Turkiye Klinikleri Journal of Health Sciences

.: REVIEW
Kardiyak Rehabilitasyon Kanıta Dayalı Yaklaşımdır: Bir Sistematik Derleme
Cardiac Rehabilitation is an Evidence-Based Approach: A Systematic Review
Sultan İĞREKa, S. Ufuk YURDALANb
aÖzel Sevgi Tıp Merkezi, İstanbul, TÜRKİYE
bMarmara Üniversitesi Sağlık Bilimleri Fakültesi, Fizyoterapi ve Rehabilitasyon Bölümü, İstanbul, TÜRKİYE
Turkiye Klinikleri J Health Sci. 2022;7(1):278-90
doi: 10.5336/healthsci.2021-82994
Article Language: TR
Full Text
ÖZET
Bu sistematik derlemenin amacı, multidisipliner bir kardiyak rehabilitasyon programının kanıta dayalı bir yaklaşım olduğunu ortaya koymak için literatürü sistematik olarak gözden geçirmek ve araştırmaların bir araya getirilmesini sağlamaktır. Sistematik derlemede, 'Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols' bildirgesi rehber alınmıştır. Araştırma stratejisinde Embase, ScienceDirect, PEDro, Cochrane, Scopus veri tabanları kullanılmıştır. Veri tabanları 1997 yılından 25/02/2021 tarihine kadar İngilizce randomize kontrollü çalışmalar için taranmıştır. Yapılan taramalarda 'kalp hastalıkları (cardiac diseases), kardiyak rehabilitasyon (cardiac rehabilitation), kardiyak rehabilitasyon programı (cardiac rehabilitation program), multidisipliner (multidisciplinary)' anahtar kelimeleri kullanılmıştır. Derleme; kalp hastalıklarında multidisipliner bir kardiyak rehabilitasyon programı içeren, toplam 4.519 katılımcıyla kanıt değeri yüksek olan 16 randomize kontrollü çalışmayı tanımlamıştır. Bu çalışmalar doğrultusunda, kardiyak rehabilitasyonun kanıta dayalı bir yaklaşım olduğu ve kanıta dayalı yönlerinin; mortalite, morbidite, yaşam kalitesi, egzersiz kapasitesi, kardiyak risk faktörleri, hastaneye yatış ve psikolojik durum olduğu belirlenmiştir. Kardiyak rehabilitasyon programı; egzersiz, sağlık davranışı değişikliği ve eğitim, risk faktörleriyle ilgili yaşam tarzı yönetimi, psikososyal sağlık, tıbbi risk yönetimi, uzun vadeli stratejiler, denetim ve değerlendirmeyi içeren temel bileşenleri kapsamaktadır. Bu derlemeye, temel bileşenleri içeren kardiyak rehabilitasyon programlarının yer aldığı randomize kontrollü çalışmalar dâhil edilmiş ve bu çalışmalarda hastaların kardiyak rehabilitasyondan yararlanmalarını sağlamak amacıyla kapsamlı kardiyak rehabilitasyon hizmetlerinin önemi ve klinik yararlılığı vurgulanmıştır.

Anahtar Kelimeler: Kardiyovasküler sistem; kardiyak rehabilitasyon; egzersiz
ABSTRACT
This study aims to systematically review the literature and gather academic texts to demonstrate that a multidisciplinary cardiac rehabilitation program is an evidence-based approach. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols was taken into account as a guidebook in the systematic review. In this direction, six electronic databases were used in the search strategy. These are: Embase, ScienceDirect, PEDro, Cochrane, and Scopus. The data bases were screened for randomized controlled studies in the English language from 1997 to 25/02/2021. The following keywords were searched in the screenings: cardiac disease, cardiac rehabilitation, cardiac rehabilitation program, and multidisciplinary. The review identified 16 randomized controlled studies with high evidence value, and they consisted of 4,519 participants, including a multidisciplinary cardiac rehabilitation program in heart diseases. In the light of these studies, it is clearly understood that cardiac rehabilitation is an evidence-based approach. Its evidence-based aspects were also detected as mortality, morbidity, quality of life, exercise capacity, cardiac risk factors, hospitalization, and psychological status. The cardiac rehabilitation program covers the main components, including exercise, health behavior change and education, lifestyle management related to risk factors, psychosocial health, medical risk management, long-term strategies, supervision and evaluation. Randomized controlled studies covering cardiac rehabilitation programs involving key components were added in this review. The importance of comprehensive cardiac rehabilitation services was emphasized to enable patients to benefit from cardiac rehabilitation in these studies.

Keywords: Cardiovascular system; cardiac rehabilitation; exercise
REFERENCES:
  1. NCD Countdown 2030 collaborators. NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4. Lancet. 2018;392(10152):1072-88. [Crossref]  [PubMed] 
  2. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385 (9963):117-71. [Crossref]  [PubMed]  [PMC] 
  3. Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139-e596. [PubMed] 
  4. Cowie A, Buckley J, Doherty P, Furze G, Hayward J, Hinton S, et al; British Association for Cardiovascular Prevention and Rehabilitation (BACPR). Standards and core components for cardiovascular disease prevention and rehabilitation. Heart. 2019;105(7):510-5. [Crossref]  [PubMed]  [PMC] 
  5. WHO Expert Committee. Rehabilitation After Cardiovascular Diseases, with Special Emphasis On Developing Countries. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1993;831:1-122. [Link] 
  6. Thomas RJ, Beatty AL, Beckie TM, Brewer LC, Brown TM, Forman DE, et al. Home-based cardiac rehabilitation a scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. Circulation. 2019;140(1):e69-e89. [Crossref]  [PubMed] 
  7. Rauch B, Davos CH, Doherty P, Saure D, Metzendorf MI, Salzwedel A, et al; 'Cardiac Rehabilitation Section', European Association of Preventive Cardiology (EAPC), in cooperation with the Institute of Medical Biometry and Informatics (IMBI), Department of Medical Biometry, University of Heidelberg, and the Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Heinrich-Heine University, Düsseldorf, Germany. The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy: a systematic review and meta-analysis of randomized and non-randomized studies - The Cardiac Rehabilitation Outcome Study (CROS). Eur J Prev Cardiol. 2016;23(18): 1914-39. [Crossref]  [PubMed]  [PMC] 
  8. Salzwedel A, Jensen K, Rauch B, Doherty P, Metzendorf MI, Hackbusch M, et al. Effectiveness of comprehensive cardiac rehabilitation in coronary artery disease patients treated according to contemporary evidence based medicine: Update of the Cardiac Rehabilitation Outcome Study (CROS-II). Eur J Prev Cardiol. 2020;27(16):1756-74. [Crossref]  [PubMed]  [PMC] 
  9. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. [Crossref]  [PubMed]  [PMC] 
  10. Kourek C, Alshamari M, Mitsiou G, Psarra K, Delis D, Linardatou V, et al. The acute and long-term effects of a cardiac rehabilitation program on endothelial progenitor cells in chronic heart failure patients: Comparing two different exercise training protocols. Int J Cardiol Heart Vasc. 2020;32:100702. [Crossref]  [PubMed]  [PMC] 
  11. Ogawa M, Satomi-Kobayashi S, Yoshida N, Tsuboi Y, Komaki K, Wakida K, et al. Effects of acute-phase multidisciplinary rehabilitation on unplanned readmissions after cardiac surgery. J Thorac Cardiovasc Surg. 2021; 161(5):1853-60.e2. [Crossref]  [PubMed] 
  12. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83(8):713-21. [Crossref]  [PubMed] 
  13. Foley NC, Bhogal SK, Teasell RW, Bureau Y, Speechley MR. Estimates of quality and reliability with the physiotherapy evidence-based database scale to assess the methodology of randomized controlled trials of pharmacological and nonpharmacological interventions. Phys Ther. 2006;86(6):817-24. [Crossref]  [PubMed] 
  14. Shiwa SR, Costa LOP, Moser AD, Aguiar IC, Oliveira LV. PEDro: a base de dados de evidências em fisioterapia [PEDro: the physiotherapy evidence database]. Fisioter Mov. 2011;24(3):523-33. [Crossref] 
  15. Chaves GSDS, Ghisi GLM, Grace SL, Oh P, Ribeiro AL, Britto RR. Effects of comprehensive cardiac rehabilitation on functional capacity in a middle-income country: a rando mised controlled trial. Heart. 2019;105(5):406-13. [PubMed] 
  16. Ma L, Deng L, Yu H. The effects of a comprehensive rehabilitation and intensive education program on anxiety, depression, quality of life, and major adverse cardiac and cerebrovascular events in unprotected left main coronary artery disease patients who underwent coronary artery bypass grafting. Ir J Med Sci. 2020;189(2):477-88. [Crossref]  [PubMed] 
  17. Dalal HM, Evans PH, Campbell JL, Taylor RS, Watt A, Read KL, et al. Home-based versus hospital-based rehabilitation after myocardial infarction: a randomized trial with preference arms--Cornwall Heart Attack Rehabilitation Management Study (CHARMS). Int J Cardiol. 2007;119(2):202-11. [Crossref]  [PubMed] 
  18. Dorje T, Zhao G, Tso K, Wang J, Chen Y, Tsokey L, et al. Smartphone and social media-based cardiac rehabilitation and secondary prevention in China (SMART-CR/SP): a parallel-group, single-blind, randomised controlled trial. Lancet Digit Health. 2019;1(7): e363-e74. Erratum in: Lancet Digit Health. 2020;2(1):e15. [Crossref]  [PubMed] 
  19. Jiang W, Zhang Y, Yan F, Liu H, Gao R. Effectiveness of a nurse-led multidisciplinary self-management program for patients with coronary heart disease in communities: a randomized controlled trial. Patient Educ Couns. 2020;103(4):854-63. [Crossref]  [PubMed] 
  20. Carrington MJ, Chan YK, Calderone A, Scuffham PA, Esterman A, Goldstein S, et al; Young at Heart Investigators. A multicenter, randomized trial of a nurse-led, home-based intervention for optimal secondary cardiac prevention suggests some benefits for men but not for women: the Young at Heart study. Circ Cardiovasc Qual Outcomes. 2013;6(4):379-89. [Crossref]  [PubMed] 
  21. Janssen V, De Gucht V, van Exel H, Maes S. A self-regulation lifestyle program for post-cardiac rehabilitation patients has long-term effects on exercise adherence. J Behav Med. 2014;37(2):308-21. [Crossref]  [PubMed] 
  22. Saffi MA, Polanczyk CA, Rabelo-Silva ER. Lifestyle interventions reduce cardiovascular risk in patients with coronary artery disease: a randomized clinical trial. Eur J Cardiovasc Nurs. 2014;13(5):436-43. [Crossref]  [PubMed] 
  23. Mosca L, Christian AH, Mochari-Greenberger H, Kligfield P, Smith SC Jr. A randomized clinical trial of secondary prevention among women hospitalized with coronary heart disease. J Womens Health (Larchmt). 2010; 19(2):195-202. [Crossref]  [PubMed]  [PMC] 
  24. Chaves GSS, Lima de Melo Ghisi G, Britto RR, Grace SL. Maintenance of gains, morbidity, and mortality at 1 year following cardiac rehabilitation in a middle-income country: a wait-list control crossover trial. J Am Heart Assoc. 2019;8(4):e011228. [Crossref]  [PubMed]  [PMC] 
  25. Lang CC, Smith K, Wingham J, Eyre V, Greaves CJ, Warren FC, et al; REACH-HF investigators,. A randomised controlled trial of a facilitated home-based rehabilitation intervention in patients with heart failure with preserved ejection fraction and their caregivers: the REACH-HFpEF Pilot Study. BMJ Open. 2018;8(4):e019649. Erratum in: BMJ Open. 2019;9(3):e019649corr1. [PubMed]  [PMC] 
  26. Davidson PM, Cockburn J, Newton PJ, Webster JK, Betihavas V, Howes L, et al. Can a heart failure-specific cardiac rehabilitation program decrease hospitalizations and improve outcomes in high-risk patients? Eur J Cardiovasc Prev Rehabil. 2010;17(4):393-402. [Crossref]  [PubMed] 
  27. Zwisler AD, Soja AM, Rasmussen S, Frederiksen M, Abedini S, Appel J, et al; DANREHAB Group. Hospital-based comprehensive cardiac rehabilitation versus usual care among patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease: 12-month results of a randomized clinical trial. Am Heart J. 2008;155(6):1106-13. Erratum in: Am Heart J. 2008;156(2):276. [Crossref]  [PubMed] 
  28. Ter Hoeve N, Sunamura M, Stam HJ, Boersma E, Geleijnse ML, van Domburg RT, et al. Effects of two behavioral cardiac rehabilitation interventions on physical activity: a randomized controlled trial. Int J Cardiol. 2018;255:221-8. [Crossref]  [PubMed] 
  29. Moreno-Palanco MA, Ibá-ez-Sanz P, Pablo CC, Pizarro-Portillo A, Rodríguez-Salvanés F, Suárez-Fernández C. Impact of comprehensive and intensive treatment of risk factors concerning cardiovascular mortality in secondary prevention: MIRVAS study. Rev Esp Cardiol. 2011;64(3):179-85. [Crossref] 
  30. Risom SS, Zwisler AD, Sibilitz KL, Rasmussen TB, Taylor RS, Thygesen LC, et al. Cardiac rehabilitation for patients treated for atrial fibrillation with ablation has long-term effects: 12-and 24-month follow-up results from the randomized copenheartRFA trial. Arch Phys Med Rehabil. 2020;101(11):1877-86. [Crossref]  [PubMed] 
  31. Anderson L, Thompson DR, Oldridge N, Zwisler AD, Rees K, Martin N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2016;2016(1):CD001800. [Crossref]  [PubMed]  [PMC] 
  32. van Halewijn G, Deckers J, Tay HY, van Domburg R, Kotseva K, Wood D. Lessons from contemporary trials of cardiovascular prevention and rehabilitation: a systematic review and meta-analysis. Int J Cardiol. 2017;232: 294-303. [Crossref]  [PubMed] 
  33. Almodhy M, Ingle L, Sandercock GR. Effects of exercise-based cardiac rehabilitation on cardiorespiratory fitness: A meta-analysis of UK studies. Int J Cardiol. 2016;221:644-51. [Crossref]  [PubMed] 
  34. Santiago de Araújo Pio C, Marzolini S, Pakosh M, Grace SL. Effect of cardiac rehabilitation dose on mortality and morbidity: a systematic review and meta-regression analysis. Mayo Clin Proc. 2017;92(11):1644-59. [Crossref]  [PubMed] 
  35. Lawler PR, Filion KB, Eisenberg MJ. Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Am Heart J. 2011;162(4):571-84.e2. [Crossref]  [PubMed] 
  36. West RR, Jones DA, Henderson AH. Rehabilitation after myocardial infarction trial (RAMIT): multi-centre randomised controlled trial of comprehensive cardiac rehabilitation in patients following acute myocardial infarction. Heart. 2012;98(8):637-44. [Crossref]  [PubMed] 
  37. Powell R, McGregor G, Ennis S, Kimani PK, Underwood M. Is exercise-based cardiac rehabilitation effective? A systematic review and meta-analysis to re-examine the evidence. BMJ Open. 2018;8(3):e019656. Erratum in: BMJ Open. 2018;8(5):e019656corr1. [Crossref]  [PubMed]  [PMC] 
  38. Blokzijl F, Dieperink W, Keus F, Reneman MF, Mariani MA, van der Horst IC. Cardiac rehabilitation for patients having cardiac surgery: a systematic review. J Cardiovasc Surg (Torino). 2018;59(6):817-29. [Crossref]  [PubMed] 
  39. Tabachnick BG, Fidell LS. Using Multivariate Statistics. 4th ed. Boston: Allyn & Bacon; 2000. [Link] 
  40. Benzer W, Rauch B, Schmid JP, Zwisler AD, Dendale P, Davos CH, et al. Kouidi E; EuroCaReD study group. Exercise-based cardiac rehabilitation in twelve European countries results of the European cardiac rehabilitation registry. Int J Cardiol. 2017;228:58-67. Erratum in: Int J Cardiol. 2017;242:50. [Crossref]  [PubMed] 
  41. Candelaria D, Randall S, Ladak L, Gallagher R. Health-related quality of life and exercise-based cardiac rehabilitation in contemporary acute coronary syndrome patients: a systematic review and meta-analysis. Qual Life Res. 2020;29(3):579-92. [Crossref]  [PubMed] 
  42. Shepherd CW, While AE. Cardiac rehabilitation and quality of life: a systematic review. Int J Nurs Stud. 2012;49(6):755-71. [Crossref]  [PubMed] 
  43. Taylor RS, Walker S, Smart NA, Piepoli MF, Warren FC, Ciani O, et al; ExTraMATCH II Collaboration. Impact of exercise rehabilitation on exercise capacity and quality-of-life in heart failure: individual participant meta-analysis. J Am Coll Cardiol. 2019;73(12):1430-43. [PubMed] 
  44. Ribeiro GS, Melo RD, Deresz LF, Dal Lago P, Pontes MR, Karsten M. Cardiac rehabilitation programme after transcatheter aortic valve implantation versus surgical aortic valve replacement: systematic review and meta- analysis. Eur J Prev Cardiol. 2017;24(7): 688-97. [Crossref]  [PubMed] 
  45. Heinl RE, Dhindsa DS, Mahlof EN, Schultz WM, Ricketts JC, Varghese T, et al. Comprehensive cardiovascular risk reduction and cardiac rehabilitation in diabetes and the metabolic syndrome. Can J Cardiol. 2016; 32(10 Suppl 2):S349-S57. [Crossref]  [PubMed]  [PMC] 
  46. Mohammed HG, Shabana AM. Effect of cardiac rehabilitation on cardiovascular risk factors in chronic heart failure patients. Egypt Heart J. 2018;70(2):77-82. [Crossref]  [PubMed]  [PMC] 
  47. Frasure-Smith N, Lespérance F, Talajic M. Depression following myocardial infarction. Impact on 6-month survival. JAMA. 1993;20;270 (15):1819-25. Erratum in: JAMA 1994; 271(14):1082. [Crossref]  [PubMed] 
  48. Lavie CJ, Menezes AR, De Schutter A, Milani RV, Blumenthal JA. Impact of cardiac rehabilitation and exercise training on psychological risk factors and subsequent prognosis in patients with cardiovascular disease. Can J Cardiol. 2016;32(10 Suppl 2):S365-S73. [Crossref]  [PubMed] 
  49. Richards SH, Anderson L, Jenkinson CE, Whalley B, Rees K, Davies P, et al. Psychological interventions for coronary heart disease. Cochrane Database Syst Rev. 2017; 4(4):CD002902. [PubMed]  [PMC] 
  50. Chauvet-Gelinier JC, Bonin B. Stress, anxiety and depression in heart disease patients: a major challenge for cardiac rehabilitation. Ann Phys Rehabil Med. 2017;60(1):6-12. [Crossref]  [PubMed] 
  51. Dalal HM, Doherty P, Taylor RS. Cardiac rehabilitation. BMJ. 2015;351:h5000. [Crossref]  [PubMed]  [PMC] 
  52. Patel DK, Duncan MS, Shah AS, Lindman BR, Greevy RA Jr, Savage PD, et al. Association of cardiac rehabilitation with decreased hospitalization and mortality risk after cardiac valve surgery. JAMA Cardiol. 2019;4(12): 1250-9. [Crossref]  [PubMed]  [PMC] 
  53. Bachmann JM, Duncan MS, Shah AS, Greevy RA, Lindenfeld J, Keteyian SJ, et al. Association of Cardiac Rehabilitation with Decreased Hospitalizations and Mortality After Ventricular Assist Device Implantation. JACC Heart Fail. 2018;6(2):130-9. [Crossref]  [PubMed]  [PMC] 

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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