Journal of Traditional Medical Complementary Therapies

.: ORIGINAL RESEARCH
Kronik Miyofasiyal Boyun Ağrısı Olan Hastalarda Enstrüman Destekli Yumuşak Doku Mobilizasyonu ve/veya Egzersizin Ağrı, Postüral Denge, Uyku ve Yaşam Kalitesi Üzerine Etkileri: Randomize Kontrollü Bir Çalışma
The Effects of Instrument-Supported Soft Tissue Mobilization and/or Exercise on Pain, Postural Balance, Sleep and Quality of Life in Patients with Chronic Myofacial Neck Pain: A Randomized Controlled Study
Mustafa ÇIBIKa, Mustafa Savaş TORLAKb
aSerbest Fizyoterapist, Konya, Türkiye
bKTO Karatay Üniversitesi Sağlık Hizmetleri Meslek Yüksekokulu, Terapi ve Rehabilitasyon Programı, Konya, Türkiye
J Tradit Complem Med. 2022;5(2):87-95
doi: 10.5336/jtracom.2021-87069
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışmanın amacı; kronik miyofasiyal boyun ağrısı (KMBA) olan hastalarda, enstrüman destekli yumuşak doku mobilizasyonu (EDYDM) ve/veya egzersizin ağrı, postüral denge, uyku ve yaşam kalitesi üzerine olan etkilerini araştırmaktı. Gereç ve Yöntemler: Çalışmaya 30-50 yaş arası KMBA olan 36'sı kadın, 36'sı erkek toplam 72 hasta dâhil edildi. Hastalar randomize EDYDM grubu, egzersiz grubu ve plasebo grubu olacak şekilde 3 gruba ayrıldı. Bireylerin demografik ve fiziksel özellikleri olgu rapor formu ile kaydedildi. EDYDM grubuna sadece EDYDM, egzersiz grubuna ev egzersiz programı, kontrol grubuna ise plasebo EDYDM uygulandı. Ağrı şiddeti, Görsel Analog Skalası [Visual Analogue Scale (VAS)] ile, denge Dört Adım Kare Testi (DAKT) ve Tek Ayak Üzerinde Durma Testi (TAÜDT) ile, uyku kalitesi Pittsburg Uyku Kalitesi İndeksi (PUKİ) ile, yaşam kalitesi SF-36 Yaşam Kalitesi Ölçeği ile değerlendirildi. Ölçümler tedavi öncesi ve sonrasında tekrarlandı. Bulgular: Çalışmada, EDYDM grubu ve egzersiz grubunda tedavi öncesi ve sonrası VAS, DAKT, TAÜDT, PUKİ ve SF-36 yaşam kalitesi ölçeklerinin alt parametrelerinde anlamlı fark vardı (p0,05). Sonuç: Çalışma sonucunda EDYDM ve egzersiz grubunda VAS, DAKT, TAÜDT, PUKİ ve SF-36 yaşam kalitesi ölçeklerinin alt parametrelerinde anlamlı gelişmeler görülürken, plasebo grubunda anlamlı bir fark yoktu.

Anahtar Kelimeler: Boyun ağrısı; egzersiz; kas-iskelet manipülasyonları; uyku
ABSTRACT
 Objective: The aim of this study is; to investigate the effects of instrument-assisted soft tissue mobilization (IASTM) and/or exercise on pain, postural balance, sleep and quality of life in patients with chronic myofascial neck pain (CMNP). Material and Methods: A total of 72 patients, 36 females and 36 males, with CMNP between the ages of 30 and 50 years were included in the study. The patients were divided into 3 groups as randomized IASTM group, exercise group and placebo group. Demographic and physical characteristics of the individuals were recorded with the case report form. Only IASTM was applied to the IASTM group, home exercise program to the exercise group, and placebo IASTM to the control group. Pain severity was assessed using Visual Analogue Scale (VAS), balance was assessed using Four Step Square Test (FSST) and the One-Leg Stand Test (OLST), sleep quality was assessed using Pittsburg Sleep Quality Index (PSQI), while assessment of quality of life was done using SF-36 Quality of Life Scale. The measurements were repeated before and after the study. Results: In the study, there was a significant difference in the sub-parameters of VAS, FSST, OLST, PSQI and SF-36 quality of life scales before and after treatment in the IASTM group and exercise group (p0.05). Conclusion: As a result of the study, significant improvements were observed in the sub-parameters of the VAS, FSST, OLST, PSQI and SF-36 quality of life scales in the IASTM and exercise group, but no significant results were obtained in the placebo group.

Keywords: Neck pain; exercise; musculoskeletal manipulations; sleep
REFERENCES:
  1. Carroll LJ, Hogg-Johnson S, van der Velde G, Haldeman S, Holm LW, Carragee EJ, et al; Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Course and prognostic factors for neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976). 2008;33(4 Suppl):S75-82. [Crossref]  [PubMed] 
  2. Harris GR, Susman JL. Managing musculoskeletal complaints with rehabilitation therapy: summary of the Philadelphia Panel evidence-based clinical practice guidelines on musculoskeletal rehabilitation interventions. J Fam Pract. 2002;51(12):1042-6. [PubMed] 
  3. Laudner K, Compton BD, McLoda TA, Walters CM. Acute effects of instrument assisted soft tissue mobilization for improving posterior shoulder range of motion in collegiate baseball players. Int J Sports Phys Ther. 2014;9(1):1-7. [PubMed]  [PMC] 
  4. Loghmani MT, Warden SJ. Instrument-assisted cross fiber massage increases tissue perfusion and alters microvascular morphology in the vicinity of healing knee ligaments. BMC Complement Altern Med. 2013;13:240. [Crossref]  [PubMed]  [PMC] 
  5. Highland TR, Dreisinger TE, Vie LL, Russell GS. Changes in isometric strength and range of motion of the isolated cervical spine after eight weeks of clinical rehabilitation. Spine (Phila Pa 1976). 1992;17(6 Suppl):S77-82. [Crossref]  [PubMed] 
  6. Kaźmierczak H, Pawlak-Osińska K, Kasprzak H. Wpływ zaburzeń propriocepcji szyjnej na odruchy posturalne--badania doświadczalne i kliniczne [The influence of the cervical proprioception on the postural reflexes--experimental and clinical study]. Otolaryngol Pol. 2004;58(4):839-42. Polish. [PubMed] 
  7. Sarig-Bahat H. Evidence for exercise therapy in mechanical neck disorders. Man Ther. 2003;8(1):10-20. [Crossref]  [PubMed] 
  8. Griffiths C, Dziedzic K, Waterfield J, Sim J. Effectiveness of specificneck stabilization exercises or a general neck exercise program for chronic neck disorders: a randomized controlled trial. J Rheumatol. 2009;36(2):390-7. [Crossref]  [PubMed] 
  9. Gulick DT. Instrument-assisted soft tissue mobilization increases myofascial trigger point pain threshold. J Bodyw Mov Ther. 2018;22(2):341-5. [Crossref]  [PubMed] 
  10. Lin IH, Chang KH, Liou TH, Tsou CM, Huang YC. Progressive shoulder-neck exercise on cervical muscle functions in middle-aged and senior patients with chronic neck pain. Eur J Phys Rehabil Med. 2018;54(1):13-21. [Crossref]  [PubMed] 
  11. Fathollahnejad K, Letafatkar A, Hadadnezhad M. The effect of manual therapy and stabilizing exercises on forward head and rounded shoulder postures: a six-week intervention with a one-month follow-up study. BMC Musculoskelet Disord. 2019;20(1):86. [Crossref]  [PubMed]  [PMC] 
  12. Tunwattanapong P, Kongkasuwan R, Kuptniratsaikul V. The effectiveness of a neck and shoulder stretching exercise program among office workers with neck pain: a randomized controlled trial. Clin Rehabil. 2016;30(1):64-72. [Crossref]  [PubMed] 
  13. Durmus B. Servikal bölge sorunlarında egzersiz reçeteleme [Prescribing exercise for neck problems]. Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi. 2014;60(Özel Sayı 2):15-24. [Crossref] 
  14. Quek J, Brauer SG, Clark R, Treleaven J. New insights into neck-pain-related postural control using measures of signal frequency and complexity in older adults. Gait Posture. 2014;39(4):1069-73. [Crossref]  [PubMed] 
  15. Humphreys BK. Cervical outcome measures: testing for postural stability and balance. J Manipulative Physiol Ther. 2008;31(7):540-6. [Crossref]  [PubMed] 
  16. Omori S, Isose S, Otsuru N, Nishihara M, Kuwabara S, Inui K, et al. Somatotopic representation of pain in the primary somatosensory cortex (S1) in humans. Clin Neurophysiol. 2013;124(7):1422-30. [Crossref]  [PubMed] 
  17. Field S, Treleaven J, Jull G. Standing balance: a comparison between idiopathic and whiplash-induced neck pain. Man Ther. 2008;13(3):183-91. [Crossref]  [PubMed] 
  18. Toprak ÇŞ, Mete O, Korkut Z, Özalp M, Ünüvar BS, Sevim M. Kronik boyun ağrılı bireylerde derin boyun fleksör kas performansının denge ve yürüme parametreleri ile ilişkisi [Relationship between deep neck flexor muscle performance, balance and gait parameters in individuals with chronic neck pain]. Turk J Physiother Rehabil. 2020;31(1):52-7. [Link] 
  19. Acet N. Nonspesifik boyun ağrılı hastalarda servikal bölgeye yapılan mobilizasyonun denge ve propriosepsiyona etkisi [Doktora tezi]. Ankara: Gazi Üniversitesi; 2020. [Erişim tarihi: 10 Ekim 2021]. Erişim linki: [Link] 
  20. Kim JE, Ha S, Kim WM. The effects of 8-week spinal stabilization exercise program on NDI, postural balance and body shape change in patients with chronic neck pain. J Korea Acad Industr Coop Soc. 2020;21(12):43-51. [Link] 
  21. Lee JH, Lee DK, Oh JS. The effect of Graston technique on the pain and range of motion in patients with chronic low back pain. J Phys Ther Sci. 2016;28(6):1852-5. [Crossref]  [PubMed]  [PMC] 
  22. Bostan A. Kronik boyun ağrısı olan hastalarda aletli yumuşak doku mobilizasyon uygulamasının etkinliği: Randomize kontrollü çalışma [Yüksek lisans tezi]. İstanbul: İstanbul Medipol Üniversitesi; 2021. [Erişim tarihi: 13 Ekim 2021]. Erişim linki: [Link] 
  23. Salo PK, Häkkinen AH, Kautiainen H, Ylinen JJ. Effect of neck strength training on health-related quality of life in females with chronic neck pain: a randomized controlled 1-year follow-up study. Health Qual Life Outcomes. 2010;8:48. [Crossref]  [PubMed]  [PMC] 
  24. Häkkinen A, Salo P, Tarvainen U, Wirén K, Ylinen J. Effect of manual therapy and stretching on neck muscle strength and mobility in chronic neck pain. J Rehabil Med. 2007;39(7):575-9. [Crossref]  [PubMed] 
  25. Kelson DM, Mathiassen SE, Srinivasan D. Trapezius muscle activity variation during computer work performed by individuals with and without neck-shoulder pain. Appl Ergon. 2019;81:102908. [Crossref]  [PubMed] 
  26. Hacıömeroğlu Ç. Kronik boyun ağrısı olan olgularda eklem pozisyon hissinin değerlendirilmesi [Yüksek lisans tezi]. İstanbul: İstanbul Medipol Üniversitesi; 2020. [Erişim tarihi: 12 Ekim 2021]. Erişim linki: [Link] 
  27. Bostan A. Kronik boyun ağrısı olan hastalarda aletli yumuşak doku mobilizasyon uygulamasının etkinliği: Randomize kontrollü çalışma [Yüksek lisans tezi]. İstanbul: İstanbul Medipol Üniversitesi; 2021. [Erişim tarihi: 12 Ekim 2021]. Erişim linki: [Link] 
  28. Falla D, Lindstrøm R, Rechter L, Boudreau S, Petzke F. Effectiveness of an 8-week exercise programme on pain and specificity of neck muscle activity in patients with chronic neck pain: a randomized controlled study. Eur J Pain. 2013;17(10):1517-28. [Crossref]  [PubMed] 
  29. Björnsdóttir SV, Jónsson SH, Valdimarsdóttir UA. Functional limitations and physical symptoms of individuals with chronic pain. Scand J Rheumatol. 2013;42(1):59-70. [Crossref]  [PubMed] 
  30. Gutiérrez-Rojas C, González I, Navarrete E, Olivares E, Rojas J, Tordecilla D. The effect of combining myofascial release with ıce application on a latent trigger point in the forearm of young adults: a randomized clinical trial. MYOPAIN. 2015;23(3):201-8. [Crossref] 
  31. Çağlar A. Miyofasiyal ağrı sendromlu bireylerde egzersiz programına ek olarak uygulanan manuel tedavi yöntemlerinin etkisi [Doktora tezi]. Ankara: Hacettepe Üniversitesi; 2019. [Erişim tarihi: 15 Ekim 2021]. Erişim linki: [Link] 

.: 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