As a physiotherapist and certified hand therapist at Westmead Hospital in Sydney, Tracey Clark APAM has long championed the role of evidence in shaping better outcomes for patients. 

Now, thanks to a major windfall from a 2025 Westmead Charitable Trust Clinician Research Career Development Award, Tracey is building a body of work to set out the way therapists approach hand therapy.

After being awarded the grant this year, Tracey plans to develop a competency framework for Australian hand therapists—a project that will have national implications and will cater to the specific needs of Australian hand therapists while also aligning with World Health Organization standards. 

Previously, much of the literature on the practice activities of hand therapists has emanated from the US.

‘Historically, we’ve relied on practitioner experience and theoretical principles to guide a lot of hand therapy treatments,’ Tracey says. 

‘Our goal is to make sure we’re delivering what the evidence supports and only what patients actually need. And that it focuses on what Australian hand therapists need.’

Although hand injuries make up between six and 28 per cent of emergency department (ED) presentations, there is currently no framework that describes the knowledge, skills and attributes that Australian hand therapists need to provide safe and effective care.

Learning journey

Tracey, who is undertaking her PhD part-time through Griffith University, has been in her role at Westmead Hospital for 11 years.

It is her second stint at the hospital after she worked at Sydney and Prince of Wales Hospitals and in private practice before undertaking her master’s at Curtin University on the relationship between sensibility and dexterity following digital nerve repair. 

She returned to her current role at Westmead Hospital in 2014. Working in public health, Tracey highly values the time she is afforded to perform her research while continuing her clinical work at Westmead two days a week. 

She also sees patients at her private practice, North West Hand Therapy, which opened in Carlingford, Sydney, in 2012.

‘I’m a physio and that’s what I love doing. But at the same time, I wanted to be able to do the research. 

Tracey Clark.

'This allows me to do both, which is personally satisfying but also fulfils the Trust’s goal to foster a culture of clinical and translational research at Westmead and to support future external funding opportunities for clinician researchers,’ Tracey says.

As president of the Australian Hand Therapy Association from 2013 to 2015, Tracey became aware of the increasing appetite for recognition of hand therapy as an advanced scope of practice in Australia. 

Introducing a credential as a practice standard was considered the best way to meet this need, she says. 

‘Because we wanted that to be a competency-based credential, we needed to have a bank of competencies to start with and what we had available in the literature was the US research,’ Tracey says.

In 2023, Tracey began undertaking a series of five studies for her PhD, starting with a scoping review of the international literature.

She presented the results of that scoping review at the 2025 IFSSH and IFSHT Triennial Congress, hosted by the American Society for Surgery of the Hand, the American Society of Hand Therapists and the American Association for Hand Surgery in Washington in March this year.

‘What the scoping review found was that there was a small amount of published literature in the space that was specific to hand therapy practice activities and competencies,’ she says. 

‘While there was some literature on competencies, there were gaps in the areas of competency that we would see as being important beyond clinical practice—for example, in research, management and leadership, learning and development or professionalism.

‘A lot of the literature is also quite dated. We know that practice changes over time—technology changes, models of care change and consumer demand changes. 

'Even the health profile of a nation can change over time. So you need to continue to revise anything like a framework in order to make sure that you’re meeting the current needs.’

Anecdotally, one notable change Tracey has seen during her own physiotherapy career is a reduced number of hand injuries
resulting from manufacturing accidents. 

Manufacturing has largely been mechanised or moved offshore, while safety standards have concurrently improved in this field.

Reaching out

The funding from the grant, which was announced in January, will facilitate the second study in Tracey’s multi-study PhD. 

That will involve a cross-section survey of the practice of Australian hand therapists, to be undertaken this year. 

The survey will expand beyond certified or accredited hand therapists to capture any physiotherapist or occupational therapist who treats hand injuries, Tracey says.

‘We want to try to make that survey as broad as possible to get a really good understanding not just of what we do but of the role that we work in, the level of responsibility, all of the things that come with the scope of practice.’

The third study will use the information from the first two studies to develop those findings into a framework of competency, Tracey says. 

The benefits of having such a framework are multifaceted. 

The framework would help set clinical standards to support safe and effective patient care, would be used by hand therapists to track their professional and career development, could be used by professional associations to advocate for full scope of practice
and could serve as a reference point for referrers and consumers to understand the standard of care they can expect to receive.

While Tracey’s work has national implications, she is excited about being able to share the knowledge within the public health system and at Westmead Hospital. 

Tracey is part of a team of hand therapists from Westmead and Auburn Hospitals who work a roster at Western Sydney Local Health District hand surgery clinic, located at Auburn Hospital. 

All of the hand trauma patients who present to EDs in Mount Druitt, Blacktown, Westmead and Auburn are directed to the clinic.

The team collaborates closely with surgeons and other allied health professionals in a multidisciplinary environment.

‘We have introduced some models of care where we’ve looked at our advanced practice physios in ED and also the nurse practitioners and other physicians in ED referring directly to hand therapy,’ Tracey says. 

‘So once they’ve triaged a simple closed hand injury, they can refer those directly to hand therapy so that those patients can be managed without having to go to the Auburn plastic surgery clinic. 

'That has improved the patient journey as well as allowing the hand therapists to work to their full scope and reducing the burden on the surgical clinic.’

Having found her way to hand therapy after graduating from the Cumberland College of Health Sciences in 1989 and entering the public health system on allocation to Westmead Hospital, Tracey discovered that her passion for science was piqued during a rotation to the hospital’s plastic surgery unit, which at the time saw patients with burns and hand injuries.

‘I’d never had exposure to treating hand injuries as an undergraduate,’ she says. 

‘So it was something completely different. It was sort of serendipitous in a way. 

'That was my first rotation as a new full-time employee at Westmead and I thought, “Wow. Why have they kept this a secret? This is so amazing.” 

'I was struck by how much potential for functional impairment there is in a hand injury and how engaged people were in their rehabilitation because they had so much motivation to get better.

‘Hands are not just what we work with. We communicate with our hands; we express with our hands. 

'Getting your hands better is an immediate functional requirement. 

'After your face, your hands are the first things that people look at in any interaction.’