p h y s io th e ra p y , J u n e 1983, v o l 39, n o 2 35 OCCUPATIONAL THERAPY - WORK ASSESSMENT AND PREPARATIONf M A R Y - A N N J A C K - B L E A C H B. SUMMARY This p aper p resents aspects o f the role o f the occupational therapist in the a ssessm ent a nd preparation o f p a tie n ts f o r work. The roles o f the occupational therapist in w orking with two broad categories o f w orkers, viz. the w orker in industry who is experiencing p ro b le m s re la te d d irectly or indirectly to his w ork situation, an d the disabled person who wishes to work, are described. Oc cu p a tio na l T h e r a p y (Stellenbosch)* O P S O M M IN G H ierdie referaat b ie d a sp e k te van d ie rol van die arbeidsterapeut in die evaluering en voorbereiding van p a siente vir w erk aan. D ie ro l van die arbeidsterapeut w a a rs y w erk m et tw ee bree ka te g o riee werkers, n a a m lik die w erker in Industrie wat problem e, d ire k o f indirek verw ant aan sy w erksituasie, ondervind, en die ge stre m d e persoon wat wil werk, w ord b e s k r y f i n t r o d u c t i o n The oc cu p a ti o n a l t h er a pi s t c an fulfil a c o n s u l ta n t role with ' w o r k e r s a lre ad y w o r k i n g in an ind ustria l setting. T hi s role, alt h o u g h in its early sta ges o f d e v e l o p m e n t in S o u t h Africa, is p r a c t i s e d fa irl y w id e ly in o v e r s e a s c o u n t r i e s . T h e oc cu pa tio n a l t h e r a p i s t ’s in te rv en ti on , as di scussed, is based on overseas studies. The as se ss me nt a n d p r e p a r a ti o n o f the di sa bl ed pe rso n for wo rk involves a t h o r o u g h assessment o f the p e r s o n ’s physical, psyc hological a n d social abilities in o r d e r to de ter mi ne his w o r k po te n ti al . T he o c c u p a ti o n a l thera pis t must also be familiar with the d e m a n d s o f wo rk available in the s u r r o u n d i n g c o m m u n i t y . T h is enabl es her to m a t c h the d e m a n d s o f w o r k to th e abilities o f the wo rk er . O CCU PA TIO NAL THERAPY IN THE IN DUSTRIAL SETTING T o d a te the a u t h o r ’s experience in the ind ustr ial setting is limited, bu t the d e m a n d f o r o u r service is gr owing. T h is aspect o f o u r w or k is ba sed on th a t o f Shirley Lew ch u c k, a co ns u lta n t o c c u p a ti o n a l th er a p ist w o r ki ng for a steel c o m p a n y o f so m e ten t h o u s a n d em pl oy ees in C a n a d a . She has clearly defined the role o f o c cu p a ti o n a l th er a p y in ind ustry , a n d un like he r S o u t h A fr ica n c o u n t e r p a r t s , has no t r em ain ed ho sp it al b o u n d . She is c o n ce r n ed with the p r o m o ti o n o f heal th in the ac tu al w o rk e n v ir o n m e n t . It is no t ^p o s si b le t o igno re the fact th at the re lat io ns hi p between a ^ w o rk e r ’s health a n d his work is d e p e n d e n t p rima rily u p o n a successful m at c h o f the w o r k d e m a n d s to his w or k abilities. Lew chu ck (1978) used e r g o n o m i c principles in desc ribing a “ systems a p p r o a c h ” to the individual in te ra c tin g with the wo rk p la ce (Fig. I). T h e individual a nd the w or k p l a c e are seen as two s e p a ra t e systems which in ter act to p r o d u c e the o u t p u t variable o f jo b perform ance. Di sc rep an cie s in the w o r k e r 's exp ect at ion o f m a n a g e m e n t , o r vice versa, woul d have a negative effect on j o b p e r fo r m a n ce . T he r e f or e a tt e m p t s to alter these d isc rep an cie s t h r o u g h , for ex am pl e, educa tio na l p r o g r a m m e s , re h ab i li t at i o n p r o g r a m m e s or mo dified w o r k p r o g r a m m e s , w o u l d affect j o b p e r fo r m a n c e a n d ul timately lead to jo b satisfaction. T he o c c u p a ti o n a l t h er a pi s t in the w o r k place can play a p r i m a r y role in the d e v e l o p m e n t a n d i m p l e m e n t a t io n o f a ’’' O c c u p a t i o n a l T h e r a p i s t , W o r k A s s e s s m e n t a n d P r e p a ra t io n A re a, T y g e rb e r g Hosp ita l, t B a s e d o n a p a p e r delivered to Western Province Bra nch on 26 F e b r u a r y 1983. systems a p p r o a c h . H o w ev er , it mu st be stressed th at such a role is p a r t o f a m u lti dis cip lin ar y a p p r o a c h . T h e profes sio nal team o f which Shirley L e w ch u c k is a m e m b e r, c om p r is e s a d o c to r , social w o r k e r , p h y s i o th er a p is t, e rg o n o m i st , safety c o - o r d i n a t o r , pe rsonnel a d m i n i s t r a t o r a n d m a n a g e m e n t from the w o r k e r ’s specific wo rk a re a . We f o l l o w th e f o l l o w i n g t h r e e s t r a t e g i e s w h e n disc rep an cie s arise: • W ork a ssessm ents which are specifically di rected at’ identify ing p r o b le m a rea s which cause the w o r k e r ’s j o b p e r f o r m a n c e to be p o o r . • Onc e the p r o b l e m / s are identified, special problem m an a g e m e n t p ro g ra m m e s are th en de ve lo p ed by o n e o r m o r e o f the prof es sio nals , d e p e n d i n g on the w o r k e r ’s needs. Thes e p r o g r a m m e s m ay also take on a p re ve nt ati ve a p p r o a c h to injuries a n d safety, a n d no t only deal with the solvi ng o f p ro b le m s. • M o d ifie d w ork p ro g ra m m e s a re im p l e m e n t ed wh en w o r k e r s are n o t r ead y to re tu r n to their p re vio us w o r k , a n d ne ed time t o c o n so lid a te f o r th eir retur n. W hen c o ns id er in g fa ct o r s c au si ng a w o r k e r inability to c o p e with the d e m a n d s o f his w o r k , t h er e is a ten dency to em ph a si se physical fact or s, a n d o v e r lo o k the w o r k e r ’s mental health. Sus an C a n t o r (1979), a co n su l ta n t w ho specialises in the a r e a o f p re ve n tio n a n d p ro bl em -so lv in g services, a n d w h o h a s experience in the field o f m en ta l he alt h, stresses the need fo r m o r e o c cu p a ti o n a l t h e r a p y i n ter ven ti on in this field. We a r e increasingly identifying p r o b l e m s in this area. F o r ex am p le work ers : • w h o w a n t to re tu r n to th eir j o b s after a psy chiatric leave o f absence; • w h o wish to e xp lor e their use o f time due to recent chang e in th ei r lives, such as divorce o r a desire to i m p r o ve the ba la n c e betw een th eir daily life activities; • facing re tiremen t; • facing conflicts ar ising f r o m j o b d e m a n d s versus family d e m a n d s (especially the fema le w or k e r) ; • w h o hav e p o o r j o b fit; • ex per ien ci ng e x tr e m e b o r e d o m a n d unn ece ssa ry j o b fatigue; • w h o sh o w p s y c ho so m a tic effects o f j o b stress, i.e. thos e w h o h a v e p o o r in te r p er s o n al relati on sh ips , fear losing their j o b or have low j o b satisfaction. T he o c c u p a ti o n a l th er a p ist deals with the la t t er g r o u p by using activities a n d g r o u p si t u at i o n s to deal with the pr o b l em s directly as they o c cu r in the wo rk situation. Pr o c e du re s used in clude role p lay in g sit ua ti on s, rela xati on exercises a n d social skill gr ou ps. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) 36 F is io te ra p ie , J u n ie 1983, d e e l 39, n r 2 D O M A I N O F O U T P U T V A R I A B L E S J O B P E R F O R M A N C E abse ntee ism p ro du c tiv ity t u r n o v e r illness activity r e du cti on I N D I V I D U A L W O R K E R p er so na li ty ch ara cteristics — abilities, needs, values kno wl ed ge health D O M A I N O F I N P U T V A R I A B L E S (internal to system) A T T E M P T S T O A L T E R S I T U A T I O N S e d u c a t i o n p r o g r a m m e s r e h ab ili ta ti o n p r o g r a m m e s m odified w o r k p r o g r a m m e s I N T E R A C T I O N att itu de s a n d e xp ect at ion s a) o f w o r k e r b) o f w or kp la ce W O R K P L A C E j o b d e m a n d s re sources m a n a g e m e n t — salary, c ow o rk er s , supe rvi sio n, fringe benefits J O B S A T I S F A C T I O N D O M A I N O F I N P U T V A R I A B L E S (external to system) C O M M U N I T Y I N F L U E N C E S news media society go v e r n m e n t un io ns S C I E N T I F I C A D V A N C E S tec hno lo gy research b e ha v io ur al science Fig. 1. A sys tems a p p r o a c h to the individual in the w o r k plac e (L ew c h u c k 1978) In these sit u at i o n s the w o r k e r receives fe edback fro m o t h e r s a b o u t his act io n s a n d re actions. It is th en possible for hi m to learn new be h a v i o u r , a n d as a result, p s y c h os o m a tic difficulties su ch as high abse ntee ism a n d low j o b p e r fo rm a n c e migh t be re duced. CA TEGO RIES O F D ISA B L E D P E R S O N S SE E N IN THE WORK A S SE S SM E N T AND PREPARATION AREA T h er e are m a n y different cat egories o f w o r k e r s w ho req uire o c c u p a ti o n a l th e r a p y interv ent io n. The following fou r cat egories p e r t a i n to the disa ble d pe r so ns seen jn the O c cu p a t io n a l T h e r a p y W o r k Asse ssm en t A r e a o f Tygerb erg Hos pit al: • W o r k e r s who , due to illnes (physical o r psychiatric), are u n a b le to re tu r n t o their p re vio us w o r k (w or k skills are affected). • D is a b le d p e r so n s w h o have n ev er w o r k e d previously. • W o r k e r s w h o are re tu r n i n g to their p r e v io u s e m p l o y m e n t after a medical leave o f ab se nce (physical o r psychiatric), and w ho need as sis ta nce with their re se tt le m en t into w ork. • D i sa b l ed pe rso n s whos e w o r k capab ili tie s have to be d e te r m in e d : f o r legal purp ose s; w h e n disability g r a n ts are be ing revised; for in su ra n ce claims o r a n o p i n i o n requ ired by the D e p a r t m e n t o f M a n p o w e r Ut ili zat io n reg ard in g the p e r s o n ’s sui tabi lity for sh el ter ed e m p l o y m e n t . R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) p h y s io th e ra p y , J u n e 1983, vot 39, n o 2 37 The m ain aim o f the w o r k p r o g r a m m e for disabled pe rso n s is to d e te r m i n e th eir w o r k capabilities. An er g o n o m i c m ode l o f w o r k d e m a n d s e qu al lin g abilities is used. By a pp ly in g e r g o n o m i c prin ciple s the oc cu p a ti o n a l th erapist can realistically m atc h the residual physical and mental capabilities o f the w o r k e r to the d e m a n d s o f the w o r k available. A w o r k e r ’s abilities to a work are no t a d a p t e d ; the e mp ha sis is on m a t c h in g wo rk d e m a n d s to the abilities o f the wor ke r, to en ab le hi m to cope successfully once he h a s been placed. It is essential to d e te rm i n e the wo rk di rec tio n early in the p r o g r a m m e , a nd to p l a n a w o r k p r o g r a m m e a cco rd ing ly for the individual. T h e assess men t a n d p r e p a r a t i o n for wo rk must be specific, a n d the w o r k e r mu st be a w ar e o f the aim o f his w or k p r o g r a m m e a nd the re as on s for its mo di fi cat io n at an y stage. Figur e 2. refers to the 1982 w o r k a r ea statistics, which s ho w the total n u m b e r o f d is ab led perso ns assessed in the area , a n d the di fferent a rea s in which they were plac ed. The possible w o r k direc tions are divided in to six b r o a d categories. Include d too , are the n u m b e r for which t e m p o r a r y o r p e r m a n e n t d i s a b i l i t y g r a n t s w e r e r e c o m m e n d e d , a n d the n u m b e r w h o did no t co me in f o r an a ssessment a fte r be ing referred. “ T r e a tm e n t d i s c o n t i n u e d ” refers to those w h o were eithe r u n m o ti v a te d to a t t e n d , to o sick to be assessed o r lived too far a w a y f ro m the ho spital to att e n d. F o r interest, a b r e a k d o w n o f h o w m a n y p e r so ns h a d either physical o r psyc hi atr ic p r o b l e m s, or b o th , was included. A p o in t o f interest which arises f ro m the statistics is that , o f the 15 h o m e in d u st ry w o r k e r s, 11 were physically disa bled . T h e inability to use pu bl ic t r a n s p o r t, even t ho u gh these were all g o o d w o r k e r s, was the reas on for r e so rt in g to h o m e in du str y , r a t h e r t h a n being placed in s o m e fo rm of em pl oy m en t. A SSE S SM E N T O F THE D ISA BL ED P E R SO N FOR WORK W h e n a disa ble d pe rso n is assessed, a tt e n ti o n is given to bo t h the assessm ent o f the w o rk e r a n d to the a ssessm ent o f the d e m ands o f th e work. The w o rk e r is assessed by m ea n s o f o b s e r v a t i o n , either using w o r k sam pl in g, si m u la t e d w o r k sit u at i o n s o r actual w o r k sit uat io ns. Specific a tt e n t i o n is given to: • w o r k m ot iv a tio n ; • basic w o r k ha b it s re lat ed to pe rso n al pr e se n t a ti o n , social pr e se n t a ti o n , w o r k co m p e te n c e; • w o r k tole ran ce (physical a n d psychological); • p r o d u c ti o n speed; • w o r k skills pe cul iar t o the type of wo rk in which the pers on is being assessed, for e xa m p le telep ho nis t, clerk, p r o d u c t i o n line w o r k e r and w o o d w o r k / m e t a l w o r k . In the assessment o f the d e m a n d s o f w o r k , the tools o f assess men t are w o r k stu d y, j o b analysis, the H u m p h r e y System, e r g o n o m i c d a t a a n d activity analysis. Because the o c c u p a ti o n a l th er a p ist an alyses activities, she is able to describe w o r k tas ks a c c o r d in g to the skills need ed a n d o p e r a t i o n s c arr ied out. PREPARATION O F TH E D ISA B L E D P ER SO N FOR WORK W h en the d i sa ble d w o r k e r is p r e p a r e d for w o r k , a tt e n ti on is given to his w ork abilities a nd w ork sk ills ( m e n t i o n e d u n d e r as sessme nt) a n d where possible w ork visits are carri ed out. W o r k visits prov ide valua bl e i n f o r m a t io n wh en either the w o rk e r req uires assista nce with his reset tl em ent into his w o r k sit u a t i o n , o r w h e n the oc cu p a ti o n a l th er a pi st is assessing a w o r k place wi th the view to p la c em e n t o f disabled wo rk e rs there in the futu re. W o r k visits enab le the o c c u p a ti o n a l th er a pi st to assess the w o r k e r ’s p a r ti c u l a r work environm ent, a n d identify pr o bl em s which c ou ld pr event the w or ke r from settling d o w n sa tisfac torily on his re tu r n to work. Arising f r om the w o r k visits, advice is given reg ard in g the p r o b l e m a rea s identified. W hen the o c c u p a ti o n a l th erapist identifies a p r o b l e m she herself is u n a b le to deal with, the p r o b l e m is re ferred to the per son into whose field it falls, for exam pl e wh en r a m p s have to be built. A t t e n t i o n is given to factors o f the w o r k place, the w o r k m e t h o d , the e q u ip m e n t a n d m ac h in er y , the presence o f a n y a r ch ite c tu r a l b ar rie rs or the need f o r all o c at in g assistive devices o r aids. A brief discussion o f each f a ct or using basic exam pl es, will illustrate this m o r e clearly. Ex am pl es o f m o d if ic at io n s r e g ar di ng w o rk place are: W o r k e r “ A ” has e m p h y s e m a a n d t h ere fo re has low physical e n d u r a n c e . He m u st a v oi d u n ne ce ss a ry m o v e m e n ts while car ry in g ou t his w o r k a n d fa ct o r s to be c o ns id ere d are the p l ac em e n t o f fu r n i tu r e , f u r n i tu r e design, w o r k heights, v en tila tio n , etc. W o r k e r “ B ” is a s c h izo p h re n ic , w h o m u s t be placed aw ay f r o m the cent re o f activity a n d f r om large g r o u p s o f w or ke rs. T he w o rk e n v ir o n m e n t must be specifically st r u c tu r e d to cu t d o w n o n the noise f act or and t h re a te n i n g stimuli. Privacy, a n d a desk o f his o w n are i m p o r t a n t. E x am pl es o f m od ify in g w ork m e th o d are: In ste ad of re q ui ri ng W o r k e r “ A ” to fetch a n d c ar r y p a p er s three times a m o rn in g , a sys tem is w o r k e d o u t whi ch redu ces the fetching to onc e a m o r n in g , o r a r r a n g e m e n t s are m a d e to have the p a p e r s delivered to his desk. 1982 W O R K A S S E S S M E N T A N D P R E P A R A T I O N A R E A S T A T I S T I C S P O S S I B L E P L A C E M E N T D I R E C T I O N S P H Y S I C A L P S Y C H I A T R I C B O T H T O T A L O p e n L a b o u r M a r k e t 42 21 2 66 Sub sid is ed labou r — — — — S he lte red E m p l o y m e n t 7 11 6 24 P ro te ct ed E m p l o y m e n t 1 — 6 7 F u r t h e r t r a i n i n g / s t u d y 6 — 1 7 H o m e I n d u s t r y 11 1 3 15 R e c o m m e n d e d disability gr a nt s 23 17 12 52 T r e a t m e n t di sc o nt in u e d 47 16 15 78 Re fer re d, n ev er a tt e n d e d 33 5 5 43 T r e a t m e n t c o n ti n u e d into 1983 7 8 8 23 T O T A L S 177 80 58 315 Fig. 2. T h is table refers to t h e diff ere nt areas in w h ic h th e disabled pers on s were placed. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) 38 F is io te ra p ie , J u n ie 1983, d e e l 39, n r 2 W o r k e r “ B” prev ious ly h a d to m a k e c o n ta c t with ten people, which is un de si ra b le . C o n t a c t sh o ul d be limited to two o r less c o n st a n t people. T he eight o t h e r pe op le m us t then r e po rt to the tw o selected pe op le , w h o then r e p o r t to W o r k e r “ B” . ' An exam pl e o f m o d ifyin g e q u ip m en t/m a ch in e ry can be illustrated with reference on c e ag ain to W o r k e r “ A ” . Instead o f pa p er s lying on eit he r side o f a ty pew riter, use o f a di ct a p h o n e w oul d re qu ire less b o d y m o v e m e n t a n d the a rm s are then kept in the mid-p ositio n. O th e r exam pl es are designing jigs for m ac h i ne r y o r f o r wo rk tasks to be ca rried o u t by o n e - h a n d e d wo rk er s; a n d ad vis ing em p lo ye rs a b o u t a d a p t a t i o n o f a s w it c h b o a r d f or a blind telephonist. O bvious exam pl es re g ar d i n g the m o d ification a nd rem oval o f architectural barriers are the re mo va l o f steps a n d the bui ldi ng o f r a m p s , o r the a d a p t a t i o n o f the swing d o o r to a sliding d o o r to a c c o m m o d a t e a w h e e l c h a i r- b o u n d worker. A n ex ample o f a n assistive device or aid, is a wri tin g splint, which w oul d be issued to a w o r k e r su ffering f r o m an injury t o his d o m i n a n t ha nd . P L A C E M E N T O F D I S A B L E D W O R K E R S Before final p la c em e n t, the oc cu p a ti o n a l t h er a p is t mu st ens ure th a t the w o r k e r is fully in d ep e n d en t in using public t r a n s p o r t , in h a n d li n g m o n e y a n d in p e r so n al care. H e mu st also be fully i n f o r m e d a b o u t w ha t will be exp ecte d f r o m him in the w o r k s i tu at io n, a n d be c a p a b le o f co m p l y i n g with w o r k n or m s. P la cem en ts are d o n e t h r o u g h close liaison with v o c at io n al officers o f the D e p a r t m e n t o f M a n p o w e r Ut ili zat io n, o r t h r o u g h per son al c ont act s. F ollow up is essential t o en su re th at the d i sa ble d w o r k e r ha s settled into his w o r k s i t ua ti on successfully. C O N C L U S I O N T h e role o f the o c c u p a ti o n a l th e r a p is t in the work sit u at io n , in my o p i n io n , has f o r so m e time n o w be en very m u ch with the d is ab led w o r k e r a n d n o t sufficiently with the w o r k e r w h o is at risk within the in d us tr ia l setting. T hi s st ate o f affairs, I a m sure , will g r a d u al ly ch an g e as i nd ust ry b e co m es m o r e a w a r e o f its high financ ial losses d u e to the p o o r heal th o f its wor ke rs, a n d the c o n tr i b u t io n o c c u p a ti o n a l t h e r a p y c an mak e. References C a n t o r , S. G. (1979). O c c u p a t i o n a l T h e r a p y a n d ( O c c u p a t io n a l M e di cin e — a merg er. A J O T 33, 631-634. Lew ch u c k, S. (1980). T he o c c u p a ti o n a l th e r a p is t in industry: A de ve lo pi ng challenge. C J O T 47, 159-164. AN APPLICATION OF PHYSIOTHERAPY TO SOUTH AFRICAN INDUSTRY* K A R E N E L S W O R T H , B.Sc. ( Ph ys io th e r ap y) , U.C .T. In a society whe re waiting lists are p a r t o f every ph ys io th era p y d e p a r t m e n t , as are ac ute s ho rt a ge s o f staff, it is time that p h y s io th er a pi st s b e cam e m o r e involved in a preventive role t h a n is the case at present. W h a t be tte r place t o d o this t h a n in the wo rk place where the m aj or ity o f co m p l a in t s begin a n d the m aj o ri ty o f the po p u l a t i o n are to be found. P h y s io t he r ap i st s have been fo u n d to be valuable m em be rs o f the O c c u p a t io n a l H e a l t h tea m in o t h e r co untries such as Sw eden, where th ere are over three h u n d r e d ph ysiot herapi sts in o c c u p a ti o n a l health, an d n u m b e r s are growing. Thes e t her ap ist s spen d their time involved in preventive studies a nd research o f w o r k i n g cond iti ons . They use five main topics f o r disc ussion a n d research: • Physical str ain fa ctors at wo rk , their e lim ina tio n or minim isa ti on, th eir r e la tio ns hi p to l o c o m o t o r di sorders a n d the pr e v en tio n a n d t r e a t m e n t o f such disorders. • W o r k in g p o st u r e a n d c o rre c tio n o f fact ors leading to stressful, tiring postures. • Preventive p au se gym nas tic s, use o f leisure time a n d breaks. • T h e role o f psychological fa ctors in musculo-skeletal disorders. ’ Ab str a ct o f pr oject c o m p le te d for final ye ar B.Sc. (Phy sio th er apy ). Received 17 S e p t e m b e r 1982. • E r g o no m i c s which co nc er n s the m ea su r in g o f wo rk in g place d im e n si o n s a n d w o r k e r a n t h r o p o m e t r y , well- designed mec han ic al aids a n d tools. A stud y was m a d e usin g three C a p e T o w n factories where the m an a ge r s ha d ag ree d to c o - o p e r a te wi th the following proc edu re: • All the sta ff were interviewed, as m an y were illiterate. E mp lo ye es e nt e r e d the office in dividua lly a n d were as sur ed o f the co nfidential n a tu r e o f the survey. They were a sk e d their na m e . age. o c c u p a ti o n in the fa cto ry and wh e th er they h a d any aches o r pains. If so they had to indic ate the a r ea on a n te r io r a n d p o s t e r io r d i a g r a m s o f the body. • A t o u r a r o u n d the fact or y followed the interview a n d an ex p la n at i o n was provided o f wha t each emp lo ye e or g r o u p o f em p lo y ees was doing. • O b s er v a ti o n s were m ad e a nd e ach m a j o r g r o u p of empl oy ees was assessed in th ei r wo rk sit u ati o n. • F r o m the results r e c o m m e n d a ti o n s f o r the entire fact ory , e.g. ligh ting a n d v e n ti la ti o n were made. C L O T H I N G M A N U F A C T U R E R ( F A C T O R Y A) Fifty eight per cent o f the em ployees interviewed were machinists, all female an d average age 25 - 30 years. A high incidence o f he ad a ch e , sho u ld er , u p p e r a n d low er back pain was f o un d , in that ord er. So m e lo we r leg pa in was also fo un d as m a n y o f the mach in ist s used tr ea d le m ac h in es not R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )