Hand involvement is one of the most disabling features of systemic sclerosis (SSc). Although occupational therapy is frequently employed in rheumatic conditions, its particular effects in SSc have not been studied in detail yet. This study aimed to evaluate the impact of a structured three-week occupational therapy program on hand function in SSc. This randomized controlled trial involved adult patients with SSc. Participants were randomly allocated to an intervention group that received a three-week occupational therapy program or a control group that received standard rheumatic care. Evaluations were performed at baseline (T1), immediately after the intervention (week 3, T2), and at follow-up (week 12, T3). Outcome measures included hand grip strength (HGS), fingertip pinch strength, tactile sensory threshold (as assessed by the Semmes-Weinstein monofilament test), pain threshold (dolorimetry), and hand functionality, as evaluated by the Duruöz Hand Index (DHI). Microvascular assessment was conducted utilizing nailfold videocapillaroscopy and the Capillaroscopic Skin Ulcer Risk Index. A total of 42 patients (22 in the intervention group, 20 in the control group) completed the study. There were no significant differences in baseline characteristics (p > 0.05). Significant improvements were observed in the intervention group regarding HGS, pinch strength, tactile sensation, and DHI scores (p < 0.05). No statistically significant changes were detected in pain threshold in either the intervention or control groups (p > 0.05). There were no significant differences in other outcome measures within the control group (p > 0.05). The structured occupational therapy program resulted in notable improvements in hand strength, tactile sensitivity, and functional hand use in SSc patients, with benefits sustained for up to 12 weeks. These findings suggest the incorporation of occupational therapy into routine multidisciplinary care for SSc.