Publications by authors named "Todd Norwood"
The continued demand for digital health requires that providers adapt thought processes to enable sound clinical decision-making in digital settings. Providers report that lack of training is a barrier to providing digital health care. Physical examination techniques and hands-on interventions must be adjusted in safe, reliable, and feasible ways to provide digital care, and decision-making may be impacted by modifications made to these techniques.
View Article and Find Full Text PDFObjectives: To estimate the economic benefit of evidence-based patient-initiated virtual physical therapy (PIVPT) service among a nationally representative sample of commercially insured patients with musculoskeletal (MSK) conditions.
Study Design: Counterfactual simulation.
Methods: Using a nationally representative sample from the 2018 Medical Expenditure Panel Survey, we simulated the direct medical care savings and indirect cost savings from reduced absenteeism resulting from PIVPT among commercially insured working adults with self-reported MSK conditions.
Global increases in thyroid cancer incidence (≥90% differentiated thyroid cancers; DTC) are hypothesized to be related to increased use of pre-diagnostic imaging. These procedures can detect DTC during imaging for conditions unrelated to the thyroid (incidental detection). The objectives were to evaluate incidental detection of DTC associated with standardized, regional imaging capacity and drivetime from patient residence to imaging facility (the exposures).
View Article and Find Full Text PDFObjective: To examine the effect of digital physical therapy (PT) delivered by mobile application (app) on reducing pain and improving function for people with a variety of musculoskeletal conditions.
Design: An observational, longitudinal, retrospective study using survey data collected pre- and postdigital PT to estimate multilevel models with random intercepts for patient episodes.
Setting: Privately insured employees participating in app-based PT as an employer health care benefit.
Background: Musculoskeletal care is now delivered via mobile apps as a health care benefit. Although preliminary evidence shows that the clinical outcomes of mobile musculoskeletal care are comparable with those of in-person care, no research has examined the features of app-based care that secure these outcomes.
Objective: Drawing on the literature around in-person physical therapy, this study examines how patient-provider relationships and program engagement in app-based physical therapy affect clinically meaningful improvements in pain, function, and patient satisfaction.
Background: Incidence rates of thyroid cancer in Ontario have increased more rapidly than those of any other cancer, whereas mortality rates have remained relatively stable. We evaluated the extent to which incidental detection of differentiated thyroid cancer during unrelated prediagnostic imaging procedures contributed to Ontario's incidence rates.
Methods: We conducted a retrospective cohort study involving Ontarians who received a diagnosis of differentiated thyroid cancer from 1998 to 2017 using linked health care administrative databases.
Objectives: Existing Canadian social determinants of health (SDOH) indicators do not quantify uncertainty to identify priority areas. The objectives of this methodologic study were: (1) to estimate and map small area (dissemination area) shared and variable-specific SDOH indicators with measures of uncertainty using a Bayesian model that accounts for spatial dependence; (2) to quantify geographic variation in the SDOH indicators and their contribution to a shared indicator; and (3) to assess the SDOH indicators' associations with behavioural risk factors and their consistency with the Ontario Marginalization Index (ON-Marg).
Methods: Lower education-, income-, unemployment-, living alone- and visible minority-related variables used in existing Canadian SDOH indices were fit as dependent variables to a Bayesian model to produce area-based SDOH indicators that were mapped with measures of uncertainty in two study areas.
Background: Premature mortality is a meaningful indicator of both population health and health system performance, which varies by geography in Ontario. We used the Local Health Integration Network (LHIN) sub-regions to conduct a spatial analysis of premature mortality, adjusting for key population-level demographic and behavioural characteristics.
Methods: We used linked vital statistics data to identify 163,920 adult premature deaths (deaths between ages 18 and 74) registered in Ontario between 2011 and 2015.
Background: Cancer screening is below targets in Ontario, Canada. Our objective was to identify and quantify the barriers and facilitators for breast, cervical and colorectal cancer screening for under and never screened (UNS) residents living in Ontario between 2011 and 2013.
Methods: We used a multi-phased mixed methods study design.
Background: Urban centers across Canada and the United States have battled syphilis epidemics with high rates of human immunodeficiency virus (HIV) coinfection for over a decade. We examined the spatial epidemiology of syphilis over time for Toronto (Canada) with the intention of forming new insights and strategies for restoring low syphilis rates.
Methods: Syphilis incidence rates, HIV-syphilis coinfection, and sexual risk behavior prevalences were estimated and mapped from primary, secondary, early latent syphilis cases reported to Toronto Public Health between January 1, 2006, and December 31, 2010, using ArcGIS 9.
Background: Observed breast, cervical and colon cancer screening rates are below provincial targets for the province of Ontario, Canada. The populations who are under- or never-screened for these cancers have not been described at the Ontario provincial level. Our objective was to use qualitative methods of inquiry to explore who are the never- or under-screened populations of Ontario.
View Article and Find Full Text PDFBackground: Our objective was to determine the extent to which geographical core areas for gonorrhea and syphilis are located in rural areas as compared with urban areas.
Methods: Incident gonorrhea (January 1, 2005-December 31, 2010) and syphilis (January 1, 1999-December 31, 2010) rates were estimated and mapped by census tract and quarter. Rurality was measured using percent rural and rural-urban commuting area (rural, small town, micropolitan, or urban).
Background: We conducted spatial analyses to determine the geographic variation of cancer at the neighbourhood level (dissemination areas or DAs) within the area of a single Ontario public health unit, Wellington-Dufferin-Guelph, covering a population of 238,326 inhabitants. Cancer incidence data between 1999 and 2003 were obtained from the Ontario Cancer Registry and were geocoded down to the level of DA using the enhanced Postal Code Conversion File. The 2001 Census of Canada provided information on the size and age-sex structure of the population at the DA level, in addition to information about selected census covariates, such as average neighbourhood income.
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