Occupation-based hand therapy (OBHT) is an approach to practice that integrates multiple frames of reference, while remaining rooted in an occupational therapy perspective. There are a number of benefits and challenges that have been recognised in hand therapy settings. The use of an occupation-based approach in the field of hand therapy is of interest to all occupational therapists practising in this field. This commentary explores the challenges and opportunities of OBHT as an approach in the assessment and treatment of clients with hand conditions in the South