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We aimed to describe the clinical characteristics of West Nile patients reported in Québec in 2012 and 2013 and to document physical, mental and functional status 24 months after symptom onset according to illness severity. The cases were recruited by a public health professional. Data were collected from public health files, medical records and two standardised phone questionnaires: the Short Form-36 and the Instrumental Activities of Daily Living. In all, 92 persons participated in the study (25 had West Nile fever (WNF), 18 had meningitis and 49 had encephalitis). Encephalitis participants were older, had more underlying medical conditions, more neurological symptoms, worse hospital course and higher lethality than meningitis or WNF participants. Nearly half of the surviving hospitalised encephalitis patients required extra support upon discharge. At 24-month follow-up, encephalitis and meningitis patients had a lower score in two domains of the mental component: mental health and social functioning (P = 0.0025 and 0.0297, respectively) compared with the norms based on age- and sex-matched Canadians. Physical status was not affected by West Nile virus (WNV) infection. In addition, 5/36 (15%) of encephalitis, 1/17 (6%) of meningitis and 1/23 (5%) of WNF participants had new functional limitations 24 months after symptom onset. In summary, mental and functional sequelae in encephalitis patients are likely to represent a source of long-term morbidity. Preventive measures should target patients at higher risk of severe illness after WNV infection.

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.