Author(s): RUI, L., RUAN, B., Institution: DEPARTMENT OF SPORTS SCIENCE AND PHYSICAL EDUCATION, Country: HONG KONG, Abstract-ID: 500

Introduction
Physical activity (PA) is increasingly utilised as a primary intervention in clinical rehabilitation. However, the introduction of novel and inherently uncertain intervention types—ranging from digital health therapies to complex behavioural models—necessitates a critical evaluation of clinical outcome predictability. This shift has prompted a necessary discussion regarding how clinical uncertainty, interpersonal trust, and technological responsibility are managed to optimise patient adherence and rehabilitation efficacy.

Methods
A comprehensive systematic search was conducted in early 2026 across major academic databases, including PubMed, Web of Science, Scopus, and Embase. Following a two-phase PRISMA-guided screening process, 1,502 records published between 2015 and 2025 were identified, resulting in the final inclusion of 296 original empirical studies, including RCTs, qualitative, and observational designs. To ensure a transparent and reproducible interpretation, data were analysed using thematic synthesis (Thomas & Harden, 2008), which involved three distinct stages: line-by-line coding of primary findings, the development of descriptive themes, and the subsequent generation of overarching analytical themes.

Results
The 296 included articles were categorised into four primary domains based on their central research focus: Patient Education and Trust Building (n=99), Rehabilitation Roles and Multidisciplinary Trust (n=86), Uncertainty in PA Interventions (n=94), and AI and Technology-related Ethical Concerns (n=17). Thematic synthesis demonstrated that interpersonal trust serves as the fundamental mediator for patient adherence in environments defined by high prognostic uncertainty. Furthermore, informational gaps during care transitions were identified as a primary barrier to long-term PA engagement, while AI-driven tools were found to improve diagnostic precision but introduce "algorithmic ambiguity" concerning clinician responsibility.

Conclusion
Rehabilitation efficacy is contingent upon the proactive management of clinical uncertainty and the deliberate cultivation of patient-provider trust. Future physical activity programmes must integrate transparent educational strategies and robust ethical AI frameworks to bridge the gap between technological advancement and clinical relationship maintenance.