Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Serebral Palsili Çocukların Annelerinin Omuz Ağrı ve Fonksiyonel Düzeyinin Değerlendirilmesi: Kesitsel Tanımlayıcı Araştırma
Evaluation of the Shoulder Pain and Functional Level of the Mothers of Children with Cerebral Palsy: Cross-Sectional Descriptive Research
Mukaddes TOPUZa , Hakan POLATa , Arzu DEMİRGÜÇa
aSANKO Üniversitesi Sağlık Bilimleri Fakültesi, Fizyoterapi ve Rehabilitasyon Bölümü, Gaziantep, Türkiye
Turkiye Klinikleri J Health Sci. 2024;9(2):302-12
doi: 10.5336/healthsci.2023-99204
Article Language: TR
Full Text
ÖZET
 Amaç: Serebral palsili çocuğu olan annelerin omuz ağrısı ve omuz ağrısı ile ilişkili fonksiyonel durumlarını değerlendirmek ve tipik gelişim gösteren çocuğa sahip annelerle karşılaştırmak; serebral palsili çocukların vücut ağırlığı ve mobilite durumları ile omuz ağrı şiddeti ve fonksiyonellik düzeyi arasındaki ilişkiyi incelemekti. Gereç ve Yöntemler: Bu çalışmaya serebral palsili çocuğu olan anne (n=75) ve tipik gelişim gösteren çocuğa sahip olan anne (n=75) toplam 150 birey dâhil edildi. Annelerin omuz ağrısı McGill Ağrı Ölçeğiyle, omuz fonksiyonelliği Kol, Omuz ve El Sorunları Anketi [Disabilities of the Arm, Shoulder and Hand (DASH)], DASH İş Modeli, Omuz Ağrı ve Dizabilite İndeksi [Shoulder Pain and Disability Index (SPADI)] ile değerlendirildi. Ayrıca katılımcıların omuz normal eklem hareketleri gonyometre ile ölçüldü. Serebral palsili çocukların mobilite düzeyi Kaba Motor Fonksiyon Sınıflandırma Sistemi (KMFSS) skalasına göre belirlendi. Bulgular: Tipik gelişim gösteren çocuk anneleriyle kıyaslandığında serebral palsili çocuk annelerinin omuz ağrı düzeylerinin anlamlı düzeyde daha yüksek, omuz fonksiyonellik düzeylerinin ise anlamlı düzeyde daha kötü olduğu gözlendi (p<0,05). Çocukların KMFSS düzeyi ile annenin omuz ağrısı ve fonksiyonel kısıtlılığı arasındaki anlamlı pozitif ilişki saptandı (r=0,314, p=0,006). DASH, DASH İş Modeli ve SPADI anketlerinde çocuğun mobilite düzeyiyle anlamlı ilişki bulunulmamıştır. Ancak omuz eklem hareketlerinde farklı düzeyde pozitif korelasyon saptanmıştır. Çocuğun vücut ağırlığı, boy uzunluğu ve yaş ile omuz eklem fleksiyon, ekstansiyon, abdüksiyon, dış rotasyon ve iç rotasyon hareket genişlikleri arasında anlamlı negatif korelasyon bulundu (p<0,05). Sonuç: Serebral palsili çocuğu olan annelerin tipik gelişim gösteren çocuğu olan annelere kıyasla omuz ağrıları daha fazla ve fonksiyonellik düzeyleri ise daha kötüdür.

Anahtar Kelimeler: Serebral palsi; omuz ağrısı; fonksiyonellik düzeyi
ABSTRACT
 Objective: To evaluate shoulder pain and functional status of mothers with children with cerebral palsy and to compare them with mothers of healthy children; The aim of this study was to examine the relationship between body weight and mobility status of children with cerebral palsy, and shoulder pain severity and functionality level. Material and Methods: A total of 150 individuals, mothers with a child with cerebral palsy (n=75) and mothers with a typically developing child (n=75), were included in this study. Mothers' shoulder pain was evaluated with the McGill Pain Scale, and shoulder functionality was evaluated with Disabilities of the Arm, Shoulder and Hand (DASH), DASH Business Model, and Shoulder Pain and Disability Index (SPADI) questionnaires. In addition, the normal joint movements of the participants' shoulders were measured with a goniometer. The mobility level of children with cerebral palsy was determined according to the Gross Motor Function Classification System scale. Results: When compared to mothers of healthy children, mothers of children with cerebral palsy had significantly higher shoulder pain levels and significantly worse shoulder functionality levels (p<0.05). A significant positive relationship was found between the children's CMFSS level and the mother's shoulder pain and functional Deciency (r=0.314, p=0.006). In the DASH, DASH Business Model and SPADI questionnaires, no significant relationship was found with the child's mobility level. However, different levels of positive correlation were found in shoulder joint movements. A significant negative correlation was found between the child's body weight, height and age, and shoulder joint flexion, extension, abduction, external rotation and internal rotation range of motion (p<0.05). Conclusion: Mothers with cerebral palsy children had more shoulder pain and worse functionality than mothers with healthy children.

Keywords: Cerebral palsy; shoulder pain; level of functionality
REFERENCES:
  1. Kabakuş N, Açık Y, Kurt A, Özdiller DŞ, Kurt A, Aygün AD. Serebral palsili hastalarımızın demografik, etiyolojik ve klinik özellikleri [Demographical, etiological and clinical characteristics of cases with cerebral palsy]. Çocuk Sağlığı ve Hastalıkları Dergisi. 2005;48(2):125-9. [Link] 
  2. Odding E, Roebroeck ME, Stam HJ. The epidemiology of cerebral palsy: incidence, impairments and risk factors. Disabil Rehabil. 2006;28(4):183-91. [Crossref]  [PubMed]  [PMC] 
  3. Kalisperis FR, Miller-Skomorucha K, Beaman J. Functional ADL training for children and youth with cerebral palsy. Cerebral Palsy. 2020:2829-43. [Crossref] 
  4. Elder GC, Kirk J, Stewart G, Cook K, Weir D, Marshall A, et al. Contributing factors to muscle weakness in children with cerebral palsy. Dev Med Child Neurol. 2003;45(8):542-50. [Crossref]  [PubMed] 
  5. Laurvick CL, Msall ME, Silburn S, Bower C, de Klerk N, Leonard H. Physical and mental health of mothers caring for a child with Rett syndrome. Pediatrics. 2006;118(4):e1152-64. [Crossref]  [PubMed] 
  6. Kaya K, Unsal-Delialioglu S, Ordu-Gokkaya NK, Ozisler Z, Ergun N, Ozel S, et al. Musculo-skeletal pain, quality of life and depression in mothers of children with cerebral palsy. Disabil Rehabil. 2010;32(20):1666-72. [Crossref]  [PubMed] 
  7. Pirinççi CŞ, Cihan E, Arca M, Durmaz ED, Ün N. Ağrılı omuz patolojilerinde görülen kinezyofobinin yaşam kalitesi ve omuz fonksiyonelliğine olan etkisi [The effect of kinesiophobia on quality of life and shoulder functionality in painful shoulder pathologies]. Anadolu Kliniği Tıp Bilimleri Dergisi. 2021;26(1):3-10. [Link] 
  8. Cilliers AM. Rheumatic fever and rheumatic heart disease in Gauteng on the decline: Experience at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. S Afr Med J. 2014;104(9):632-4. [Crossref]  [PubMed] 
  9. Beyazova M, Kutsal YG. Fiziksel tıp ve Rehabilitasyon. 3. Baskı. Ankara: Güneş Tıp Kitabevleri; 2016.
  10. Aşık İ. Hematolojik hastalıklarda ağrı tedavisi: temel ilkeler [Pain treatment in hematological diseases: basic principles]. THD. 2007:46-52. [Link] 
  11. Düger T, Yakut E, Öksüz Ç, Yörükan S, Bilgütay B, Ayhan Ç, et al. Kol, omuz ve el sorunları (disabilities of the arm, shoulder and hand-DASH) anketi Türkçe uyarlamasının güvenirliği ve geçerliği [Reliability and validity of the Turkish version of the Disabilities of thr arm, shoulder and hand (DASH) questionnaire]. Fizyoterapi Rehabilitasyon. 2006;17(3):99-107. [Link] 
  12. Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis Care Res. 1991;4(4):143-9. [Crossref]  [PubMed] 
  13. MacDermid JC, Solomon P, Prkachin K. The Shoulder Pain and Disability Index demonstrates factor, construct and longitudinal validity. BMC Musculoskelet Disord. 2006;7:12. [Crossref]  [PubMed]  [PMC] 
  14. Ginns P, Kitay J, Prosser M. Transfer of academic staff learning in a research-intensive university. Teaching in Higher Education. 2010;15(3):235-46. [Crossref] 
  15. Tonga E, Düger T. Factors affecting low back pain in mothers who have disabled children. Journal of Back and Musculoskeletal Rehabilitation. 2008;21(4):219-26. [Crossref] 
  16. McStay RL, Trembath D, Dissanayake C. Stress and family quality of life in parents of children with autism spectrum disorder: parent gender and the double ABCX model. J Autism Dev Disord. 2014;44(12):3101-18. [Crossref]  [PubMed] 
  17. Vural AN. Engelli çocuğa sahip annelerin postür analizi ve ağrı değerlendirmesi [Yüksek lisans tezi]: İstanbul: İstanbul Medipol Üniversitesi; 2018. [Erişim tarihi: 2018] [Link] 
  18. Ramezani M, Eghlidi J, Pourghayoomi E, Mohammadi S. Caring-related chronic low back pain and associated factors among mothers of children with cerebral palsy. Rehabil Res Pract. 2020;2020:8854435. [Crossref]  [PubMed]  [PMC] 
  19. Terzi R, Tan G. Musculoskeletal system pain and related factors in mothers of children with cerebral palsy. Agri. 2016;28(1):18-24. [PubMed] 
  20. Wu J, Zhang J, Hong Y. Quality of life of primary caregivers of children with cerebral palsy: a comparison between mother and grandmother caregivers in Anhui province of China. Child Care Health Dev. 2017;43(5):718-24. [Crossref]  [PubMed] 
  21. Telci EA, Yarar F, Cavlak U, Atalay OT. Comparison of musculoskeletal pain distribution, quality of life and hopelessness level in mothers with disabled children in different ambulation levels. J Back Musculoskelet Rehabil. 2018;31(2):305-13. [Crossref]  [PubMed] 
  22. Davis M, Eshelman ER, McKay M. The Relaxation and Stress Reduction Workbook. 6th ed. Oakland: New Harbinger Publications; 2008.
  23. Karaman S, Özdemir ÖÇ. The effect of low back and neck pain on posture, burnout, and quality of life in formal caregivers of children with disabilities and the elderly. Ir J Med Sci. 2023;192(5):2059-64. [Crossref]  [PubMed] 
  24. Ötegen Ö. Engelli çocuklara sahip annelerin bel ağrısı, yaşam kalitesi ve depresyon düzeylerinin karşılaştırılması [Yüksek lisans tezi]. İstanbul: Bezm-i Alem Vakıf Üniversitesi; 2019. [Erişim tarihi: 26.07.2019]. [Link] 
  25. Tong HC, Haig AJ, Nelson VS, Yamakawa KS, Kandala G, Shin KY. Low back pain in adult female caregivers of children with physical disabilities. Arch Pediatr Adolesc Med. 2003;157(11):1128-33. [Crossref]  [PubMed] 
  26. Gokcin Eminel A, Kahraman T, Genc A. Physical workload during caregiving activities and related factors among the caregivers of children with cerebral palsy. Ir J Med Sci. 2021;190(2):701-9. [Crossref]  [PubMed] 
  27. Yilmaz Ö, Aki E, Düger T, Kayihan H, Karaduman A. Susceptibility of mothers of children with muscular dystrophy to chronic back pain. Journal of Back and Musculoskeletal Rehabilitation. 2004;17(2):51-5. [Crossref] 
  28. Yoosefinejad A, Hosseini A, Ashjaei H, Ghalamghash R. Prevalence of musculoskeletal pain disorders in mothers with disabled children in İran. Journal of Pharmaceutical and Biomedical Sciences. 2012;24(24):74-6. [Link] 
  29. Fakirullahoğlu A. Engelli çocukların annelerinde muskuloskeletal ağrı değerlendirilmesi [Yüksek lisans tezi]. İstanbul: İstanbul Bilim Üniversitesi; 2013. [Erişim tarihi: 2013]. [Link] 
  30. Lach LM, Kohen DE, Garner RE, Brehaut JC, Miller AR, Klassen AF, et al. The health and psychosocial functioning of caregivers of children with neurodevelopmental disorders. Disabil Rehabil. 2009;31(9):741-52. [Crossref]  [PubMed] 
  31. Berger AM, Parker KP, Young-McCaughan S, Mallory GA, Barsevick AM, Beck SL, et al. Sleep wake disturbances in people with cancer and their caregivers: state of the science. Oncol Nurs Forum. 2005;32(6):E98-126. [Crossref]  [PubMed] 
  32. Czupryna K, Nowotny-Czupryna O, Nowotny J. Back pain in mothers of cerebral palsied children. Ortop Traumatol Rehabil. 2014;16(5):497-505. [Crossref]  [PubMed] 
  33. Farajzadeh A, Maroufizadeh S, Amini M. Factors associated with quality of life among mothers of children with cerebral palsy. Int J Nurs Pract. 2020;26(3):e12811. [Crossref]  [PubMed] 
  34. Pandit B, Singh JK, Karn AK, Pandit R. Quality of Life among Primary Caregivers of Children with Cerebral Palsy Living in Sarlahi and Rautahat Districts of Nepal. J Nepal Health Res Counc. 2021;18(4):619-25. [Crossref]  [PubMed] 
  35. Freysinger VJ, Alessio H, Mehdizadeh SA. Re-Examining the morale-physical health-activity relationship: a longitudinal study of time changes and gender differences. Activities, Adaptation & Aging. 1993;17(4):25-41. [Crossref] 

.: Up To Date

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