Our splints are created to maximize function. The splint pictured here is holding the patient in extension and facilitating functional flexion. 

What is the difference between seeing a Certified Hand Therapist (CHT) and seeing an Occupational Therapist (OT) or Physical Therapist (PT) who says they can also treat hands?

     A Certified Hand Therapist (CHT) is a clinician who has completed either an Occupational Therapy (OT) or Physical Therapy (PT) program and then met the requirements to sit for and pass the Hand Therapy Certification Examination, an exam that had a 55% pass rate in 2019 (Hand Therapy Certification Commission [HTCC], n.d.a). The requirements include practicing therapy in a practice area that specializes in the upper extremity (shoulder, arm, wrist, hands, fingers) for 4,000 hours and three years. It is not required for a future CHT to practice under a current CHT during this time, but it is highly recommended. Currently, there are only 6,460 CHTs in America (HTCC, n.d.b). A CHT must be either an OT or PT first, but not all OTs or PTs go on to become a CHT. Some OTs and PTs treat hands even though they are not a CHT. In some cases, this is acceptable, but in others, it is best to see a CHT secondary to a CHT’s experience and knowledge of complex upper extremity cases; due to the anatomical structure of the human upper extremity, most of these cases are considered complex. Similar to how you would prefer to see a hand surgeon over a general surgeon (emergency room doctor, plastic surgeon, etc.), you should consider seeing a certified hand therapist over a general OT or PT.

     The Hand Therapy Scope of Practice emphasizes a hand therapists’ responsibility and credibility to perform evaluations, determine prognosis and plan of care, and implement therapeutic interventions within state and federal law requirements based on a certified hand therapists’ extensive knowledge and experience of anatomical, biological, and neurological science (Hand Therapy Certification Commission [HTCC], 2015). The Hand Therapy Certification Commission (HTCC) has determined it takes a minimum of three years and four- thousand hours for an OT or PT to gain this extensive knowledge and experience before even being eligible to take the Hand Therapy Certification Examination.

     The Colorado Physical Therapy Practice Act defines PT as “the examination, physical therapy diagnosis, treatment, or instruction of patients and clients to detect, assess, prevent, correct, alleviate, or limit physical disability, movement dysfunction, bodily malfunction, or pain from injury, disease, and other bodily conditions” (Colorado Revised Statutes, 2020b). For a general PT treating hands, this means relieving pain and decreasing disability. This prepares a PT to become a CHT, but does not account for the refined knowledge required to therapeutically treat hands. For example, a patient came to us from a generalized PT with the diagnoses of finger stiffness and CRPS. It took Mitzi’s expertise as a CHT to identify an anatomical issue and recommend the necessary surgical procedure.

The Occupational Therapy Scope of Practice has an extensive definition of occupational therapy, which is linked below (American Occupational Therapy Association [AOTA], 2014). This definition, in short, discusses OT’s focus on the end result of participation, through evaluation and intervention of patients performing daily tasks within their natural environments. In hand therapy, this includes adapting activities and/ or tools or addressing client factors (pain, limited range of motion, etc.) in order to facilitate the completion of daily tasks (AOTA, 2014). For example, this would mean using ultrasound and manual techniques to reduce pain and inflammation so that a patient is able to garden with adaptive ergonomic tools. However, if pain persists or if this activity causes inflammation, the OT Scope of Practice is no longer applicable, and the Hand Therapy Scope of Practice becomes more relevant, as more clinical experience and knowledge is clearly needed here, as basic pain relief methods and adaptations did not work for the patient.

     The Colorado Occupational Therapy Practice Act states that an occupational therapist must have successfully completed a graduate level occupational therapy program, successfully completed a minimum period of supervised fieldwork (at least six months), passed the National Board Certification of OT (NBCOT), applied and paid for a Colorado license, and renew this license every other year (renewal includes application and at least twenty- four hours of continuing education classes) (Colorado Revised Statutes, 2020a; Colorado Revised Statutes 12-40.5-109.3, 2020). The Colorado Physical Therapy Practice Act states that a physical therapist must have successfully completed an accredited physical therapy program, successfully completed a minimum period of supervised fieldwork, passed the National Physical Therapy Exam (NPTE), applied and paid for a Colorado license, and renew this license every other year (Colorado Revised Statutes, 2020b, 2020). However, the OT Scope of Practice, the PT Scope of Practice, and the education requirements required by most states, including Colorado, does not include specific education or exposure to complex upper extremity conditions. Domain four of the Hand Therapy Scope of Practice is in the image below, and gives an example of the complex cases expected to be understood by a CHT, that the general anatomy classes required in both OT and PT programs do not explicitly cover.

     In 2014, research was conducted to determine if current hand therapy practice was comparable and equal to the content of the Certified Hand Therapist examination (Keller et al., 2016). This research found small variances between practice and the exam, and thus led to slight revisions of the test specifications and refinements of the Hand Therapy Scope of Practice, and has since been kept updated and relevant by the HTCC (Keller et al., 2016). This research shows that passing of the exam now fully distinguishes CHTs from general OTs and PTs. The HTCC and this exam serves potential patients and the hand therapy community by maintaining high standards of the practice of certified hand therapy, prioritizing the quality of patient care, recognizing OTs and PTs who have achieved this specialized and advanced level of professional knowledge, and enforcing continual education and professional development.

     In conclusion, general OTs and PTs can treat hands, but typically not as efficiently as a CHT or a clinician who is currently studying for the CHT exam and practicing under a CHT. In some settings, future CHTs practice independently, so are not learning first- hand from a current CHT. Credentialing is voluntary since the HTCC was established in 1989, but this credentialing signifies excellence in the field of hand therapy and should be prioritized when searching for your clinician for upper extremity rehabilitation. Here at Certified Hand Therapy LLC, Mitzi is our CHT with thirty-six years of experience.

References

American Occupational Therapy Association [AOTA]. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68.

Colorado Revised Statutes 12-40.5-109.3. (2020). Occupational Therapy Profession- Continuing Competence Requirements. American Journal of Occupational Therapy. Retrieved from https://www.aota.org/-/media/Corporate/Files/Advocacy/Licensure/StateRegs/ContComp/Continuing-Competence-Chart-full.pdf

Colorado Revised Statutes. (2020a). Title 12: Professions and Occupations- Article 270: Occupational Therapists and Occupational Therapist Assistants. Retrieved from https://drive.google.com/file/d/0B-K5DhxXxJZbbVdjQjYyRVh0dkE/view

Colorado Revised Statutes. (2020b). Title 12: Professions and Occupations- Article 285: Physical Therapists and Physical Therapist Assistants. Retrieved from https://drive.google.com/file/d/0B-K5DhxXxJZbZWgxLW9sYWRwbEE/view

Hand Therapy Certification Commission [HTCC]. (2015). Scope of Practice and Domains of Hand Therapy. Retrieved from https://www.htcc.org/consumer-information/the-cht-credential/benefits-of-a-cht/scope-of-practice

Hand Therapy Certification Commission [HTCC]. (n.d.a). Passing Rates for the CHT Exam. Retrieved from https://www.htcc.org/certify/exam-results/passing-rates

Hand Therapy Certification Commission [HTCC]. (n.d.b). Who is a Certified Hand Therapist (CHT). Retrieved from https://www.htcc.org/consumer-information/the-cht-credential/who-is-a-cht

Keller, J., Caro, C., Dimick, M., Landrieu, K., Fullenwider, L., & Walsh, M. (2016). Thirty years of hand therapy: The 2014 practice analysis. Journal of Hand Therapy, 29(3), 222-234.