Turkiye Klinikleri Journal of Sports Sciences

.: ORIGINAL RESEARCH
Effect of Chronic Ankle Instability on Functionality, Mental and Physical Health Among Elite Athletes: A Case-Control Study
Elit Atletlerde Kronik Ayak Bileği İnstabilitesinin Fonksiyonellik, Mental ve Fiziksel Sağlık Üzerine Etkisi: Vaka-Kontrol Çalışması
Özlem FEYZİOĞLUa, Özgül ÖZTÜRKa, Stefanos GADISb
aDepartment of Physiotherapy and Rehabilitation, Acıbadem Mehmet Ali Aydınlar University Faculty of Health Sciences, İstanbul, Türkiye
bClinic of Physical Therapy and Rehabilitation, Suadiye Sportomed, İstanbul, Türkiye
Turkiye Klinikleri J Sports Sci. 2023;15(1):123-30
doi: 10.5336/sportsci.2022-92483
Article Language: EN
Full Text
ABSTRACT
 Objective: Chronic ankle instability (CAI) leads to a decrease in physical performance and a delay in return to sportive activities in elite athletes. Approximately 40% of the lateral ankle sprains result in CAI. The purpose of the current study was to compare the functionality of foot and ankle and health-related quality of life in elite athletes with or without CAI. Material and Methods: A total of 104 elite athletes 79 men, 25 women with (n=52) and without (n=52) CAI participated in this study. The functionality of the foot and ankle was determined using Foot and Ankle Ability Measure (FAAM) FAAMactivity of daily living and FAAM-sports subscales. Health-related quality of life was assessed using the short form-12 (SF-12) physical and mental subscores. Results: FAAM-activity of daily living and FAAM-sport subscale scores of elite athletes with CAI were lower than athletes without CAI (p<0.05). The SF-12 physical and mental subscores differed between the 2 groups (p<0.05) and the most affected side was the dominant one in chronic ankle insatbility group. Conclusion: CAI causes functional performance decline and mental impairment by showing general and regional symptoms in the Professional athletic population. During the planning of the treatment and rehabilitation process, priority should be given to increase the perceived quality of life by diminishing the symptoms. In addition, focusing on multidimensional treatment approaches that take into account the level of mental health would be beneficial in increasing athletic performance.

Keywords: Chronic ankle instability; functionality; elite athlete; mental health; quality of life
ÖZET
 Amaç: Kronik ayak bileği instabilitesi, profesyonel sporcuların spordan uzun süre uzak kalmalarına ve fiziksel performanslarına negatif etki etmektedir. Lateral ayak bileği instabilitelerinin yaklaşık %40'ı kronik ayak bileği instabilitesine dönüşmektedir. Bu çalışmanın amacı, kronik ayak bileği instabilitesi olan ve olmayan profesyonel sporcuların, ayak ve ayak bileği fonksiyonellik ve sağlıkla ilgili yaşam kalitesi etkilenimi açısından karşılaştırmaktır. Gereç ve Yöntemler: Bu çalışmaya 25 kadın, 79 erkek olmak üzere toplam 104 katılımcı [kronik ayak bileği stabilitesi olan (n=52) ve olmayan (n=52)] katıldı. Katılımcıların ayak ve ayak bileği fonksiyonellik seviyesi Ayak Bileği Kullanılabilirlik Ölçüsü [Foot and Ankle Ability Measure (FAAM)] Ölçeği'nin FAAM-günlük yaşam aktiviteleri ve FAAM-spor alt ölçekleri ile sağlıkla ilgili yaşam kalitesi kısa form-12'nin [short form-12 (SF-12)] fiziksel ve mental alt skorları ile değerlendirildi. Bulgular: Kronik ayak bileği instabilitesi olan sporcuların, FAAM günlük yaşam aktiviteleri ve spor alt ölçekleri skorları bakımından olmayan sporculara göre anlamlı bir azalma gösterdiği görülmüştür (p<0,05). Katılımcıların SF-12'nin fiziksel ve mental alt skorları açısından gruplar arasında istatistiksel olarak anlamlı fark bulunmuştur (p<0,05) ve kronik ayak bileği instabilitesinin daha fazla dominant taraf ekstremitede görüldüğü saptanmıştır. Sonuç: Kronik ayak bileği instabilitesi, profesyonel atletik popülasyonda genel ve bölgesel semptomlar göstererek, fonksiyonel performans düşüşüne ve mental etkilenime neden olmaktadır. Tedavi ve rehabilitasyon sürecinin planlanmasında kişiye özel semptomlar giderilerek, yaşam kalitesinin artırılması hedeflenmelidir. Ayrıca mental sağlık düzeyini dikkate alan çok yönlü tedavi yaklaşımlarına odaklanılması atletik performansın artırılmasında yararlı olacaktır.

Anahtar Kelimeler: Kronik ayak bileği instabilitesi; fonksiyonellik; elit sporcu; mental sağlık; yaşam kalitesi
REFERENCES:
  1. Fong DT, Hong Y, Chan LK, Yung PS, Chan KM. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37(1):73-94. [Crossref]  [PubMed] 
  2. Gribble PA, Delahunt E, Bleakley C, Caulfield B, Docherty CL, Fourchet F, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. J Orthop Sports Phys Ther. 2013;43(8):585-91. [Crossref]  [PubMed] 
  3. van Rijn RM, van Os AG, Bernsen RM, Luijsterburg PA, Koes BW, Bierma-Zeinstra SM. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med. 2008;121(4):324-31.e6. [Crossref]  [PubMed] 
  4. Houston MN, Hoch JM, Gabriner ML, Kirby JL, Hoch MC. Clinical and laboratory measures associated with health-related quality of life in individuals with chronic ankle instability. Phys Ther Sport. 2015;16(2):169-75. [Crossref]  [PubMed] 
  5. Simon JE, Docherty CL. Health-related quality of life is decreased in middle-aged adults with chronic ankle instability. J Sci Med Sport. 2018;21(12):1206-9. [Crossref]  [PubMed] 
  6. Hubbard-Turner T, Turner MJ. Physical activity levels in college students with chronic ankle instability. J Athl Train. 2015;50(7):742-7. [Crossref]  [PubMed]  [PMC] 
  7. Donovan L, Hetzel S, Laufenberg CR, McGuine TA. Prevalence and impact of chronic ankle instability in adolescent athletes. Orthop J Sports Med. 2020;8(2):2325967119900962. [Crossref]  [PubMed]  [PMC] 
  8. Hertel J. Sensorimotor deficits with ankle sprains and chronic ankle instability. Clin Sports Med. 2008;27(3):353-70, vii. [Crossref]  [PubMed] 
  9. Houston MN, Hoch JM, Hoch MC. Patient-reported outcome measures in individuals with chronic ankle instability: a systematic review. J Athl Train. 2015;50(10):1019-33. [Crossref]  [PubMed]  [PMC] 
  10. Hertel J, Corbett RO. An updated model of chronic ankle instability. J Athl Train. 2019;54(6):572-88. [Crossref]  [PubMed]  [PMC] 
  11. Hiller CE, Refshauge KM, Bundy AC, Herbert RD, Kilbreath SL. The Cumberland ankle instability tool: a report of validity and reliability testing. Arch Phys Med Rehabil. 2006;87(9):1235-41. [Crossref]  [PubMed] 
  12. Wright CJ, Arnold BL, Ross SE, Linens SW. Recalibration and validation of the Cumberland Ankle Instability Tool cutoff score for individuals with chronic ankle instability. Arch Phys Med Rehabil. 2014;95(10):1853-9. [Crossref]  [PubMed] 
  13. Wright CJ, Linens SW, Cain MS. Establishing the minimal clinical important difference and minimal detectable change for the cumberland ankle instability tool. Arch Phys Med Rehabil. 2017;98(9):1806-11. [Crossref]  [PubMed] 
  14. Martin RL, Irrgang JJ, Burdett RG, Conti SF, Van Swearingen JM. Evidence of validity for the foot and ankle ability measure (FAAM). Foot Ankle Int. 2005;26(11):968-83. [Crossref]  [PubMed] 
  15. Mazaheri M, Salavati M, Negahban H, Sohani SM, Taghizadeh F, Feizi A, et al. Reliability and validity of the Persian version of Foot and Ankle Ability Measure (FAAM) to measure functional limitations in patients with foot and ankle disorders. Osteoarthritis Cartilage. 2010;18(6):755-9. [Crossref]  [PubMed] 
  16. Ware JE, Kosinski M, Keller SD. SF-36 Physical and Mental Summary Scales: A User's Manual. 5th ed. Boston, MA: The Health Institute; 1994
  17. Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220-33. [Crossref]  [PubMed] 
  18. Kocyigit H, Aydemir O, Fisek G, Olmez N, Memis A. Validity and reliability of Turkish version of Short form 36: A study of a patients with romatoid disorder. J Drug Ther. 1999;12(2):102-6. [Link] 
  19. Tanen L, Docherty CL, Van Der Pol B, Simon J, Schrader J. Prevalence of chronic ankle instability in high school and division I athletes. Foot Ankle Spec. 2014;7(1):37-44. [Crossref]  [PubMed] 
  20. Spor Hizmetleri Genel Müdürlüğü [İnternet]. [Erişim tarihi: 30.06.2022]. Erişim linki: [Link] 
  21. Valderrabano V, Leumann A, Pagenstert G, Frigg A, Ebneter L, Hintermann B. Chronische Instabilität des oberen Sprunggelenks im Sport -- ein Review für Sportärzte [Chronic ankle instability in sports -- a review for sports physicians]. Sportverletz Sportschaden. 2006;20(4):177-83. German. [Crossref]  [PubMed] 
  22. Hertel J. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train. 2002;37(4):364-75. [PubMed]  [PMC] 
  23. Hiller CE, Kilbreath SL, Refshauge KM. Chronic ankle instability: evolution of the model. J Athl Train. 2011;46(2):133-41. [Crossref]  [PubMed]  [PMC] 
  24. Hadadi M, Heghighat F, Hossein I. Comparison of health-related quality of life in different types of chronic ankle instability. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin. 2020;30(04):230-6. [Crossref] 
  25. Fukano M, Mineta S, Hirose N. Fear avoidance beliefs in college athletes with a history of ankle sprain. Int J Sports Med. 2020;41(2):128-33. [Crossref]  [PubMed] 
  26. Suttmiller AMB, McCann RS. Injury-related fear in individuals with and without chronic ankle instability: a systematic review. J Sport Rehabil. 2021;30(8):1203-12. [Crossref]  [PubMed] 
  27. Lohrer H, Nauck T, Gehring D, Wissler S, Braag B, Gollhofer A. Differences between mechanically stable and unstable chronic ankle instability subgroups when examined by arthrometer and FAAM-G. J Orthop Surg Res. 2015;10:32. [Crossref]  [PubMed]  [PMC] 
  28. Al Mahrouqi MM, MacDonald DA, Vicenzino B, Smith MD. Quality of life, function and disability in individuals with chronic ankle symptoms: a cross-sectional online survey. J Foot Ankle Res. 2020;13(1):67. [Crossref]  [PubMed]  [PMC] 
  29. Oztekin HH, Boya H, Ozcan O, Zeren B, Pinar P. Foot and ankle injuries and time lost from play in professional soccer players. Foot (Edinb). 2009;19(1):22-8. [Crossref]  [PubMed] 
  30. Gribble PA, Bleakley CM, Caulfield BM, Docherty CL, Fourchet F, Fong DT, et al. Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med. 2016;50(24):1496-505. [Crossref]  [PubMed] 
  31. Zuckerman SL, Wegner AM, Roos KG, Djoko A, Dompier TP, Kerr ZY. Injuries sustained in National Collegiate Athletic Association men's and women's basketball, 2009/2010-2014/2015. Br J Sports Med. 2018;52(4):261-8. [Crossref]  [PubMed] 
  32. Houston MN, Van Lunen BL, Hoch MC. Health-related quality of life in individuals with chronic ankle instability. J Athl Train. 2014;49(6):758-63. [Crossref]  [PubMed]  [PMC] 
  33. Lin CI, Houtenbos S, Lu YH, Mayer F, Wippert PM. The epidemiology of chronic ankle instability with perceived ankle instability- a systematic review. J Foot Ankle Res. 2021;14(1):41. [Crossref]  [PubMed]  [PMC] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com