Professor Lynne Turner-Stokes
Director Regional Rehabilitation Unit and Dunhill Chair of Rehabilitation
Phone: 0207 848 5357
Fax: 0207 848 5517
Researcher ID: http://www.researcherid.com/rid/F-4418-2012
Location 1: Regional Hyperacute Rehabilitation Unit
Northwick Park Hospital
Middlesex HA1 3UJ
Location 2: Department of Palliative Care, Policy and Rehabilitation
Floor 2, Bessemer Road
London SE5 9PJ
In addition to providing an excellent clinical service the RHRU also provides a regional focus for research and clinical training for all professions involved in rehabilitation. In particular, to champion the development of research skills in nursing staff and PAMs. Development of an academic base with a strong multi-professional focus is consistent with the NWLHT research and development strategy to become a leader in multi-disciplinary training and research.
Over the last 20 years, I have built a substantial research programme on the RHRU. The main focus is on clinical and Health Services research. The aim is to apply rigorous scientific methodology to evaluation of the effectiveness of different approaches in rehabilitation, be they philosophies, service designs, specific interventions, or types of equipment.
As well as collaborating extensively with other centres in the North West Thames region, we have undertaken collaborative projects with other major rehabilitation centres and university departments in the UK.
Research in Rehabilitation:
- Research projects in rehabilitation needs and outcome measurement
- 5- year NIHR programme grant (£2million) - to set up a national database for collating case-episode data from all specialist neurorehabilitation services in the UK
- Large international programme for evaluation of treatments for upper limb spasticity
- Use of Integrated Care Pathways (ICPs) to monitor and evaluate intervention
- User and Carer experiences in complex disability
- The evidence for effectiveness of rehabilitation – systematic reviews
Key Leadership Roles
Lynne Turner-Stokes was educated at Bedales School (1966-1973), Oxford University (1973-6) and University College Hospital (1976-9). She qualified in Medicine in 1979 and after accrediting in Rheumatology and Rehabilitation in 1992, she was appointed as consultant to set up a new Regional Hyperacute Rehabilitation Unit (RHRU) at Northwick Park Hospital in Harrow.
The Regional Hyperacute Rehabilitation Unit provides a tertiary specialist rehabilitation service for younger adult patients with severe complex disabilities, mainly resulting from acquired brain injury. The RRU acts as a central focus for research and training for all professionals involved in rehabilitation, and has a national and international reputation as a leading service in the field of neurological rehabilitation.
Lynne was appointed to the Herbert Dunhill Chair of Rehabilitation at KCL in 2001, with a view to developing a two-site academic department of rehabilitation between KCL and Northwick Park. Academic Rehabilitation joined forces with the Department of Palliative Care and Policy in 2003.
Working with the Department of Health, the British Society of Rehabilitation Medicine (BSRM) and the Royal College of Physicians (RCP), Prof Turner-Stokes has played a key role in the development of national policy for rehabilitation though the following national leadership roles:
- Deputy Chair and Clinical Lead for development of the National Service Framework for Long Term Conditions 2002-5
- Chair of BSRM Research and Clinical Standards Committee 2003-13
- Chair of the DoH's Expert Reference Panel for development of Payment by Results in Rehabilitation2009-
- Chair of the NHS England Clinical Reference Group for Specialised Rehabilitation in the transition to national commissioning 2012-2016.
- Chair of the RCP Guideline Development Group for Prolonged Disorders of Consciousness
She is on the editorial board of Clinical Rehabilitation and Journal of Rehabilitation Medicine and is editor of the series 'Concise Clinical Guidelines' for Clinical Medicine.
- Turner-Stokes L, McCrone P, Jackson DM, Siegert RJ.(2013) The Needs and Provision Complexity Scale: a multicentre prospective cohort analysis of met and unmet needs and their cost implications for patients with complex neurological disability. BMJ Open. 2013 Feb 22;3(2). pii: e002353.
- Turner-Stokes L, Fheodoroff K, Jacinto J, Maisonobe P, (2013)Results from the Upper Limb International Spasticity Study-II (ULIS-II): a large, international, prospective cohort study investigating practice and goal attainment following treatment with botulinum toxin A in real-life clinical management. BMJ Open 2013; June 3 (6) doi:10.1136/; e002771
- Turner-Stokes L, Williams H, Sephton K, Rose H, Harris S, Thu A. (2012) Engaging the hearts and minds of clinicians in outcome measurement – the UK Rehabilitation Outcomes Collaborative approach. Disability and Rehabilitation. 2012: 34(22); 1871-9
- Siegert RJ, Jackson D, Tennant A, Turner-Stokes L. (2010) A psychometric evaluation of the Northwick Park Dependency Scale (NPDS). Journal of Rehabilitation Medicine 2010: 42: 936-943
- Turner-Stokes L, Williams H, Johnson J. (2009) Goal Attainment Scaling: does it provide added value as a person-centred measure for evaluation outcome in neurorehabilitation following acquired brain injury?Journal of Rehabilitation Medicine 2009: 41(7): 528-35.
- Turner-Stokes L. (2008) Evidence for the effectiveness of multi-disciplinary rehabilitation following acquired brain injury: a synthesis of two systematic approaches. Journal of Rehabilitation Medicine 2008;40(9):691-701
- Turner-Stokes L, Paul, S, Williams H. (2006) Efficiency of specialist rehabilitation in reducing dependency and costs of continuing care for adults with complex acquired brain injuries. Journal of Neurology, Neurosurgery and Psychiatry 2006; 77: 634-639
- Turner-Stokes L. (2007) Cost-efficiency of longer-stay rehabilitation programmes: Can they provide value for money? Brain Injury 2007 21(10):1015-21.
- Turner-Stokes L, Harding R, Sergeant J, Lupton C, McPherson K. (2006) Generating the evidence base for the National Service Framework (NSF) for Long Term Conditions: a new research typology. Clinical Medicine 2006; 6 (1): 91-97
Major Clinical Guidelines
- Turner-Stokes L and Goebel A (2011) Complex Regional Pain Syndrome: Concise guidance, Clinical Medicine
- Turner-Stokes L, Ashford S 2008 (Lead Authors, on behalf of Guideline Development Group). Spasticity in Adults: Management using Botulinum Toxin: National Guidelines, Royal College of Physicians, London 2008
- Gall A, Turner-Stokes L. (2008) Chronic spinal cord injury – management of patients in acute hospital settings. National guidelines. Concise Guidance series No 9. Royal College of Physicians, London 2008
- Use of anti-depressant medication in adults undergoing recovery or rehabilitation following acquired brain injury (2005). Prepared in collaboration the British Society of Rehabilitation Medicine, British Geriatrics Society. Royal College of Physicians, London.
- Turner-Stokes L 2003 (Ed) Rehabilitation following acquired brain injury: national clinical guidelines. London: Prepared in collaboration with the British Society of Rehabilitation Medicine. Royal College of Physicians, London.
Current PHD Students
- Educational Supervisor and Programme Director – NW Thames SpR rotation 1994-2002
- Academic lead with responsibility for supervision of research and audit training for Specialist registrars on the Pan Thames SpR Training programme 2002-
- Postgraduate clinical teaching for the North Thames Specialist Registrar trainees in Rehabilitation Medicine
- Involvement on the National Specialist Registrar Education programme - British Society of Rehabilitation Medicine.
- Co-responsibility for undergraduate teaching in rehabilitation at King's College London
Multi-disciplinary teaching and training
- In-service training programmes at Northwick Park
- The RHRU runs 10-15 courses per year, for multi-disciplinary rehabilitation professionals
- Regular contributions to MSc courses and other taught elements of the post-graduate education programme.
Supervision of research
- Post graduate co-ordinator for department of Palliative Care and Policy, KCL
- Supervision and examination of students and trainees undertaking research degrees
- Support and supervision for students from neighbouring universities (KCL and Brunel University) whilst attached to the RRU for clinical aspects of their research.
- Supervision and support of clinicians undertaking research and higher degrees on the RHRU
Dr. Stephen Ashford
Doctor of Philosophy
01-Sep-2004 until 01-Jun-2012
Mphil/PhD in cancer studies research
Thesis title: Assessment of functional improvement in the hemiparetic arm following focal rehabilitation intervention.
- NIHR Programme Grant – Applied Research programme: Cost-efficient service provision in neurorehabilitation: defining needs, costs and outcomes for people with long term neurological conditions Principal investigator - Lynne Turner-Stokes (£1,999,636 over 5 years). July 2008 – Sept 2014
- NIHR grant – Health Services Development and Research programme: Evaluation of community rehabilitation service delivery in Long term neurological Conditions Principal investigators: Prof Richard J Siegert/Prof Lynne turner-Stokes (£420,309 over 4 years) January 2009-Jan 2013
- NIHR grant –Policy Research programme, Long term neurological Conditions: How do carers of people with long term neurological conditions experience the provision of replacement care? Principal investigator - Lynne Turner-Stokes (£281,215 over 3 years). October 2008 – September 2011
Department of Health 2006-2011: Support for carers with multiple caring roles: balancing the competing demands of caring for someone with a long term neurological condition alongside other family dependents. Principal investigator - Lynne Turner-Stokes (£289,000 over 4 years). December 2006-February 2011.
Our rehabilitation research has directly led to the development of a novel costing and evaluation system for specialist rehabilitation services in the UK.
Our research demonstrated the cost-effectiveness of specialist rehabilitation for profoundly dependent patients and has led to the development and validation of a robust set of tools which measure needs, inputs and outcomes from rehabilitation. The tools have now been incorporated into the national commissioning dataset for specialist rehabilitation services across England, which is implemented in the UK Rehabilitation Outcomes Collaborative (UKROC) database.
The data have been used by the DoH, and more recently by Monitor, to develop tariffs under Payment by Results (PbR) and to underpin commissioning of rehabilitation services by NHS England.
In addition to providing on-going data on effectiveness and cost-efficiency, the database provides benchmarking data on quality of care for patients and their families. The collection of patient-centred outcomes in this way has a real impact on people as it ensures the evaluation of services reflects outcomes that matter most to patients. Being able to demonstrate that investment in rehabilitation represents value for money helps to support expansion of local services, providing better services closer to home for more people.
Our Rehabilitation Complexity Scale (RCS) has been adopted by the DoH to identify patients with complex needs requiring treatment in specialist rehabilitation services. Under the new commissioning rules specialist (Level 1 and 2) services across England are required to report the RCS for all patients in order to qualify for prescribed commissioning by NHS England and all 63 Level 1 and 2 services in England routinely report the RCS.
- Adjunct Professor, Auckland University of Technology, NZ. 2004-
- Clinical Professor of Rehabilitation, School of Surgery, University of Western Australia 2008-
- Visiting Scholar, Epstein University, Philadelphia USA 2005
- Interstate Visitor, Royal Melbourne Hospital, Australia, 2009
Overseas appointments and collaborations
Auckland University of Technology, New Zealand. We have a very active collaboration with AUT – in particular with Prof Kathryn McPherson, Professor of Rehabilitation and Director of the National Institute for Rehabilitation Research, New Zealand, and Prof Richard Siegert, who who was Reader in our department at KCL for 5 years before returning to NZ in 2012. Prof McPherson and Prof Siegert hold a visiting professorships within our department, and Prof Lynne Turner-Stokes has an Adjunct Professorship with AUT. The departments collaborate through exchange visits, and through joint grant applications and publications.
University of Western Australia, Perth. We have a further active research collaboration with Professors Kevin and Barbie Singer in UWA, where Professor Turner-Stokes also holds an Adjuct Professorship.
We also have a clinical research collaboration with the Brightwater Rehabilitation Centre in Perth, sharing our interest in outcome measurement
Australasian Rehabilitation Outcomes Centre, Wollongong University. The UK Rehabilitation Outcomes Collaborative (UKROC) has worked closely with its counterpart in Australia (AROC) to develop the UKROC National Clinical Database for specialist rehabilitation in the UK. Prof Kathy Eagar of AROC is a co-applicant on the NIHR Programme Grant that supports UKROC and we share data and publications.
Royal Melbourne Hospital/University of Melbourne, Australia: A further research collaboration is currently active with Prof Fary Khan in Melbourne with both university and hospital based collaborations. Through this partnership we have developed and maintained a series of Cochrane reviews on the effectiveness of multi-discplinary rehabilitation in various disabling conditions.
Upper Limb International Spasticity (ULIS) Programme. Professor Turner-Stokes is the Clinical Research Lead for the ULIS programme. ULIS is funded by Ipsen, Paris, and has generated several large international cohort studies of real life clinical practice in the use of botulinum toxin and concomitant therapies for the management of upper limb spasticity. The programme has generated publications in BMJ Open and numerous conferences presentations across 4 continents.
Key Collaborators on the ULIS programme steering group are Dr Klemens Fheodoroff (Austria), Dr Jorge Jacinto (Portugal), A/Prof Ian Baguley and Dr Stephen De Graaf (Australia), Dr Stephen Ashford (UK)
USA. A successful collaboration with Dr Karyl Hall in Santa Clara valley in the 1990s led to the development of the UK Functional Assessment Measure (UK FIM+FAM) which is now the principal outcome measure for the UKROC nationl Clinical dataset for specialist rehabilitation.
Following a Prof Turner-Stokes’ Visiting Scholarship to Moss Rehabilitation Research Institute, Thomas Jefferson University, Philadelphia, we maintain a shared interest in Prolonged Disorders and Consciousness and have continued to collaborate with Professor John Whyte on the development of evidence-based guidelines in this field.
World Health Organisation. Prof Turner-Stokes is a member of an international WHO working party to develop international WHO Guidelines for Rehabilitation, following publication of the WHO report in Disability
Annual overseas visits
Australasia Professor Turner-Stokes travels to Australia/New Zealand 1-2 times per year to attend collaborative research meetings in Melbourne, Perth, Sydney and Wollongong, Australia, and in Auckland, New Zealand.
USA Professor Turner-Stokes is a foreign member and regular attendee of the American Academy of Physical Medicine and Rehabilitation (AAPMR) and where we regularly present elements of our research at the annual meetings, which are held throughout the United States.
International Professor Lynne Turner-Stokes regularly presents updates of innovation in neurorehabilitation to an international audience alongside her peers and conferences including the International Society for Physical and Rehabilitation Medicine (ISPRM), the World Congress for Neuro-rehabilitation (WCNR) which are held in different locations each meeting across the world.