Impact of Artificial Intelligence or Telerehabilitation on Consumer Ratings in Physical Therapy: An Online Randomized Experiment

ABSTRACT Importance Artificial intelligence (AI) is increasingly integrated into health care delivery, but its influence on consumer perceptions of physical therapist services remains unclear. Objective The objective was to examine how the use of AI influences consumer perceptions of in-person and telerehabilitation physical therapist services. Design This study used a randomized 2 × 2 factorial experimental design comparing AI use and delivery mode. Setting The experiment was conducted online in Australia. Participants The study included 710 Australian adults recruited through a paid panel. Exposure Participants were randomized to 1 of 4 hypothetical physical therapist consultation scenarios (in-person vs telerehabilitation; AI used vs not used). Main Outcomes and Measures Perceived warmth; competence; safety; provider trust; emotional trust; relational and functional service quality; working alliance; and intention to use were measured on 7-point Likert-scales. Composite mean scores were analyzed using ordinary least squares regression with heteroskedasticity-robust standard errors. Results Mean scores in the no-AI, in-person condition ranged from 4.8 to 5.8. Among in-person scenarios, described AI use was associated with lower ratings across all outcomes, including warmth (b = -0.3, 95% CI = -0.5 to -0.1), competence (-0.4, -0.6 to -0.2) and safety (-0.8, -1.1 to -0.6), provider trust (-0.5, -0.7 to -0.3) and intention to use (-0.8, -1.0 to -0.5). Without AI, telerehabilitation also reduced ratings by 0.2 to 0.7 points across outcomes. Positive interaction effects indicated attenuation of AI-related reductions in telerehabilitation for relational (interaction b = 0.4, 95% CI = 0.1 to 0.8) and functional service quality (0.36, 0.02 to 0.70), intention to use (0.6, 0.1 to 1.0), and perceived safety (0.5, 0.1 to 0.9). Conclusions Hypothetical in-person consultations described as involving AI were associated with poorer consumer perceptions of physical therapists and services. Telerehabilitation was also perceived less favorably than in-person care. Relevance Future studies should test whether transparency and reassurance mitigate the effects of AI-use on consumer perceptions of physical therapy.