Recommendations of Polish Society of Physiotherapy, Polish Society of Family Medicine and College of Family Physicians in Poland for hip joint pain in primary health care

Background
The authors share the view that the treatment of degenerative changes concerning the hip is a multidisciplinary activity. In the opinion of the authors, in the physiotherapeutic procedure, the order of developing periarticular structures is important when restoring normal homeostasis (blood supply, oxygenation, tonus, nutrition), in the area of the joint where there is a modified distribution of resting tension of soft tissues. Patient condition improvement, especially in those with less severe symptoms of degenerative disease (yet are without significant structural changes in the joint and without functional limitations), seems to be the most justified at the level of services provided by the primary care physician.

Objectives
The objective of this recommendation for hip joint physiotherapy within the basic health care stage is to propose a simple, uncomplicated set of physiotherapeutic actions that would allow, in particular at the first stage of change, the performance of activities decelerating degenerative processes in this joint and, hence, limiting the pain. The publication is a proposal for a new model of patient care in the system of Polish primary health care, and it is intended to form a background for systemic solutions (including the creation of an interdisciplinary cooperation model) that could be implemented.

Material and methods
Experts from the Polish Society of Physiotherapy, the Society of Family Medicine and the College of Family Physicians have reviewed published evidence from 2008-2018 regarding the use of physiotherapy in treating degenerative changes of the hip joint that have been placed online in PubMed and Cochrane Collaboration.

Conclusions
Maintaining good efficiency in hip joint pain patients is the priority in the treatment proceedings. Achievement of the above mentioned goal is possible through improvement of the accessibility of health services, the introduction of early (basic) therapeutic actions (education and physioprophylaxis) and actively engaging patients in the rehabilitation process (self-therapy) as conducted by the physiotherapist and the individual patient in cooperation with a primary care physician. Shaping a health-conscious attitude within primary care patients, the slowing down of disease progression and the postponing more advanced treatment forms are all further benefits resulting in reduction of the treatment costs within the healthcare system.