title: Exploring routine use of telemedicine through a case study in rehabilitation.
abstract: OBJECTIVE
  This study examines how telerehabilitation becomes part of existing and new clinical routines and identifies factors that enable or constrain its routine use.
  
  
  METHODS
  An in-depth case study of a telemedicine program in rehabilitation implemented between an urban specialized rehabilitation center and a rural regional rehabilitation center was conducted. Using a conceptual framework based on Giddens' theory of structuration, a qualitative analysis was carried out using four data sources: focus groups and phone interviews (with health professionals, managers, and patients and their family members); telerehabilitation video recordings; and project documents (e.g., proposals, requests for funding, summaries, agendas of meetings, operating procedures, patient handouts, and tools for clinicians).
  
  
  RESULTS
  In two rehabilitation programs for 1) patients who sustained a traumatic brain injury and 2) those who sustained a spinal cord injury, telerehabilitation was successfully incorporated into routine clinical practices for activities such as interdisciplinary care plans. However, for specialized clinical consultations or long-term patient follow-up, telerehabilitation was not successfully incorporated. Factors that facilitated or prevented the integration of telerehabilitation in routine practices stemmed from both the structure (norms, rules, resources, and values) and the agent (e.g., users of telerehabilitation, including clinicians, managers, and patients and their families) and include 1) shared beliefs and assumptions held by patient care team members regarding the nature of the clinical activities, and the perceptions of patients and their family members; 2) clinical and organizational leadership; 3) extent and type of telerehabilitation use; 4) available resources; and 5) collaborations already in place or needing to be developed.
  
  
  CONCLUSIONS
  This study provides empirical evidence of how telerehabilitation activities may become integrated into routine day-to-day clinical activities.
authors.affiliation: School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada, dahlia.kairy@umontreal.ca.
authors.forename: Dahlia
authors.initials: D
authors.lastname: Kairy
authors.affiliation: Department of Health Administration, Institute of Public Health Research, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Pascale
authors.initials: P
authors.lastname: Lehoux
authors.affiliation: Department of Rehabilitation, Université Laval, Quebec City, Quebec, Canada.
authors.forename: Claude
authors.initials: C
authors.lastname: Vincent
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017216:Telemedicine / Q000706:statistics & numerical data; D000069350:Telerehabilitation / Q000706:statistics & numerical data*; D055815:Young Adult