Functional locus coeruleus imaging to investigate an ageing noradrenergic system.

The locus coeruleus (LC), our main source of norepinephrine (NE) in the brain, declines with age and is a potential epicentre of protein pathologies in neurodegenerative diseases (ND). In vivo measurements of LC integrity and function are potentially important biomarkers for healthy ageing and early ND onset. In the present study, high-resolution functional MRI (fMRI), a reversal reinforcement learning task, and dedicated post-processing approaches were used to visualise age differences in LC function (N = 50). Increased LC responses were observed during emotionally and task-related salient events, with subsequent accelerations and decelerations in reaction times, respectively, indicating context-specific adaptive engagement of the LC. Moreover, older adults exhibited increased LC activation compared to younger adults, indicating possible compensatory overactivation of a structurally declining LC in ageing. Our study shows that assessment of LC function is a promising biomarker of cognitive aging.

Exploring influences of environmental information, beliefs and self-efficacy on nurses' climate health behaviours and their relationships.

BACKGROUND: To create a healthy nursing environment and protect human health in response to climate change, it is essential to encourage behaviour change among nurses. Although numerous studies have been conducted on nurses to address climate change, few studies have explored the relationships of factors that influence and promote nurses' climate health behavioural behavioural change, making it difficult to determine how nurses should act and prioritise regarding climate health behaviours. AIMS: To investigate influential environmental factors on climate health behaviours among nurses through the causal relationships between environmental information, environmental beliefs and environmental self-efficacy using the Information-Motivation-Behavioural Skills (IMB) model. DESIGN: A cross-sectional study. METHODS: This study recruited 186 nurses working in hospitals nationwide in July 2023. Self-reported questionnaires (Climate, Health, and Nursing Tool; National Environmental Consciousness Survey; New Ecological Paradigm Scale; Personal Efficacy Scale) were used to collect the data. Path analysis was performed. RESULTS: The factors influencing nurses' climate health behaviours were environmental information, environmental beliefs and environmental self-efficacy. Environmental self-efficacy was found to be more influenced by the exogenous variables of environmental information than environmental beliefs and to be the most significant factor affecting climate health behaviours. CONCLUSIONS: It is more important for nurses to obtain environmental information than environmental beliefs to achieve the goal of climate health behaviours. This in turn, will lead to personal self-efficacy that nurses can mitigate the climate crisis. Their strong self-efficacy affects their climate health behaviours. IMPLICATIONS FOR THE PROFESSION: Nurses should seek and draw on the appropriate environmental information related to climate health change and nurses with environmental self-efficacy become environmental nursing leaders, encouraging other health care workers to participate actively in climate health behaviours and continuously carry out the behaviours within daily life, hospital and community environments. IMPACT: The study addressed the lack of relationship research on factors influencing nurses' climate health behaviours, emphasizing the importance of accessing environmental information to foster self-efficacy. Nurses with heightened self-efficacy can lead healthcare professionals in climate health actions. REPORTING METHOD: This research has adhered to relevant EQUATOR and STROBE. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Incidence of overtriage and undertriage and associated factors: A cross-sectional study using a secondary data analysis.

BACKGROUND: Improving triage accuracy for accurate patient identification and appropriate resource allocation is essential. Little is known about the trend of triage accuracy, and factors associated with mistriage vary from study to study. AIM: To identify incidence and risk factors of mistriage, such as overtriage and undertriage. DESIGN: This is a cross-sectional study. METHODS: The data came from the National Emergency Department Information System database in 2016-2020. All patients 15 years and older visiting emergency departments in Korea were assessed for eligibility, and 20,641,411 emergency patients' data were used. Multivariable logistic regressions were conducted to confirm the associated factors with overtriage and undertriage compared to expected triage. Demographic characteristics, disease-related signs and triage-related factors were independent variables. RESULTS: Expected triage decreased from 96.8% in 2016 to 95.7% in 2020. Overtriage (0.5%-0.7%) and undertriage (2.4%-3.3%) increased. The occupation that performed triage the most (over 85%) was nurses. Associated factors with overtriage were demographic characteristics (40-64 age group, female), disease-related signs (known disease, direct visit) and triage-related factors (regional emergency medical centre). Risk factors to undertriage were disease-related signs (systolic/diastolic blood pressure and pulse rates within normal range). CONCLUSIONS: While the acuity degree remained within the recommended range, the accuracy of triage decreased, and there was a gradual increase in mistriaged cases. Nurses have performed most of the triage and played a key role in expected triage. Associated factors with overtriage were demographic characteristics, disease-related signs and triage-related factors and risk factors to undertriage were disease-related signs. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. IMPLICATIONS FOR THE PROFESSION: Nurses should be aware of what factors are associated with mistriage and why the factors cause mistriage to improve the triage accuracy because they are responsible for the majority of the triage assessments.

Exploring the potential use of the metaverse in nurse education through a mock trial.

BACKGROUND: The metaverse has been attracting attention as a space for the application of education, where integrating the real and virtual worlds offers immersive 3D experiences. Consequently, its potential for higher education, including nursing, is being explored as a dynamic alternative to traditional education. OBJECTIVES: This study explores the applicability of metaverse in nurse education. It was conducted to implement a mock court on the metaverse platform and explore the learning experiences of nursing students through mock trials. DESIGN: Qualitative study. SETTINGS: A virtual mock court in VRChat (a virtual reality space). PARTICIPANTS: Fourteen participants were divided into three groups. METHODS: An orientation was conducted to explain the virtual space before the mock trial. On the day of the mock trial, a health survey of study participants was conducted in advance. After the mock trial, questionnaires and reflective diaries were written. RESULTS: The experiences of nursing students were organized into eleven sub-themes and three themes: "core features of the metaverse platform," "participation in a mock trial in the VRChat virtual space," and "metaverse-based learning using a mock trial." CONCLUSIONS: Nursing students participated and immersed themselves in learning while accepting the characteristics of the metaverse platform, which differs from face-to-face classes or existing educational methods. The metaverse enables reflective learning based on experiential learning and strengthens awareness of diverse viewpoints.

Structural and functional characterization of the locus coeruleus in young and late middle-aged individuals.

Introduction: The brainstem locus coeruleus (LC) influences a broad range of brain processes, including cognition. The so-called LC contrast is an accepted marker of the integrity of the LC that consists of a local hyperintensity on specific Magnetic Resonance Imaging (MRI) structural images. The small size of the LC has, however, rendered its functional characterization difficult in humans, including in aging. A full characterization of the structural and functional characteristics of the LC in healthy young and late middle-aged individuals is needed to determine the potential roles of the LC in different medical conditions. Here, we wanted to determine whether the activation of the LC in a mismatch negativity task changes in aging and whether the LC functional response was associated to the LC contrast. Methods: We used Ultra-High Field (UHF) 7-Tesla functional MRI (fMRI) to record brain response during an auditory oddball task in 53 healthy volunteers, including 34 younger (age: 22.15y ± 3.27; 29 women) and 19 late middle-aged (age: 61.05y ± 5.3; 14 women) individuals. Results: Whole-brain analyses confirmed brain responses in the typical cortical and subcortical regions previously associated with mismatch negativity. When focusing on the brainstem, we found a significant response in the rostral part of the LC probability mask generated based on individual LC images. Although bilateral, the activation was more extensive in the left LC. Individual LC activity was not significantly different between young and late middle-aged individuals. Importantly, while the LC contrast was higher in older individuals, the functional response of the LC was not significantly associated with its contrast. Discussion: These findings may suggest that the age-related alterations of the LC structural integrity may not be related to changes in its functional response. The results further suggest that LC responses may remain stable in healthy individuals aged 20 to 70.

It is the locus coeruleus! Or is it?: a proposition for analyses and reporting standards for structural and functional magnetic resonance imaging of the noradrenergic locus coeruleus.

The noradrenergic locus coeruleus (LC) is one of the protein pathology epicenters in neurodegenerative diseases. In contrast to PET (positron emission tomography), MRI (magnetic resonance imaging) offers the spatial resolution necessary to investigate the 3-4 mm wide and 1.5 cm long LC. However, standard data postprocessing is often too spatially imprecise to allow investigating the structure and function of the LC at the group level. Our analysis pipeline uses a combination of existing toolboxes (SPM12, ANTs, FSL, FreeSurfer), and is tailored towards achieving suitable spatial precision in the brainstem area. Its effectiveness is demonstrated using 2 datasets comprising both younger and older adults. We also suggest quality assessment procedures which allow to quantify the spatial precision obtained. Spatial deviations below 2.5 mm in the LC area are achieved, which is superior to current standard approaches. Relevant for ageing and clinical researchers interested in brainstem imaging, we provide a tool for more reliable analyses of structural and functional LC imaging data which can be also adapted for investigating other nuclei of the brainstem.

Priorities for research on neuromodulatory subcortical systems in Alzheimer's disease: Position paper from the NSS PIA of ISTAART.

The neuromodulatory subcortical system (NSS) nuclei are critical hubs for survival, hedonic tone, and homeostasis. Tau-associated NSS degeneration occurs early in Alzheimer's disease (AD) pathogenesis, long before the emergence of pathognomonic memory dysfunction and cortical lesions. Accumulating evidence supports the role of NSS dysfunction and degeneration in the behavioral and neuropsychiatric manifestations featured early in AD. Experimental studies even suggest that AD-associated NSS degeneration drives brain neuroinflammatory status and contributes to disease progression, including the exacerbation of cortical lesions. Given the important pathophysiologic and etiologic roles that involve the NSS in early AD stages, there is an urgent need to expand our understanding of the mechanisms underlying NSS vulnerability and more precisely detail the clinical progression of NSS changes in AD. Here, the NSS Professional Interest Area of the International Society to Advance Alzheimer's Research and Treatment highlights knowledge gaps about NSS within AD and provides recommendations for priorities specific to clinical research, biomarker development, modeling, and intervention. HIGHLIGHTS: Neuromodulatory nuclei degenerate in early Alzheimer's disease pathological stages. Alzheimer's pathophysiology is exacerbated by neuromodulatory nuclei degeneration. Neuromodulatory nuclei degeneration drives neuropsychiatric symptoms in dementia. Biomarkers of neuromodulatory integrity would be value-creating for dementia care. Neuromodulatory nuclei present strategic prospects for disease-modifying therapies.

Associations among workplace incivility, stress coping, and nursing performance in hospital nurses: A path analysis.

PURPOSE: This study aimed to identify the associations among workplace incivility, stress-coping strategy, and nursing performance and confirm how workplace incivility influences nursing performance through the stress-coping strategy. DESIGN: This is a descriptive, cross-sectional study. Data were collected using a self-reported questionnaire from 245 nurses working at seven hospitals in Korea between December 2019 and January 2020. METHODS: The associations among the study variables (workplace incivility, stress coping, and nursing performance) were analyzed using path analysis with bootstrapping. RESULTS: Supervisors' incivility affected directly and negatively nursing performance although problem-focused coping was mediating between them. By contrast, coworkers' and doctors' incivility was not directly associated with nursing performance through stress-coping strategies. CONCLUSION: Problem-focused coping enhanced nursing performance and was a more effective stress-coping strategy than emotion-focused coping for nurses affected by coworkers' and doctors' incivilities. Supervisors' incivility may be considered a threatening factor to nursing performance even though problem-focused coping partially mediates between supervisors' incivility and nursing performance. CLINICAL RELEVANCE: Organizations must prevent all kinds of workplace incivilities from occurring. Nursing managers should periodically monitor the relationship between the supervisors and nurses and be aware of nurses' stress-coping strategies under stressful situations.

Factors influencing mental health nurses in providing person-centered care.

BACKGROUND: Mental health nurses advocate for patients through a person-centered approach because they care for people experiencing mental distress who tend to be limited to exercising their human rights and autonomy through interpersonal relationships. Therefore, it is necessary to provide high-quality person-centered care for these patients by identifying the influencing factors. AIM: This study aims to identify the factors affecting mental health nurses in performing person-centered care for patients. RESEARCH DESIGN: This study had a cross-sectional, descriptive-correlational survey design. PARTICIPANTS AND METHOD: Nurses (N = 166) working at psychiatric wards in Korea completed an online questionnaire on moral sensitivity, attitudes toward people with mental illness, and person-centered care. The t-test and stepwise multiple regression analysis were used. ETHICAL CONSIDERATIONS: Ethical approval for the study was obtained from the relevant ethics committee. FINDINGS: Moral sensitivity was a significant factor correlating with the provision and perception of person-centered care. Attitudes toward patients had no effect on person-centered care. The predictor variables for the provision of person-centered care (R2 = 0.247) were moral sensitivity (ß = 0.33), having a professional qualification (ß = 0.19), marital status (ß = 0.18), and closed ward (ß = -0.15). The predictor variables for the perception of person-centered (R2 = 0.150) care were closed ward (ß = -0.25), moral sensitivity (ß = 0.23), and marital status (ß = 0.18). DISCUSSION AND CONCLUSION: Mental health nurses can strengthen person-centered care by improving moral sensitivity related to the ethical aspect of nursing and professional competence to address the complex needs of patients. Person-centered care needs to be applied more carefully in closed wards where human rights issues may arise. Through these efforts, the dignity of patients can be protected.

Workplace spirituality and organizational justice in turnover intention of mental health professionals at small-sized centres.

AIM: To investigate the influence of workplace spirituality and organizational justice on the turnover intentions of mental health professionals working in small-sized communities. BACKGROUND: Many community mental health facilities in Korea are consist of the small size of members, and the turnover rate of mental health professionals is high. However, the influence of individual and organizational factors for lowering the turnover is not clearly identified. METHOD: This was a descriptive study. Data of 168 participants were collected through a self-reported online questionnaire using a convenience sample, June 2020. RESULT: Multiple regression analysis uses interactional justice (ß = -.437, p = .002), distributional justice (ß = -.190, p = .011) and age (ß = -.152, p = .033) that were the most important predictors of turnover intention. CONCLUSION: Orgnisational factors such as distributional and interactional justice affect to reduce turnover intention more than an individual factor like the workplace spirituality of professionals. IMPLICATIONS FOR NURSING MANAGEMENT: Small-sized mental health institutions in the community should establish a clear working guideline that can make the distribution, procedure and interactional justice. Because only a small percentage of nurses work at community mental health facilities, it is necessary to reduce turnover by creating a work environment where young nurse practitioners can work long-term and grow into leaders.

FDG-PET assessment of the locus coeruleus in Alzheimer's disease.

Sensitive and reliable in vivo imaging of the locus coeruleus (LC) is important to develop and evaluate its potential as a biomarker in neurodegenerative diseases such as Alzheimer's disease (AD). It is not known whether AD-related alterations in LC integrity can be detected using 18F-labelled fluoro-2-deoxyglucose (FDG) positron emission tomography (PET). Mean FDG-PET images from AD patients (N â€‹= â€‹193) and controls (N â€‹= â€‹256) from the ADNI database were co-registered to a study-wise anatomical template. Regional LC median standardized uptake value ratio (SUVR) values were obtained using four previously published LC masks and normalized to values from pons and cerebellar vermis reference regions. To support the validity of our methods, other regions previously reported to be most and least affected metabolically in AD were also compared to controls. The LC did not show between-group differences in FDG-PET signal, whereas the mammillary bodies did, despite these regions having comparable volumes and SUVR ranges. Brain regions previously reported to be most and least affected metabolically in AD compared to controls showed medium-to-large and small effect sizes for SUVR differences respectively. The results do not support the current application of LC FDG-PET signal as an in vivo biomarker for AD. Methodological and demographic factors potentially contributing to these findings are discussed. Future research may investigate age-related differences in LC FDG-PET signal and higher resolution images to fully explore its biomarker potential.

Effects of a web-based education program for nurses using medical malpractice cases: A randomized controlled trial.

BACKGROUND: Education on legal obligations in healthcare related to medical malpractice is insufficient, which has the potential to reduce patient safety. Nurses need to improve their understanding of legal obligations in order to enhance patient safety. However, no easily accessible education program has been developed that covers both the concepts of legal obligations and patient safety. OBJECTIVE: This study sought to develop a web-based education program using medical malpractice cases and to evaluate the effectiveness with regard to legal obligations and patient safety competency of nurses. DESIGN: The study design was a randomized controlled trial evaluating the effectiveness of a newly-developed web-based education program. PARTICIPANTS AND SETTING: Seven experts and 19 learners evaluated the developed program. One hundred eighteen nurses working in three hospitals were randomly assigned to the intervention group (N = 59) and the control group (N = 59). METHODS: The web-based program was developed using the analysis-design-development-implementation-evaluation model and evaluated by experts and learners. Data were collected from January to May 2019. The intervention was the five-week web-based education program. The post-test was conducted five weeks after the pre-test in the control and intervention groups. RESULTS: The web-based program consisted of two modules on theoretical knowledge and seven modules on medical malpractice cases. The findings demonstrated significant differences in knowledge and cognition of legal obligations and patient safety competency between the control and intervention groups after the five-week intervention. CONCLUSION: A web-based education program on medical malpractice cases enhanced nurses' awareness of legal obligations and patient safety competency. Therefore, this web-based educational program should be organized as an online continuing education program for clinical nurses. It will improve awareness of patient safety by clearly specifying the relationship between legal obligations and root causes of medical errors from various perspectives.

Hand motor functions on the presence of red fluorescent dental biofilm in older community-dwelling Koreans.

BACKGROUND: The Quantitative Light-induced Fluorescence-Digital (QLF-D) system visualizes old and mature dental biofilm as red fluorescence. Risk factors for poor oral hygiene have been identified, however, few studies have evaluated the relationship between mature dental biofilm and hand motor functions. This study aimed to investigate the effects of two important manual motor functions for object manipulation -handgrip strength and manual dexterity- on the presence of red fluorescent dental biofilm in older community-dwelling Koreans using QLF-D, an optical device that reveals dental biofilm. METHODS: This cross-sectional study included 70 Korean participants aged ≥65 years, all of whom completed questionnaires and were tested for handgrip strength and manual dexterity. In total, 840 dental surfaces were photographed using QLF-D, and ΔR20 values, which reflect mature dental biofilm accumulation, were calculated. The t-test was performed to analyze the differences in the ∆R20 values according to sociodemographic characteristics, health-related characteristics and hand motor functions, while multiple linear regression analysis was used to investigate the effects of hand motor functions on the ∆R20 values. RESULTS: Multivariate regression analysis revealed that handgrip strength (ß = -0.294) was the factor most strongly affecting mature dental biofilm accumulation (ΔR20), followed by tooth-brushing time (ß = -0.262) and manual dexterity (ß = -0.241). CONCLUSIONS: Reductions in handgrip strength and manual dexterity were independent risk factors for pathogenic dental biofilm accumulation. The results of this investigation suggest that programs designed to prevent the decline, as well as improve, handgrip strength and manual dexterity might improve the oral hygiene of older adults.

The association between dyslipidemia, oral health behavior, and periodontal disease: The Korea National Health and Nutrition Examination Survey.

OBJECTIVES: This research aims to confirm the association between dyslipidemia, oral health behaviors, and periodontal disease according to age groups. METHOD AND MATERIALS: This cross-sectional study used collected data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted from 2012 to 2015 with 17,004 adults. Complex samples logistic regression analysis confirmed the relevant factors of oral disease. RESULTS: Hypo high-density lipoprotein cholesterol (HDL-C) related to periodontal disease in two groups (under 40 and over 40 years old). In the over-40 age group, the level of low-density lipoprotein cholesterol (LDL-C) was associated with periodontal disease; toothbrushing frequency and usage of interdental hygiene products were associated with periodontal disease. CONCLUSIONS: Better HDL-C level in all age groups, management of LDL-C level, tooth-brushing at least twice a day, and additional use of interdental hygiene products in the over-40 age group were associated with better oral health. Thus, public and oral health professionals should emphasize the relationship according to age group during health care education and share relevant information.

[Evaluation of the Korean formal educational program for training care workers for frail elderly].

PURPOSE: This study was done to evaluate the formal education program provided by the Korean government for care workers for frail elderly people. METHODS: This study was a cross-sectional survey in which 438 certified care workers who had completed the education program participated. Data were collected from June to October 2009, using a self-report questionnaire consisting of satisfaction with, and understanding of the education program. RESULTS: The participants had a mean age of 46.7 yr, 87.9% were female and 58.2% were high school graduates. For the theory part of the education, the highest score for understanding was for'supporting household & activities of daily living' while the lowest score for understanding was for'care for death and dying'. For the practical education, the highest score for understanding was for'talking with the client' and the lowest score was for'first aid & basic life support'. There was a significant difference in satisfaction and understanding of the theoretical and practical parts according to educational level. CONCLUSION: Continuing education programs are needed for care workers for elders, both in the theoretical and practical areas. Also the content of programs should address the weak points of this formal education program.

[Comparison of the effects of an exercise program in non-obese and obese women].

PURPOSE: The purpose of this study was to compare the effects of an exercise program on physical fitness, obesity indices, and blood lipids in cases of non-obese and obese women. METHOD: Data was collected from May, 2006 to November, 2006 in a public health center. All Subjects(37 women) participated in an exercise program that consisted of Latin dance, muscular strength training, and dumbbell exercises. Thirty-seven women were divided into two groups(16 non-obese women and 21 obese women) by %body fat. After 8 weeks, the effects of treatment were compared between pre-test and post-test in each group. RESULTS: Physical fitness(abdominal muscle strength, muscle endurance, flexibility, agility, balance) was significantly different between the pre-test and post-test in the non-obese and obese group. Obesity indices(body weight, BMI) was significantly different in obese women after the 8-week exercise program. There was no decrease of blood lipids in either group. CONCLUSION: These findings indicate that an exercise program could be an effective nursing intervention to increase physical fitness in non-obese and obese women and to decrease obesity indices(body weight, BMI) in obese women.

[Factors effecting health promoting behaviors in middle-aged women].

PURPOSE: This study was to evaluate the casual relationship between the factors in the Pender's model and to explain health promoting behaviors among middle-aged women in order to facilitate nursing interventions for this population group. METHOD: 116 women between 40-60 years old living in Incheon were asked to complete a questionnaire about their health. The data was collected between March and November, 2003. The data was analyzed by descriptive statistics and the correctional analysis SPSSWIN 11.5 program. The LISREL 8.12 program was used to find the best fit model which explained a causal relationship of the variables. RESULTS: The climacteric symptoms of middle-aged women negatively correlated with health promoting behaviors. However, marital satisfaction positively correlated with health promoting behaviors. CONCLUSION: Marital satisfaction and climacteric symptoms had an effect on health promoting behaviors. Therefore, based on this study, we plan to develop a health education program to decrease climacteric symptoms and to promote marital satisfaction for health promotion.

[Factors on decision-making participation related to clinical experience difference].

PURPOSE: The purpose of this study was to investigate the relationship between decision-making factors(theoretical knowledge, expertise, empowerment, intuition) and participation in proportion to nurses's clinical experience. METHOD: Data was collected by quota sampling from July 10, 2001 to August 22, 2001 from 132 clinical nurses who work for 3 General hospitals. Data was analyzed using SPSSWIN 10.0 with crosstab, ANOVA, and stepwise multiple regression. RESULT: Expertise(F=34.347, p=.000), empowerment(F=29.316, p=.000), and participation(F=3.276, p=.041) were significantly different among 3 clinical experience groups. Clinical experience correlated with expertise(r=.551, p=.000) and empowerment(r=.492, p=.000), and Decision-making participation also correlated with expertise(r=.351, p=.000) and empowerment(r=.265, p=.002). Decision-making participation is effected by theoretical knowledge(under 3.00 yr clinical experience), expertise(3.01-5.00 yr), and empowerment(above 5.01 yr). CONCLUSION: These findings indicate that factors(theoretical knowledge, expertise, or empowerment) on decision-making participation varies as nurses's clinical experience differs. Therefore, decision-making needs bilateral agreement between staff nurses and nurse managers rather than the responsibility of one.

[The effects of Koryo Hand-Acupuncture on the patients with chronic low back pain].

PURPOSE: The purpose of this study was to identify the effects of Koryo Hand-Acupuncture on health status(pain, trunk flexion, IADL, depression) of patients with chronic low back pain. METHOD: This study used a quasi experimental pre-test and post-test design. Data were collected from December 1st, 2000 to December 20th, 2001. 63 chronic low back pain patients(35 experimental group, 28 control group) admitted to the Back-School and consented to this study. The experimental group participated in treatment : Koryo Hand-Acupuncture and AB-Bong. Two groups was homogeneity. After 4 weeks the effects of treatment on the health status was measured between experimental and control group. Data were analyzed using SPSSWIN 10.0 with crosstab, t-test, and paired t-test. RESULT: In the experimental group, pain(t=4.85, p=.000) and IADL difficulty(t=2.05, p=.045) was significantly lower than those in the control group. It makes no difference trunk flexion(t=-1.60, p=.114) and depression(t=1.50, p=.138) between experimental and control group. CONCLUSION: These findings indicate that Koryo-Hand Acupuncture is an effective method for reducing pain and IADL difficulty in patients with chronic low back pain, and is considered as a independent nursing intervention for chronic low back pain.