The extensive range of symptoms reflects not only clinical heterogeneity but also methodological inconsistencies. The frequent presence of secondary diagnoses further complicates attribution to implants. A way forward includes the use of standardized, validated questionnaires and instruments addressing psychological domains, administered at predefined time points. Achieving international consensus on such tools is crucial to minimize bias, improve comparability, and enable prospective studies to clarify causal links and support the recognition of BII as a distinct clinical entity.
Petritsch et al. (Tue,) studied this question.