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Clinical

Dr Stephen Ashford

NIHR Clinical Lecturer and Consultant Physiotherapist

Phone: 0207 848 5564
Fax: 0208 869 5517
Email: stephen.ashford@kcl.ac.uk
Researcher ID: http://www.researcherid.com/rid/D-6653-2013
Address 1: Regional Rehabilitation Unit
Northwick Park Hospital
Watford Road, Harrow
Middlesex HA1 3UJ
Address 2: King’s College London
Cicely Saunders Institute
Department of Palliative Care, Policy and Rehabilitation
Bessemer Road
Denmark Hill, SE5 9PJ


Research

Dr Ashford has published peer-reviewed papers in the rehabilitation literature as well as book chapters and clinical guideline contributions. He has experience of writing for publication independently and with others and of acting as a reviewer for a number of peer reviewed journals. His PhD work has been contributory to the publication of updated national guidelines (Royal College of Physicians, 2009) on the management of spasticity using botulinum toxin and concurrent therapy interventions. He has just completed the spasticity section of the updated intercollegiate stroke guidelines (hosted by the Royal College of Physicians), due for publication this year and has been consulted on the current NICE guideline document. Dr Ashford, in collaboration with colleagues at Brunel University has just begun work on an intercollegiate guideline for splinting intervention in neurological rehabilitation.

Dr Ashford’s ongoing work includes the use of Goal Attainment Scaling (GAS) His research has considered the use of GAS alongside standardised outcome measures, considering the need for standardisation of measurement alongside measures responsive to very specific and individual changes in many patients undergoing rehabilitation. He published a small but seminal paper on the use of GAS for spasticity management using botulinum toxin, which has lead to a wide up take of this approach in clinical practice. Recent work has involved the development of an Upper limb Spasticity Index (ULSI) - outcomes recording tool (including the Arm Activity measure-ArmA) with the addition of development of a method of systematically recording therapy intervention applied alongside botulinum toxin. This work will be used in a large international (over 20 contries worldwide) multicentre, prospective cohort study currently in the planning stage.

He has been a member of the Society for Research in Rehabilitation for the past 7 years and became a member of the governing council of the society last year. Work for the society involves contribution to the development of the research programmes for the twice yearly meetings, undertaking review of submitted abstacts to these meetings and contributing to the governance of the society. Crucially the society has a role in advising and reviewing national guidelines and other research and clinical implementation documents and Dr Ashford has been involved in this work since January this year.

Biography

Dr Ashford trained in Physiotherapy at Salford University and qualified in 1993. He completed an MSc in Neurorehabilitation at Brunel University in 1998. Then undertook a Post Graduate Certificate in Education through the University of Greenwich while working at the Royal Hospital for Neurodisability, Putney. He subsequently became part-time lecturer and course director for the MSc Neurorehabilitation at Brunel University from 2001 until 2003, while working clinically at the Regional Rehabilitation Unit (RRU), Northwick Park Hospital.

In 2003 Dr Ashford became clinical specialist and research physiotherapist at the RRU and Honorary Research Fellow, Department of Palliative Care, Policy and Rehabilitation, King’s College London. Dr Ashford completed a PhD at King’s College London investigating the measurement of arm function following focal interventions for spasticity. In 2012 he became consultant physiotherapist and in 2013 NIHR Clinical Lecturer and is undertaking further investigations into focal spasticity and measurement of outcome. Dr Ashford completed a Post Graduate Certificate in non-medical prescribing in 2013 at London Southbank University. Dr Ashford has published a number of peer-reviewed papers in the rehabilitation literature as well as book chapters and clinical guideline contributions.

Key Leadership Roles

Dr Ashford in collaboration with Professor Turner-Stokes has developed a programme of research, which builds strongly on his clinical interests in management of spasticity and the physical aspects of neurodisability. The programme of research has incorporated development of outcome measurement approaches using Goal Attainment Scaling (GAS) in conjunction with standardised measures such as ArmA developed through his PhD. Since completing his PhD Dr Ashford has been successful in being awarded a grant from Ipsen Ltd (Pharma) to further develop this work in producing an Upper Limb Spasticity Index (ULSI) for evaluation of spasticity intervention and systematic recording of therapy based interventions used alongside botulinum toxin injection.

In the clinical environment Dr Ashford provides consultant leadership in management of people with complex neurodisability and support to their carers. He works with multidisciplinary teams (physiotherapy, rehabilitation medicine, occupational therapy, nursing, GPs) in Hertfordshire, Bedfordshire, Essex, Harrow, Brent (approx. 5m population) and the RRU inpatient service (covering a population of 10m) across London. He has a special interest in the management of spasticity and is one of the first physiotherapists in the UK to undertake injection of botulinum toxin as one component of this role.

The work has resulted in development of national guidelines for spasticity management using botulinum toxin, the update of the National stroke guideline and NICE guidance. Dr Ashford has a key role as a practice leader, firstly to the team of physiotherapists on the RRU, Northwest London Hospitals and more widely. He provides clinical supervisory input to these teams and consultant support across the region.

He has responsibility for developing AHP (over 100 WTE) research at North West London Hospitals Trust and received NIHR-CLRN funding to support this activity (£25,000). Dr Ashford has supported four MSc students in dissertation planning and completion over the past 18 months. He has also developed research programmes, funding applications and collaborations integrating academic and clinical environments ensuring research utility.

Selected Publications
  • Ashford S. Alexandrescu R. Siegert RJ. (2016) The Arm Activity measure (ArmA) passive function sub-scale conjoint measurement and ordinal scaling, SRR Proceedings doi: 10.1177/0269215515627283 Clinical Rehabilitation July 2016 vol. 30 no. 7 714-718
  • Alexandrescu R. Ashford S. Siegert RJ. (2016) Rasch analysis of the UK functional assessment measure in patients with complex disability after stroke, SRR Proceedings doi: 10.1177/0269215515627283 Clinical Rehabilitation July 2016 vol. 30 no. 7 714-718
  • Turner-Stokes L. Ashford S. Jacinto J. Maisonobe P. Balcaitiene J. Fheodoroff K. (2016) Impact of integrated upper limb spasticity management including botulinum toxin A on patient-centred goal attainment: rationale and protocol for an international, prospective, longitudinal cohort study (ULIS III), BMJ Open; 6:e011157.
  • Ashford S. Jackson D. Mahaffey P. Vanderstay R. Turner-Stokes L. (2016) Conceptualisation and development of the Leg Activity Measure (LegA) for patient and carer reported assessment of activity (function) in the paretic leg in people with acquired brain injury, Physiotherapy Reasearch International. E Pub ahead of print.
  • Ashford S. Jacinto J. Fheodoroff K. Turner-Stokes L. (2016) Common goal areas in the treatment of upper limb spasticity: a multicentre analysis, Clinical Rehabilitation. 30(6) 617–622, DOI: 10.1177/0269215515593391.
  • Kilbride C. Ashford S. Baird T.  Hoffman K. Tuckey J. (2015) Clinical Update: Guideline on splinting. Frontline. 4 Nov. 21. 19. 28-29.
  • Pike S. Lannin N. Cusick A. Wales K. Turner-Stokes L. Ashford S. (2015) A systematic review protocol to evaluate the psychometric properties of measures of function within adult neuro-rehabilitation. Systematic Reviews, 4:86 doi:10.1186/s13643-015-0076-5.
  • Turner-Stokes L. Bassett P. Rose H. Ashford S. Thu A. (2015) Serial measurement of Wessex Head Injury Matrix in the diagnosis of patients in vegetative and minimally conscious states: a cohort analysis. BMJ Open, p. 1-12 12 p.006051
  • Ashford S. Siegert RJ. Alexandrescu R. (2015) Rasch measurement: The Arm Activity Measure (ArmA) passive function sub-scale. Disability and Rehabilitation. DOI: 10.3109/09638288.2015.1041613.
  • Turner-Stokes L. Rose H. Ashford S. Singer B. (2015) Patient engagement and satisfaction with goal planning: Impact on outcome from rehabilitation, International Journal of Therapy and Rehabilitation. Vol 22, No 5, p 210-216
  • Fheodoroff  K. Ashford S. Jacinto J. Maisonobe P. Balcaitiene J. Turner-Stokes L. (2015) Factors influencing goal attainment in patients with post-stroke upper limb spasticity following treatment with botulinum toxin A in real-life clinical practice: sub-analyses from the Upper Limb International Spasticity (ULIS)-II Study. Toxins. 7, 1192-1205; doi:10.3390/toxins7041192
  • Ashford S. Jackson D. Turner-Stokes L. (2015) Goal setting, using goal attainment scaling, as a method to identify patient selected items for measuring arm function. Physiotherapy, 101, 88-94. http://dx.doi.org/10.1016/j.physio.2014.04.001
  • College of Occupational Therapists and Association of Chartered Physiotherapists in Neurology (2015) Splinting for the prevention and correction of contractures in adults with neurological dysfunction Practice guideline for occupational therapists and physiotherapists, GDG: Kilbride C. Ashford S. Ashworth-Beaumont J. Baird T.  Hoffman K. Malaprade F. Mohagheghi A. Tuckey J. DeSouza L.
  • Ashford S, Brown S, Turner-Stokes L. (2015) Systematic review of patient-reported outcome measures for functional performance in the lower limb. J Rehabil Med. 47(1):9-17. doi: 10.2340/16501977-1889.
  • Ashford, S., Slade, M., Nair, A., Turner-Stokes, L., & Ashford, S. (2015). Arm Activity measure (ArmA) application for recording functional gain following focal spasticity treatment. International Journal of Therapy and Rehabilitation21(1), 10-17. 10.12968/ijtr.2014.21.1.10
Teaching

As part of his current clinical role, Dr Ashford undertakes teaching to teams throughout the region on a number of different topics including; the management of spasticity, management of patients with long-term neurological conditions, measurement of clinical outcome and use, goal setting and evaluation (including Goal Attainment Scaling) and selection of clinical outcome measures.

Dr Ashford currently holds an NIHR clinical lecturship at King’s College London. He continues to teach on MSc programmes at Brunel University on outcome measurement, use and selection of measures and various aspects of clinical practice in neurorehabilitation including management of spasticity and challenging behaviour in brain injury

Selected Grants
    • Ashford, S. (2013 to 2017) NIHR Clinical Lectureship (£139,000).Turner-Stokes, L. Ashford, S. (2011 to 2012) Development of an upper limb spasticity INDEX (£32000).
    • Ashford, S. (2010 to 2011) North West London, Comprehensive Local Research Network (NIHR-CLRN). Preliminary development of funding applications and therapy research support (£25,000).
    • Ashford, S. (2005 to 2011) Educational award for PhD fees. Regional Rehabilitation Unit - Trust Fund, North West London Hospitals NHS Trust (£1990 per year).
    • Turner-Stokes, L. Ashford, S. (2004 to 2007) Management of shoulder and proximal upper limb spasticity using botulinum toxin and concurrent therapy interventions. Unrestricted research grant IPSEN Ltd (£50,000)
Critical Impact

Dr Ashford's PhD thesis, which produced award-winning research (Society for Research in Rehabilitation Verna Wright prize 2008), investigated the assessment of functional improvement in the hemiparetic arm following focal rehabilitation intervention and spasticity management using botulinum toxin. The work included development of a Patient (and carer) Reported Outcome Measure (PROM) based on findings from a systematic review and a novel approach in patient involvement incorporating items taken form clinical goal setting with patients and carers. The Arm Activity measure (ArmA) is unique in being reflective of real life and measuring both active function (self performance of tasks) and passive function (care related tasks by the person or a carer). Psychometric evaluation of ArmA included both classical and item response approaches resulting in a robust measure with demonstrated clinical utility. The measure was then applied in a prospective cohort study, which importantly demonstrated the expected pattern of change in spasticity and corresponding function.

The ArmA was appended and recommended in the Royal College of Physicians National Guideline for management of spasticity using botulinum toxin. Dr Ashford has since undertaken development of an Upper Limb Spasticity Index (including the ArmA) in collaboration with colleagues internationally (France, Germany, Spain and Australia). In the U.K. there has been a wide uptake in use of the ArmA in clinical practice; including spasticity management services and also applied in other focal interventions such as Constraint Induced Movement Therapy (CIMT) and upper limb task training programmes including Saeboflex device use.

International Links

Dr Ashford has international collaborators across Europe and Australasia as part of the ULIS study. He also has on-going collaboration with colleagues in New Zealand for his current NIHR project (Measuring functional outcome following treatment for leg spasticity) as well as secondary evaluation of data sets with colleagues in both Australia and New Zealand.

    • Current collaborative work with colleagues in Australia and USA on secondary analysis of Disability of the Arm, Shoulder and Hand (DASH) data from hemiplegic participants.  Attempting to validate DASH for use in hemiplegic patients.
    • Formulating programme grant applications with colleagues in the UK and New Zealand to consider the influence of goal setting on clinical practice and specifically explore the element of motivation in task practice for patients with hemiparesis.
    • On-going presentation of research findings at international meetings.
    • Development of the outcome measure pack for the Upper Limb International Spasticity study III (ULIS III). This work involved consultation with colleagues across Europe, Asia and Australia.
    • Co-investigator on the Upper Limb International Spasticity study III (ULIS III). Collaborating with colleagues in France, Portugal and Austria in development of study protocol and trial management.
    • Collaboration with Professor Richard Siegert, AUT University  on Rasch analysis and development of interval level measurement for the Arm Activity measure (ArmA) in focal upper limb rehabilitation including spasticity management.
    • Development of aspects of the NIHR Clinical Lectureship project with Professor Richard Siegert, AUT University, on measurement of lower limb function (Leg Activity measures – LegA) in conjunction with Professor Turner-Stokes and the team at the Cicely Saunders Institute.
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