BACKGROUND: Artificial intelligence (AI) is increasingly reshaping health professions education, but its relationship with students' future career outlook remains insufficiently understood, particularly in professions where human interaction remains central to practice. This study examined whether career optimism in physiotherapy and rehabilitation students was more closely associated with AI literacy than with AI anxiety. METHODS: This cross-sectional study included 438 undergraduate physiotherapy and rehabilitation students from universities in Ankara and Konya, Türkiye. Data were collected online between 27 February 2026 and 10 March 2026 using Turkish versions of the Artificial Intelligence Literacy Scale, Artificial Intelligence Anxiety Scale, and the Career Optimism subscale of the Career Futures Inventory. Pearson correlations, subgroup comparisons, and hierarchical multiple linear regression analyses were performed. HC3 robust standard errors were used in sensitivity analyses. RESULTS: AI literacy was positively associated with career optimism (r = 0.396, p < 0.001), whereas AI anxiety showed a weaker negative association (r = - 0.147, p = 0.002). In hierarchical regression analyses, AI literacy was the only variable independently associated with career optimism in both the crude model (B = 0.281, β = 0.384, p < 0.001) and the adjusted model controlling for age, gender, class year, grade point average, formal AI-related training, and weekly AI use frequency (B = 0.284, β = 0.388, p < 0.001). AI anxiety was not independently associated with career optimism in either model. Sensitivity analyses using HC3 robust standard errors supported these findings. CONCLUSIONS: Among physiotherapy and rehabilitation students, career optimism was more strongly associated with AI literacy than with AI anxiety. Even in a strongly human-centered health profession, students' career-related expectations appear to be linked more closely to perceived AI-related competence than to AI-related anxiety. Educational strategies may therefore benefit from supporting AI literacy as part of future professional readiness. TRIAL REGISTRATION: Not applicable.