General Information About the CHT Credential and HTCC

A Certified Hand Therapist (CHT) is an occupational therapist or physical therapist who has a minimum of three years of clinical experience, including 4,000 hours or more in direct practice in hand therapy. In addition, the Certified Hand Therapist has successfully passed a comprehensive test of advanced clinical skills and theory in upper quarter rehabilitation. Because of changes in the profession, every CHT is required to demonstrate continued professional development and competency by recertifying every five years.

The definition of hand therapy is based on the study of hand therapy practice conducted by the Hand Therapy Certification Commission (HTCC) in 2008. Certified Hand Therapists in the United States and Canada responded to a survey that asked questions about practice, the theory and knowledge necessary to perform as a hand therapist, the types of patients seen, and the tools and techniques used. This information was used to revise the original Definition and Scope of Practice of Hand Therapy that was published in 1987. The HTCC Board of Directors adopted this revised definition and scope of practice in March 2009.

Hand therapy is the art and science of rehabilitation of the upper limb, which includes the hand, wrist, elbow and shoulder girdle. It is a merging of occupational and physical therapy theory and practice that combines comprehensive knowledge of the structure of the upper limb with function and activity. Using specialized skills in assessment, planning and treatment, hand therapists provide therapeutic interventions to prevent dysfunction, restore function and/or reverse the progression of pathology of the upper limb in order to enhance an individual’s ability to execute tasks and to participate fully in life situations.

Our Mission

The mission of the Hand Therapy Certification Commission, Inc. is to support a high level of competence in hand therapy practice and to advance the specialty through a formal credentialing process.

Our Vision

The Hand Therapy Certification Commission envisions a time when every qualified therapist who treats hand patients will become a Certified Hand Therapist.

Our Purpose

The purposes of the Hand Therapy Certification program are to:

  • Serve the public and hand therapy community by maintaining high standards in the practice of hand therapy.
  • Enhance the quality of patient care.
  • Recognize occupational therapists and physical therapists that have achieved an advanced level of professional knowledge.
  • Encourage participation in continuing education and professional development

There is no formal educational process for becoming a Certified Hand Therapist (CHT). Therapists may develop a special interest by working with patients with upper extremity dysfunction, or by exposure to hand therapists and hand surgeons. Most will take continuing education courses to develop new skills in the area. Some will have fieldwork experiences in hand therapy or will apply for a fellowship. Eventually their interest and experiences will lead them to pursue the CHT credential.

The most frequent question HTCC is asked is how a therapist can obtain the direct practice experience required to take the examination. The 4,000 hours of direct practice experience must all be in the upper extremity so it is beneficial to seek employment in a setting that provides hand therapy services. HTCC has job postings at Find a Job. Although many employers prefer to hire a CHT, some will hire an inexperienced person and train them. Depending on your location, there may be a local study group of hand therapists you could join to learn more about the specialty and network with hand therapists. You might also want to take one or two general hand therapy educational courses to make sure this is an area you are truly interested in. Continuing Education listings can be found on the CE calendar.

Once you think you are ready to take the exam, review the Examination Blueprint which has the tasks and knowledge areas that are used as the basis of the exam questions to help you determine the areas to target for study.

Ready to Apply? Start here.

No the European Certified Hand Therapist (ECHT) credential is in no way affiliated with the Hand Therapy Certification Commission or the Certified Hand Therapist (CHT) Credential. The ECHT credential is a separate credential offered by the European Federation of Societies for Hand Therapy (EFSHT). HTCC has not assisted in the development of the ECHT program.

Most CHTs are located in the United States but our program is open to professionals worldwide.  HTCC offers the CHT credential to any OT or PT in any country who meets HTCC's general eligibility requirements and successfully passes the Hand Therapy Certification Examination.  We are proud to have CHTs in Canada, Australia, New Zealand, Germany, Ireland, and other countries.

Since 1991, HTCC has used the marks “CHT” and “Certified Hand Therapist” to recognize those individuals who have successfully completed the Hand Therapy Certification Examination.  HTCC owns trademark registrations for the names “CHT” and “Certified Hand Therapist” in the European Community (Community Trade Mark registrations No. 9116344 and No. 9116377). 

HTCC recognizes the importance of options for professionals seeking training and certification programs.  This FAQ has been posted for the purpose of eliminating any confusion among employers, consumers, and the general public regarding who is responsible for these independent programs.  If you are in Europe and have any questions regarding the Certified Hand Therapist credential, please do not hesitate to contact HTCC.

For more information regarding the ECHT credential click here.

The CHT credential is a registered trademark of HTCC in the United States and some foreign countries.  In general, a trademark registration consists of the trademark and also the class(es) of goods and services with which the trademark is used.  HTCC’s CHT credential is registered in connection with occupational and physical therapy.  Official registrations and intellectual property laws protect HTCC’s CHT credential from competing, confusing, or misleading uses of “CHT” regarding occupational and physical therapy. In other words, another organization may use a ‘CHT’ credential with professions other than occupational or physical therapy.

Applying for Certification

Apply Online

To apply for the Hand Therapy Certification Examination online:
  • Click here to go to the application login page.
  • Follow the prompts for filling out the Online Application.
  • Complete the Consent Form.
  • Complete the payment process by submitting your credit card information online.
  • Fax, mail or upload the following supporting documentation to HTCC, (All documents can be found in the forms section):
    • Documentation of three years of practice as an occupational therapist or physical therapist;
    • Documentation of 4,000 hours of Direct Practice Experience using the Employment Verification Form;
    • Completed Explanation of Practice Experience Form;
    • A copy of current license, certificate or registration to practice occupational therapy or physical therapy;
    • If requesting a special accommodation, complete the candidate and provider forms. Download forms and read more information on the special accommodations page.

You must include documentation that verifies three years of practice as a certified, registered, or licensed occupational therapist. Practice under a temporary license is not applicable. Years as a Certified OT Assistant may not be applied to this requirement. Length of practice may be verified by submitting ONE of the following documents:

  1. Photocopy of your large NBCOT certificate that reflects your date of initial certification as an OTR. If you do not have this certificate, you can obtain verification from NBCOT by submitting a request using NBCOT's Verification of Certification Request form, which is available at www.nbcot.org. There is a $30 processing fee. NBCOT advises to allow three weeks for processing.
  2. OR
  3. Photocopy of your state license with the original date of licensure, or verification of date of licensure from your state. Contact the state licensing board of the state in which you were originally licensed for verification. Each state board has its own procedures and fees and should be contacted for more information. A print-out of license verification from the website of an official state agency is acceptable verification.

PLEASE NOTE: Membership in the American Occupational Therapy Association(AOTA) does not apply to this requirement.

For therapists outside the United States, you may submit verification of original professional credential (license, certificate or registration) that is required to legally practice in your location. If you were eligible for the exam in 2003 or after, you do not need to submit this documentation.

HTCC and PSI comply with the Americans with Disabilities Act and strive to ensure that no individual with a disability, defined by the ADA as a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment, is deprived of the opportunity to take the examination solely by reason of that disability. HTCC will provide reasonable accommodations for candidates with disabilities.

If you require special accommodations in order to sit for the examination, you should contact the HTCC administrative office. You and your qualified health care provider will need to complete a form to document the disability and the need for accommodation. You must provide medical documentation of the disability that is less than five years old. This means that you must have a current evaluation from the appropriate provider. HTCC must receive this documentation no later than March 15th for the May exam and September 15th for the November exam. You must submit two forms with your application: the Candidate Form and the Provider Form.

You DO need to complete the application again; however if you took the exam after 2008 we will only need a copy of your current license since all your supporting documentation has been archived electronically. If you log in to the Certification Center with the same email address and password that you created after 2008, your supporting documentation information will have been preserved.

Once You Are Eligible

Upon confirmation of eligibility to take the examination, you will receive email notification from HTCC telling you that your information has been sent to PSI. You will then receive a second email from PSI with instructions on how to make your appointment for the test. It may take approximately 5-10 working days to receive the PSI email. Please Note: These email notifications will be sent to the e-mail address listed on your account. It is your responsibility to keep your e-mail address current with HTCC.

Name Changes

If your legal name changes AFTER the examination application has been submitted, your new name must be updated with HTCC. This is especially important because the name given on the examination application is the name that is provided to PSI. The IDs presented to PSI at the time of the exam must match the name that PSI has in its records.

To make a name change, log into your account using the User Name and Password assigned to you during the application process. No changes can be made within five days before the scheduled exam.

Address Changes

To change your address, log into your account in the Certification Center using the user name and password assigned to you during the application process. Changes may be made at any time. Please be sure this information is correct to assure receipt of your test score.

Exam Scoring and Results

To view the overall pass rates click here. We do not release the breakdown of pass rates by first vs. second examination attempt. The passing rate for first-time test takers is higher than repeat test takers, and the ultimate passing rate for those who take the exam more than once is about 65%.

HTCC strives to bring the latest industry standards to our testing program. Multiple test forms are used for each administration of the test. Every examination form uses a unique combination of questions from the question bank, so that no two test forms are identical. Although each test form is designed to fairly assess the knowledge and skills that are required for the proficient practice of hand therapy, the overall level of difficulty may fluctuate slightly among test forms as the difficulty of the questions on the test may fluctuate. To compensate for these potential minor fluctuations, a process known as “equating” is used to statistically analyze and adjust the passing score for each test form.

Equating ensures that candidates of comparable knowledge and skill will receive comparable scores on the examination regardless of which version of the test they take. Thus, no candidate will be penalized for taking a version of the examination that turns out to be more difficult than another version of the examination, and no candidate will be given an advantage by taking a version of the examination that is less difficult. The end result is that all candidates have an equal and fair opportunity to receive a score on the examination that accurately reflects their knowledge and understanding of hand therapy.

In addition to equating, other statistical procedures transform raw scores to “scaled scores”. Comparison of test scores from one test form to another would be difficult if raw scores were used, since the raw passing score on each form varies. Thus, in order to compare test scores, a uniform frame of reference is used. Scaled scores ensure that scoring on different forms of the examination have the same meaning so that candidates are not unfairly rewarded or penalized based on test form differences. Transforming raw scores to scaled scores is similar to transforming a temperature from Fahrenheit to Centigrade.

PLEASE NOTE THAT A SCALED SCORE IS NEITHER THE NUMBER OF QUESTIONS YOU ANSWERED CORRECTLY NOR THE PERCENTAGE OF QUESTIONS YOU ANSWERED CORRECTLY. Your results will be reported as a scaled score, on a scale ranging from 0 – 99 points. The passing score for the Hand Therapy Certification Examination is 75 points.

After the examination has been administered, PSI and our testing consultant execute a detailed statistical analysis of the performance of each item (question) on the examination. The data from the analysis, along with candidate comments, are reviewed item-by-item by HTCC to determine if any question might be flawed (e.g. no clear correct answer, more than one correct answer). Flawed items, if any, are adjusted by accepting 2, 3, or all 4 of the choices as correct responses. HTCC engages in this process to ensure that no candidate is penalized by the presence of a flawed item. This is for your benefit and all of the flagged questions are reviewed by the examination committee via a video conference call. Unfortunately this process can take some time.

The exam is not available for review because some of the questions will be used on subsequent examinations.

Test results will be sent to you approximately 4 to 6 weeks after the examination. If you achieve the minimum passing score, you will receive a letter informing you that you have passed the examination. The test has been designed to identify those who meet the standard of competence set by HTCC. Those who pass have met this standard.

If you do not pass, you will receive a score report that includes your scaled score and the percentage of questions that you answered correctly in each of the four subject areas.

General Certification Questions

You may count any hours related to the treatment of the upper extremity, including the ones you describe here. However, the Hand Therapy Certification Examination is based on more traditional hand and upper extremity rehabilitation, including injuries and post-operative management of a variety of conditions. Before deciding to take the exam you should review the exam domains and associated tasks as well as the scope of practice, knowledge areas, diagnoses and treatment techniques. If you are not familiar with what is listed there, it would be very difficult to pass the exam. Please check this link for the test blueprint.

  • You must be an occupational therapist or physical therapist with a current professional credential to practice as an OT or PT. This credential must be active and in good standing with the agency that issued it.
  • You must have been licensed or certified for a minimum of three years, based on date of issue of the certificate or license.
  • You must have a minimum of 4,000 hours of Direct Practice Experience in hand therapy. These hours may have been accrued at any time during your career as a licensed OT or PT.

Direct Practice Experience is the direct provision of patient care through assessment and implementation of an individualized treatment plan including but not limited to orthotics/splinting, modalities and/or exercise to prevent dysfunction, maximize functional recovery, or influence the effect of pathology in the upper quarter. It does not include time spent in administration, research, teaching, or consultation.

No the Direct Practice Experience hours do NOT have to be under the supervision of a CHT. Any Direct Practice Experience hours in hand therapy will be accepted. Please refer to the Eligibility Requirements for a complete explanation regarding Direct Practice Experience in Hand Therapy.

Only registered occupational or physical therapists are eligible for the Hand Therapy Certification Examination as the exam was designed for OTs and PTs and many of the questions on the exam fall outside of a COTA or PTA's practice act.

HTCC has been asked why there is not a certification examination for COTAs and PTAs and this is something we have considered and explored. Unfortunately, developing a new exam is extremely expensive and we would have to have sufficient numbers of people to test to offset the investment, which we do not believe to be the case. You may wish to contact AOTA or APTA who may have some advanced practice certifications for Occupational or Physical Therapy Asssitants.

Any direct patient clinic time associated with these programs ​can be included in the 4,000 hour direct practice experience hours for eligibility to sit for the Hand Therapy Certification Examination as long as the direct patient care was performed as a licensed OT or PT. Classroom, instruction and observation time ​can not be included. Hours obtained as a student or under a temporary license cannot be included as well.

No, HTCC only recognizes individual physical therapists and occupational therapists who meet HTCC’s general eligibility requirements, successfully pass the Hand Therapy Certification Examination, and recertify at the end of their 5 year accrual cycle.  Since 1991, HTCC has used the marks “CHT” and “Certified Hand Therapist” to recognize these individuals.

Hand therapy services are provided in a variety of settings.  HTCC is not involved in evaluating other aspects of healthcare operations, such as assistants and other staff, billing practices, or overall patient satisfaction, at hospitals, clinics, hand centers, hand therapy offices, or other business settings in which hand therapy services may be provided.

Certified Hand Therapists and their employers are asked to use HTCC trademarks in a manner that is truthful and not misleading.  The CHT credential is an indication of individual competency so it is the policy of HTCC that business names should be distinct from the credential. 

In particular, HTCC finds it inappropriate for a business to hold itself out to the public as “certified” if no third party has certified its operations.

HTCC recognizes the importance of accurate information regarding the scope of its program.  This FAQ has been posted for the purpose of eliminating any confusion among employers, consumers, and the general public regarding what “Certified Hand Therapist” represents.  If you have any questions regarding the Certified Hand Therapist credential, please do not hesitate to contact HTCC.