A Geographic- and socioeconomic-based analysis of the certified hand therapist workforce in the United States.

Abstract

Certified hand therapists (CHTs) are specialized physical or occupational therapists who meet standards established by the Hand Therapy Certification Commission (HTCC) which encompass four domains including assessing the patient and specifically their upper limb, determining an individualized plan of care and prognosis, implementing the plan of care, and mastering relevant basic science and upper extremity knowledge. However, these healthcare providers are non-uniformly distributed throughout the United States (US) with geographic- and socioeconomic-based disparities. To define overall prevalence of CHTs in the US with geographic and socioeconomic sub-analysis and provide an update to research by Stegink-Jansen. Cross-sectional study. Zip Code Tabulation Area (ZCTA) of active CHTs were determined using 2024 HTCC registry and cross-referenced for geographic area and population income and race/ethnicity using the 2020 US Census. Cohorts were defined as no CHT (ZCTAs with no CHT) and CHT (ZCTAs with at least one CHT). The no CHT cohort consisted of 30,277 ZCTAs (228,520,642 people), while the CHT cohort consisted of 3497 ZCTAs (102,928,639 people). The average number of CHTs / ZCTA and CHTs / 100,000 people overall was 0.2 and 2.1 respectively. The predominant disparity was geographic area with the no CHT cohort consisting of 50.9% rural and 49.1% urban ZCTAs, and the CHT cohort consisting of 7.6% rural and 92.4% urban ZCTAs. The overall prevalence of CHTs remains low despite a recent increase in CHTs. Combined with the increased demand for hand therapy, there is likely a supply-demand mismatch that will make it difficult for patients to access these healthcare professionals. In addition, the disproportionally low prevalence of CHTs in rural geographic locations may lead to suboptimal outcomes.