Response to Reviewer

Comment 14 This is a reasonable summary of the paper. However, authors could include some changes after the manuscript has been amended so that methods and results are summarised in line with the document. Response 14 We have now updated the abstract to ensure consistency with the updated and improved descriptions provided in the manuscript. Response to Reviewer 3. Thank you for your comments and suggestions. We have now made amendments to address each of your comments. Amended text in the manuscript document has been bolded. Background Comment 1. The paper reports some demographic literature on the incidence of ankle fractures, and states that there is little empirical research literature specifically on ankle fractures, patient recovery from ankle fractures and their rehabilitation. However, this does not mean to say that relevant literature on fractures or recovery from injuries causing fractures does not exist. Moreover, there is a case for examining the conceptual distinction between recovery from fractures generally, ankle fractures, and other types of orthopaedic problems, to provide a context for an analysis of ‘ankle fractures’. In this sense there is no justification for why ankle fractures, rather than knee dislocations, shoulder injuries or other types of musculoskeletal problems are important to investigate. Also, as ‘pain’ seems to be a central tenet in the respondents’ experiences, it would seem logical to review some of the literature on musculoskeletal pain more broadly. Response 1. In response to this comment, and comments by other reviewers, we have re-written the introduction to cover these suggestions. We have also updated and included a brief discussion of literature that was not available at the time the original manuscript was prepared. Additional comparison of study findings to prior research literature has also been provided in the discussion. Methods Comment 2. More information on respondents would be helpful. For instance, age, sex, cause of the ankle fractures etc. The method of recruiting patients is not described, so we cannot deduce who agreed to participate and who declined, and why. Response 2 We have now provided much greater description of procedure and participants in the methods and results section. We have also included an additional table (Table 1) that includes age, gender, cause of ankle fracture etc. The results section now also outlines who agreed to participate and why. Comment 3. What was the response rate? Response 3. We have now described outlined how participants were recruited, and that only one potential participant who was identified and met the criteria (i.e. could have filled one of the vacant purposive sampling strata) declined participation (as they were unable to find a suitable appointment time when they were able to travel to the hospital to complete the interview). Comment 4. The interview questions are divided into three very broad topic areas, which seem to be asking one very general question e.g. ‘life impacts’ immediately following ankle injury, after 6 months, and at the present time. However, the authors then claim that respondents were asked to describe the treatment received and rehabilitation. These questions seem to be very clinically focused. I was therefore wondering about the specific questions patients were asked in relation to their ‘life impacts’ (not just the clinical impacts). However, we are not told anything about the interviews with health professionals, or for the choice of these particular groups of clinicians/health professionals. More information on the questions that were explored with HC professionals is needed. Comment 4. We acknowledge that our initial description of the interview schedule was suboptimal and have made extensive revisions to the methods and results to clarify a number of points. The interview questions were not divided into three topic areas, but rather four broad partitions; 1) demographic and injury description, 2) life impacts immediately following the ankle fracture, 3) life impacts at approximately 6 weeks post-fracture (or immediately after the cast was removed), and 4) life impacts at the present time. During the first partition of the interview we did indeed ask patients to describe treatment / duration of participation in rehabilitation following their ankle fracture. The purpose of these questions was to describe the sample (not inform the thematic framework) by providing a brief description of how they injured their ankle, whether they received surgical fixation and the duration of rehabilitation received. We had always intended to include this information in the manuscript, but it unfortunately slipped through our net when we were preparing and revising the initial submission. However, we have now included the description of the sample from these clinically focused questions in the methods and results section of the manuscript and Table 1. With our ultimate aim of developing a measure to quantify the progress a person has made in their rehabilitation from an ankle fracture, we felt that it was of utmost importance to capture this temporal breadth of recovery to ensure that our measure will capture domains that are of importance over the entire rehabilitation period. We have now made extensive amendments to the methods to provide a more accurate and precise description for our sampling method and semi-structured interview design and schedule. We have also included example stimulus questions (Table 2) and discussed the justification and limitations of the interview schedule and procedure (methods and discussion). We have also more clearly outlined the justification for including the health professionals and a more detailed description of their interview schedule and procedure. We have also provided more details on the limitations of the methodology employed. Comment 5. The analysis section claims that data saturation was reached following 10 interviews, though that may be because the questions covered a narrow spectrum of issues? Could the authors elaborate on why they reached saturation after only 10 interviews?