Journal Article

Accuracy of ChatGPT-3.5, ChatGPT-4o, Copilot, Gemini, Claude, and Perplexity in advising on lumbosacral radicular pain against clinical practice guidelines: cross-sectional study

Bargeri, Silvia, Palese, Alvisa, Rossettini, Giacomo, Castellini, Greta, Guida, Stefania, Gianola, Silvia, Turolla, Andrea, Rodeghiero, Lia, Cook, Chad, Pillastrini, Paolo

2025

Overview

Artificial Intelligence (AI) chatbots, which generate human-like responses based on extensive data, are becoming important tools in healthcare by providing information on health conditions, treatments, and preventive measures, acting as virtual assistants. However, their performance in aligning with clinical practice guidelines (CPGs) for providing answers to complex clinical questions on lumbosacral radicular pain is still unclear. We aim to evaluate AI chatbots' performance against CPG recommendations for diagnosing and treating lumbosacral radicular pain. We performed a cross-sectional study to assess AI chatbots' responses against CPGs recommendations for diagnosing and treating lumbosacral radicular pain. Clinical questions based on these CPGs were posed to the latest versions (updated in 2024) of six AI chatbots: ChatGPT-3.5, ChatGPT-4o, Microsoft Copilot, Google Gemini, Claude, and Perplexity. The chatbots' responses were evaluated for (a) consistency of text responses using Plagiarism Checker X, (b) intra- and inter-rater reliability using Fleiss' Kappa, and (c) match rate with CPGs. Statistical analyses were performed with STATA/MP 16.1. We found high variability in the text consistency of AI chatbot responses (median range 26%-68%). Intra-rater reliability ranged from \"almost perfect\" to \"substantial,\" while inter-rater reliability varied from \"almost perfect\" to \"moderate.\" Perplexity had the highest match rate at 67%, followed by Google Gemini at 63%, and Microsoft Copilot at 44%. ChatGPT-3.5, ChatGPT-4o, and Claude showed the lowest performance, each with a 33% match rate. Despite the variability in internal consistency and good intra- and inter-rater reliability, the AI Chatbots' recommendations often did not align with CPGs recommendations for diagnosing and treating lumbosacral radicular pain. Clinicians and patients should exercise caution when relying on these AI models, since one to two-thirds of the recommendations provided may be inappropriate or misleading according to specific chatbots.

• Publisher: Frontiers Media SA,Frontiers Media S.A
• Subject: Accuracy / Agreements / Artificial intelligence / Back pain / Chatbots / Clinical medicine / Clinical practice guidelines / Cross-sectional studies / Health literacy / Large language models / machine learning / Medical referrals / musculoskeletal / natural language processing / orthopaedics / Patients / physiotherapy / Systematic review / Transcutaneous electrical nerve stimulation-TENS