The Autonomous Clinic: Navigating AI, Sensors and the Equity Gap in Modern Physiotherapy

Technology-enabled rehabilitation has moved from the margins of physiotherapy practice to a routine service option within a single decade, propelled by pandemic-era necessity, favourable trial results and sustained policy enthusiasm for digital health. The dominant justification offered for this shift is that remote and digitally mediated care widens access for people who cannot easily reach a clinic. This critical narrative review interrogates that justification. It synthesises evidence on effectiveness, access, ethics and workforce consequences of digital physiotherapy, and evaluates whether the equity claim is supported by the available literature. Sources were identified through structured searching of biomedical and multidisciplinary scholarly databases and authoritative institutional repositories, with critical appraisal of methodological quality, evidence–claim alignment and geographical representativeness. The synthesis identifies a persistent mismatch between an efficacy literature drawn largely from connected, literate, high-income and predominantly urban samples and an equity rhetoric that invokes rural, disabled, older and low-income populations who are systematically under-represented in that same literature. Comparable clinical outcomes between remote and in-person physiotherapy are reasonably well supported for musculoskeletal and selected neurological conditions, yet this finding speaks to efficacy among those who enrol rather than to distributional effect across a population. Ethical analysis of digital physiotherapy remains thin and inconsistently reported, particularly regarding consent to commercial data processing, adverse-event surveillance, the altered therapeutic relationship and the governance of algorithmic tools. Workforce evidence indicates that digital health competencies are largely absent from physiotherapy competency standards and that clinician capability lags behind organisational deployment. Three arguments are advanced: that access should be conceptualised as realised benefit rather than nominal availability; that digital substitution risks displacing rather than supplementing scarce services in low-resource settings; and that equity outcomes must be measured as trial endpoints rather than assumed. Research priorities are proposed accordingly.