The Dual Dynamics of Technology Acceptance and Psychological Reactance: Patients' Psychological Conflicts in AI-Assisted Rehabilitation and the Moderating Effects of Social Environment

Abstract

Background Artificial intelligence (AI)-assisted rehabilitation technologies hold significant promise for improving patient outcomes, yet adoption rates remain suboptimal. Existing research has predominantly examined acceptance mechanisms in isolation, neglecting the concurrent operation of resistance pathways and social contextual influences. This study developed an integrated theoretical model combining the Technology Acceptance Model (TAM) and Psychological Reactance Theory (PRT) to examine how facilitating and inhibiting psychological mechanisms simultaneously shape patients' behavioral intentions toward AI-assisted rehabilitation, and how social environmental factors moderate these dual pathways. Methods A cross-sectional survey was conducted with 434 rehabilitation patients from three tertiary hospitals in eastern China between March and May 2025. Structural equation modeling was employed to test direct effects, mediation, and moderation hypotheses. Results Both the acceptance pathway (perceived usefulness → behavioral intention: β = 0.387, p < 0.001) and the reactance pathway (psychological reactance → behavioral intention: β = −0.276, p < 0.001) significantly influenced behavioral intentions. Perceived ease of use exerted both direct (β = 0.109, p = 0.013) and indirect effects on behavioral intention. Family support amplified the positive effect of perceived usefulness (Δ X² = 6.847, p < 0.01), while physician-patient trust buffered the negative effect of psychological reactance (Δ X² = 8.234, p < 0.01). Social norms did not significantly moderate the reactance-intention relationship. The integrated model explained 52.3% of variance in behavioral intention. Conclusions Patient acceptance of AI-assisted rehabilitation is shaped by concurrent facilitating and inhibiting psychological processes that are differentially moderated by social environmental factors. Implementation strategies should address both perceived usefulness and autonomy concerns through trusted physician relationships and family engagement.