Integrating innovations such as telerehabilitation (TR) into routine clinical care is a complex process. This study aimed to identify the factors which impact on TR implementation and routine use. Methods. A mixed-method prospective single-case study with multiple embedded units of analysis was conducted. Interviews (implementation leaders, clinical champions and upper management) and focus groups with users and non-users of TR were conducted, and TR use was recorded. The Consolidated Framework for Implementation Research and Normalization Process Theory were used to examine factors which impacted on TR implementation and routine use. Results. Over 18 months, 155 TR sessions were carried out by 12 clinicians (6% of potential staff), eight of which continued using TR routinely clinical activities. During implementation, deviations to the intended implementation and unexpected delays impacted on TR use. TR continued to be used for some clinical activities. Facilitators and barriers were related to the intervention, the organisations and the health care context. Discussion. Comprehensive frameworks and theories used in long term studies of TR use can help identify factors which impact on implementation and routine clinical use.