Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Geriatrik Bireylerde Total Diz Protezi Ameliyatı Öncesi Verilen Hasta Eğitiminin Ağrı ve Hareket Korkusu Üzerine Etkisi: Randomize Kontrollü Çalışma
The Effect of Preoperative Patient Education on Pain and Kinesiophobia in Geriatric Individuals Undergoing Total Knee Replacement Surgery: Randomized Control Trial
Aşkın Deniz KAYAa , Neslihan DURUTÜRKb , Murat BOZKURTc
aSerbest Hekim, Ankara, Türkiye
bBaşkent Üniversitesi Sağlık Bilimleri Fakültesi, Fizyoterapi ve Rehabilitasyon Bölümü, Ankara, Türkiye
cAnkara Acıbadem Hastanesi, Ortopedi ve Travmatoloji Kliniği, Ankara, Türkiye
Turkiye Klinikleri J Health Sci. 2025;10(1):97-105
doi: 10.5336/healthsci.2024-104532
Article Language: TR
Full Text
ÖZET
 Amaç: Çalışma, geriatrik bireylerde total diz protezi (TDP) ameliyatı öncesi verilen hasta eğitiminin ağrı ve hareket korkusu üzerine etkisini araştırmak için planlandı. Gereç ve Yöntemler: Çalışmaya yaş ortalamaları kontrol grubunda 69,65±3,99 yıl, müdahale grubunda 70,65±4,32 yıl olan 52 birey (44K/8E) dâhil edildi. Hastalar randomize olarak müdahale (26 birey) ve kontrol olmak üzere (26 birey) 2 gruba ayrıldı. Müdahale grubundaki hastalara ameliyattan 3 gün önce, 1 seans, 30-45 dk, hasta eğitimi ve broşür verildi. Kontrol grubundaki bireylerle ise 15 dk'lık ön görüşme yapılarak, ameliyat hakkında bilgi verildi. Tüm bireylerin cerrahi öncesi ve postoperatif 4. haftada ağrı durumları; görsel analog skala, Ağrı Felaketleştirme Ölçeği (AFÖ) ve Ağrı İnançları Ölçeği (AİÖ) ile hareket korkuları Hareket Korkusu Nedenleri Ölçeği (HKNÖ) ile değerlendirildi. Bulgular: Gruplarda VAS ve AFÖ ölçümlerinin karşılaştırılmasında tüm alt bileşenlerinde farklılık bulundu (p<0,05). Gruplarda AİÖ skorları karşılaştırılmasında müdahale grubunda tüm alt bileşenlerinde anlamlı fark bulundu (p<0,05). Kontrol grubunda organik bileşende fark varken (p<0,05) psikolojik bileşende bir fark bulunmadı (p=0,055). Gruplarda HKNÖ skorları karşılaştırılmasında müdahale grubunda tüm alt parametrelerde fark bulundu (p<0,05); kontrol grubunda ise bulunmadı (p>0,05). Çalışma gruplarının karşılaştırılmasının yapıldığı gruplar arasında fark saptanmadı (p>0,05). Sonuç: Çalışmamızın sonucunda, geriatrik bireylerde TDP ameliyatı öncesi verilen kapsamlı hasta eğitiminin ağrı ve hareket korkusu üzerine olumlu etkileri olabileceği görüldü. Geriatrik bireylere özel hazırlanan ameliyat öncesi fizyoterapi ve rehabilitasyon programlarında mutlaka bu yönde de değerlendirme ve eğitimlere yere verilmesi gerektiği ve ileriki çalışmalarda bu popülasyonda daha çok seanstan oluşan preoperatif hasta eğitim programlarının ve uzun dönem sonuçlarının gösterilmesi gerektiğini düşünmekteyiz.

Anahtar Kelimeler: Total diz protezi; hasta eğitimi; ağrı; kinezyofobi; fizyoterapi ve rehabilitasyon
ABSTRACT
 Objective: This study was designed to investigate the effect of preoperative patient education on pain and fear of movement in geriatric individuals undergoing total knee arthroplasty (TKA). Materials and Methods: A total of 52 individuals (44 females, 8 males) were included in the study, with an average age of 69.65±3.99 years in the control group and 70.65±4.32 years in the intervention group. Patients were randomly assigned to two groups: the intervention group (26 individuals) and the control group (26 individuals). The intervention group received a single session of patient education and a brochure three days before surgery, lasting 30-45 minutes. The control group received a 15-minute preoperative consultation providing general information about the surgery. Pain levels were assessed preoperatively and at the 4th postoperative week using the Visual Analog Scale (VAS), the Pain Catastrophizing Scale (PCS), and the Pain Beliefs Questionnaire (PBQ). Kinesiophobia was evaluated using Kinesiophobia Causes Scale (KCS). Results: Comparisons of VAS and PCS scores between groups revealed significant differences in all subcomponents (p<0.05). When comparing PBQ scores, significant differences were found in all subcomponents within the intervention group (p<0.05). In the control group, a difference was found in the organic component (p<0.05), whereas no significant difference was observed in the psychological component (p=0.055). When comparing KCS scores, significant differences were found in all subparameters in the intervention group (p<0.05), while no significant differences were observed in the control group (p>0.05). No significant differences were found between the study groups in overall comparisons (p>0.05). Conclusion: The findings suggest that comprehensive preoperative patient education may have positive effects on pain and fear of movement in geriatric individuals undergoing TKA. It is recommended that preoperative physiotherapy and rehabilitation programs specifically designed for geriatric patients include assessments and educational components addressing these concerns. Future studies should explore preoperative patient education programs with multiple sessions and assess their long-term outcomes in this population.

Keywords: Total knee arthroplasty; patient education; pain; kinesiophobia; physical therapy and rehabilitation
REFERENCES:
  1. Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage. 2013;21(9):1145-53. [Crossref]  [PubMed]  [PMC] 
  2. Senna ER, De Barros AL, Silva EO, Costa IF, Pereira LV, Ciconelli RM, et al. Prevalence of rheumatic diseases in Brazil: a study using the COPCORD approach. J Rheumatol. 2004;31(3):594-7. [PubMed] 
  3. Kahlenberg CA, Nwachukwu BU, McLawhorn AS, Cross MB, Cornell CN, Padgett DE. Patient satisfaction after total knee replacement: a systematic review. HSS J. 2018;14(2):192-201. [Crossref]  [PubMed]  [PMC] 
  4. Doury-Panchout F, Metivier JC, Fouquet B. Kinesiophobia negatively influences recovery of joint function following total knee arthroplasty. Eur J Phys Rehabil Med. 2015;51(2):155-61. [PubMed] 
  5. Johansson K, Nuutila L, Virtanen H, Katajisto J, Salanterä S. Preoperative education for orthopaedic patients: systematic review. J Adv Nurs. 2005;50(2):212-23. [Crossref]  [PubMed] 
  6. Clarke HD, Timm VL, Goldberg BR, Hattrup SJ. Preoperative patient education reduces in-hospital falls after total knee arthroplasty. Clin Orthop Relat Res. 2012;470(1):244-9. [Crossref]  [PubMed]  [PMC] 
  7. Güngen C, Ertan T, Eker E, Yaşar R, Engin F. Standardize Mini Mental Test'in Türk toplumunda hafif demans tanısında geçerlik ve güvenilirliği [Reliability and validity of the standardized mini mental state examination in the diagnosis of mild dementia in Turkish population]. Türk Psikiyatri Dergisi. 2002;13:273-81. [Link] 
  8. Huskisson EC. Measurement of pain. J Rheumatol. 1982;9(5):768-9. [PubMed] 
  9. Ugurlu M, Karakas Ugurlu G, Erten S, Caykoylu A. Validity of Turkish form of Pain Catastrophizing Scale and modeling of the relationship between pain-related disability with pain intensity, cognitive, and emotional factors. Psyc. Clin Psychopharmacol. 2017;27(2):189-96. [Crossref] 
  10. Süren M, Okan I, Gökbakan AM, Kaya Z, Erkorkmaz U, Arici S, et al. Factors associated with the pain catastrophizing scale and validation in a sample of the Turkish population. Turk J Med Sci. 2014;44(1):104-8. [Crossref]  [PubMed] 
  11. Sertel Berk HÖ. Kronik ağrı yaşantısı ve ağrı inançları: Ağrı İnançları Ölçeği'nin Türkçe geçerlik ve güvenirlik çalışması [Doktora tezi]. İstanbul: İstanbul Üniversitesi; 2006. [Link] 
  12. Çayır M, Durutürk N, Tekindal MA. Kinezyofobi Nedenleri Ölçeği'nin Türkçe uyarlamasının geçerlik ve güvenirliği [Reliability and validity of the Turkish version of kinesiophopia causes scale]. J Exerc Ther Rehabil. 2020;7(1):64-73. [Link] 
  13. Lucas B. Total hip and total knee replacement: postoperative nursing management. Br J Nurs. 2008;17(22):1410-4. [Crossref]  [PubMed] 
  14. Beaupre LA, Lier D, Davies DM, Johnston DB. The effect of a preoperative exercise and education program on functional recovery, health related quality of life, and health service utilization following primary total knee arthroplasty. J Rheumatol. 2004;31(6):1166-73. [PubMed] 
  15. McNaught J, Paul L. The use of adaptive equipment following total knee replacement. British Journal of Occupational Therapy. 2015;78(3):187-95. [Crossref] 
  16. Ho CJ, Chen YT, Wu HL, Huang HT, Lin SY. The effects of a patient-specific integrated education program on pain, perioperative anxiety, and functional recovery following total knee replacement. J Pers Med. 2022;12(5):719. [Crossref]  [PubMed]  [PMC] 
  17. Becker R, Döring C, Denecke A, Brosz M. Expectation, satisfaction and clinical outcome of patients after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2011;19(9):1433-41. [Crossref]  [PubMed] 
  18. McGregor AH, Hughes SP. The evaluation of the surgical management of nerve root compression in patients with low back pain: Part 2: patient expectations and satisfaction. Spine (Phila Pa 1976). 2002;27(13):1471-6; discussion 1476-7. [Crossref]  [PubMed] 
  19. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010;468(1):57-63. [Crossref]  [PubMed]  [PMC] 
  20. Gonzalez Sáenz de Tejada M, Escobar A, Herrera C, García L, Aizpuru F, Sarasqueta C. Patient expectations and health-related quality of life outcomes following total joint replacement. Value Health. 2010;13(4):447-54. [Crossref]  [PubMed] 
  21. Kriwanek S, Armbruster C, Beckerhinn P, Blauensteier W, Gschwantler M. Patients' assessment and recall of surgical information after laparoscopic cholecystectomy. Dig Surg. 1998;15(6):669-73. [Crossref]  [PubMed] 
  22. Sinikallio SH, Helminen EE, Valjakka AL, Väisänen-Rouvali RH, Arokoski JP. Multiple psychological factors are associated with poorer functioning in a sample of community-dwelling knee osteoarthritis patients. J Clin Rheumatol. 2014;20(5):261-7. [Crossref]  [PubMed] 
  23. Sullivan M, Tanzer M, Stanish W, Fallaha M, Keefe FJ, Simmonds M, Dunbar M. Psychological determinants of problematic outcomes following total knee arthroplasty. Pain. 2009;143(1-2):123-9. [Crossref]  [PubMed] 
  24. Forsythe ME, Dunbar MJ, Hennigar AW, Sullivan MJ, Gross M. Prospective relation between catastrophizing and residual pain following knee arthroplasty: two-year follow-up. Pain Res Manag. 2008;13(4):335-41. [Crossref]  [PubMed]  [PMC] 
  25. Edwards RR, Haythornthwaite JA, Smith MT, Klick B, Katz JN. Catastrophizing and depressive symptoms as prospective predictors of outcomes following total knee replacement. Pain Res Manag. 2009;14(4):307-11. [Crossref]  [PubMed]  [PMC] 
  26. Birch S, Stilling M, Mechlenburg I, Hansen TB. No effect of cognitive behavioral patient education for patients with pain catastrophizing before total knee arthroplasty: a randomized controlled trial. Acta Orthop. 2020;91(1):98-103. [Crossref]  [PubMed]  [PMC] 
  27. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012;2(1):e000435. [Crossref]  [PubMed]  [PMC] 
  28. Meyer VM, Beydoun HA, Gyenai L, Goble NM, Hunter MM, McGill RJ. The effect of preoperative behavioral intervention on pain, anxiety, opioid use, and function in patients undergoing total knee arthroplasty: a randomized controlled study. Mil Med. 2023;188(5-6):e1010-7. [Crossref]  [PubMed] 
  29. Russo LR, Benedetti MG, Mariani E, Roberti di Sarsina T, Zaffagnini S. The Videoinsight® Method: improving early results following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2017;25(9):2967-71. [Crossref]  [PubMed] 

.: 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