The COMPACT: A New OT Assessment—A Mixed-Methods Study

HYPOTHESIS: We hypothesized that the COMPACT™ assessment would encourage occupation-based and client-centered occupational therapy (OT) processes within physical rehabilitation settings, thereby establishing initial content validity and clinical utility as demonstrated by the occupational therapist and client participants.

RATIONALE: The COMPACT, developed by the two presenters, is designed for use by OT practitioners with adult physical rehabilitation clients across the service delivery continuum. This assessment tool brings together the constructs of client-centered practice (i.e., through interview with the client and/or caregiver) and occupation-based practice (i.e., through an assessment structure enabling the OT process to emphasize occupation).

DESIGN: A mixed-methods design was utilized; we used focus groups of OT participants’ (qualitative) experiences in combination with the clients’ clinical use of the COMPACT tool (quantitative data).

PARTICIPANTS: Twenty experienced OT practitioners at Midwestern U.S. physical rehabilitation health systems were recruited using convenience sampling; they, in turn, recruited 18 client participants for COMPACT data completion.

METHOD: We conducted focus groups to gather OT participants’ qualitative perceptions of the assessment tool’s clinical utility and congruence with occupation-based and client-centered practice. Quantitative client data from COMPACT tool completion served as a means to confirm the content validity and clinical utility of the COMPACT.

ANALYSIS: We analyzed the focus group audiotapes’ content qualitatively for patterns and themes. Descriptive analyses of the client data (counts and percentages of client-selected occupations across physical rehabilitation setting type) were achieved via SPSS (Version 21). Finally, integration of the qualitative focus group data with the client case-aggregate quantitative data was performed, looking for areas of convergence and/or divergence.

RESULTS: All OT participants (100%) were in agreement as to the value of the COMPACT tool to promote occupation-based and client-centered practice. The occupational therapists found the clinical utility acceptable but with usage patterns variable across acute-care, inpatient rehabilitation, and outpatient physical rehabilitation practice settings. Fifteen of the 18 client participants (83%) completed the COMPACT and selected five occupational priorities. The majority (78%) of clients chose instrumental activities of daily living (IADLs) as occupational priorities. This was divergent from the OT reports that activities of daily living (ADLs) are a needed priority throughout inpatient care.

Although selected features of the COMPACT, including self-ratings and prioritized occupations, were viewed as helpful by occupational therapists to facilitate open communication and occupation-based intervention planning with clients, client preferences for IADL focus in therapy was mitigated by an OT focus on ADLs to support a safe discharge home.

DISCUSSION: Occupational therapists recognized the value of the broad range of occupations represented in the COMPACT for promoting client partnership and clarifying the potential contributions of OT. Contextual tensions were revealed in regard to implementation in the workplace setting. The findings support a need for broader professional study of OT use of client perspectives to guide collaborative planning across practice settings.

IMPACT STATEMENT: The COMPACT assessment tool demonstrated initial content validity and clinical utility, as determined by this mixed-methods study. With future expanded study, the COMPACT assessment tool holds promise in aiding OT practitioners within physical rehabilitation settings to better understand client occupational priorities and to facilitate collaborative goal setting, bringing best practices more explicitly into current practice.