary teams consistently prove the most effective model of working.
Meeting agreed standards There needs to be clear standards for measuring success. Programs need to be developed to provide advice and support for providers wishing to improve their services. Specific standards can only be developed at the local level, taking into account local structures, resources, professional and service links and of course the needs and expectations of people affected by MS. Working closely with people affected by MS will ensure that agreed standards take account of the complex nature of MS-related care needs.

 


 

 

References
Lifetime Continuous Care
MS Australia, in a 2008 submission to the Australian Government, highlighted the need for improved coordination in the delivery of dedicated lifetime continuous care programs and services (including respite) for people with MS. It went on to say that Australians living with MS and their families need viable alternative care models to those currently available. Many support programs are designed for static disability groups or ageing, and do not cope with increasing and changing needs. The submission observed ‘people with MS pose a significant challenge due to the changing nature of their condition which does not respect waiting lists’  A priority in dealing with the unmet demand is overhauling the interfaces of the various care and support programs with and across government jurisdictions.
 
Measuring Quality of Life
Overview of a presentation (2006 ) by Dr Gary Fulcher the NSW MS Society's Principle
Clinical Psychologist  and Research Director - includes a study by De Toffol, E (2005): Doctorate of Clinical Psychology/Master of Science dissertation - University of Sydney. A purely “health-status” approach to MS rehabilitation underestimates the challenges faced by people with MS. Studies relating to the quality of life perceptions of people with MS, show that psychosocial aspects are represented much more frequently than physical aspects
MS Referral Pathways and Benchmarks
A common theme in research relating to MS rehabilitation relates to establishing 'referral pathways'  most appropriate to meeting the often complex and cumulative needs of people with MS.  This area of the Road Map provides an overview of  MS service delivery guidelines cross referenced to regional  examples.  These guidelines were adopted by the Pathways Project as benchmarks
for identifying and prioritising shortfalls in regional service delivery. The inclusion of regional 'effectiveness' indicators for each benchmark identified services most in need of review.

Living with Multiple Sclerosis in New South Wales at the beginning of the 21st Century
The NSW MS Society surveyed  2618 people registered with the Society in 2001 (estimated at 70% of the NSW MS population). The findings of this study clarify the broad impact of MS, and in particular the impact of mobility disability, on the lives of people living with MS in NSW, Australia, at the beginning of the 21st century. The study’s wide ranging findings enables the Society to better target its policies on service provision and to identify areas where advocacy activity may be required.  By way of example, by highlighting a range of 'common' issues
relevant to the needs of MS communities it provides a focus for identifying related support services - example. The results of this study became more widely accessible when published in the International Journal of MS Care in 2006. 

Acting Positively - The Strategic Implications of MS in Australia
A wide ranging study by Access Economics (2005), titled ''Acting Positively - The Strategic Implications of MS in Australia'' observes:

* The majority of people with MS do not become severely disabled. Longitudinal studies have shown that around half of people with MS are independently mobile after 15 years and can live normal and productive lives (para 1.4.1)
* People with MS are over-represented in rural and regional areas, where access to services (particularly respite) and workforce adequacy (notably medical) is poorest.
* People with MS, like others with a lifelong chronic illness, experience lower income levels than the general community.74% are women, and 87% are of working age, since peak incidence is in the mid-twenties. 21% experience severe disability, 46% moderate disability and 33% mild disability, with life expectancy reduced by 6-7 years.
* MS has higher one-year prevalence than breast cancer, bowel cancer, sports injuries or poisoning. Prevalence is expected to grow 6.7% in the next 5 years, faster than population growth due to demographic ageing.

Needs Analysis of Australians with MS
 Some 5 years later the Access Economics findings were echoed in a Needs Analysis of Australians with MS prepared by Deakin University in collaboration with MS Research Australia in November 2012.

 
  Facts Sheet RM1873MS

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