Introduction. We undertook a qualitative study to explore what is important to people with lower limb conditions requiring reconstruction (LLR) and how it impacted their quality of life (QOL), in order to develop a conceptual framework for a new patient reported outcome measure (PROM). This builds on a previous qualitative evidence synthesis of existing research to develop a preliminary conceptual framework as part of the Patient Reported Outcomes for Lower Limb Reconstruction (PROLLIT) study. Materials and Methods. Patients (n=32) and Orthopaedic staff (n=23) were interviewed (November 2020-June 2021) from three centres in England using one-to-one, semi-structured interviews. Patient interviews focused on experiences during and after LLR, including impact on QOL. Staff interviews explored important outcomes and goals for patients and how the LLR impacted QOL. Recordings were transcribed verbatim and analysed using thematic analysis. Results. The conceptual framework consists of 6 overarching factors important to patients: Pain, Identity, Work, Daily lifestyle, Emotional well-being and Support. These factors are not independent of each other, rather they're all interrelated (e.g. pain impacts identity, work, emotional well-being and daily lifestyle. Work impacts identity, pain, emotional well-being and daily lifestyle). Support from the hospital, physiotherapists and family underpins the other factors and acts as a moderator of their influence. Conclusions. This conceptual framework displays key factors important to patients after a LLR. Further research is required to map these factors onto existing PROMs to establish whether the factors we identified are captured by existing PROMs

Introduction. Patient reported outcome measures (PROMs) are used to understand the impact of lower limb reconstruction on patient's quality of life (QOL). Existing measures have not been developed to specifically capture patient experiences amongst adults with lower limb conditions that require reconstruction surgery. This systematic review of qualitative studies (qualitative evidence synthesis) aimed to identify what is important to these patients. Materials and Methods. MEDLINE, Embase, PsychINFO and Cinahl were searched from inception until November 2020. Studies were included if they employed qualitative research methods, involved patients requiring, undergoing or following lower limb reconstruction and explored patients' experiences of care, treatment, recovery and QOL. Mixed methods/population studies that did not separate the findings from each group and studies not in English were excluded. Included studies were analysed using thematic synthesis. The review followed the methodological framework published by the Cochrane Qualitative and Implementation Methods Group for qualitative evidence syntheses. Results. Nine studies met the inclusion criteria. Thematic synthesis identified two overarching themes:(1) areas of living key to QOL for lower limb reconstruction patients, with sub-themes: pain, daily functioning and lifestyle, identity, income and emotional wellbeing and (2) moving towards a new normal, with sub-themes: support, the ability to adapt and adjust and the ability to move forwards. The impact of lower limb reconstruction on QOL and recovery is complex and is influenced by a range of inter-related factors, which will affect patients to varying degrees depending on individual circumstances. Conclusions. The impact of lower limb reconstruction on patients' QOL is complex, may change over time and is strongly linked to their recovery. This review was conducted as part of the wider ‘PROLLIT' study, which will develop a conceptual framework to identify what outcomes are important to patients and should be included in a PROM. We will then map our conceptual framework onto existing PROMS to establish whether our identified factors are captured by current PROMS. Depending on the outcome of this work, a new PROM for patients following lower limb reconstruction may be developed