Quadriceps and ankle weakness in inclusion body myositis: impact on descending balance control and rehabilitation strategies - a systematic review

Impaired knee extensor control, ankle dorsiflexor weakness, and poor leg joint coordination are key contributors to balance deficits and fall risk in IBM. Moderate evidence supports resistance training and STS/StandTS exercises for improving strength and functional capacity, though consistent fall risk reduction has not been established. Tailored, multifaceted rehabilitation, potentially including emerging strategies such as STS/StandTS, and walking, appears most promising. Large-scale, high-quality studies are needed to refine interventions, validate lower-evidence approaches, and establish standardized protocols to optimize safety and functional outcomes in IBM.