Multidimensional factors associated with community reintegration in the early chronic phase after stroke: the role of fear-related activity avoidance

Background Community reintegration is a key outcome after stroke, but many individuals experience persistent participation restrictions despite functional recovery.However, clinically interpretable indicators for identifying individuals at risk of restricted community reintegration, especially in the early chronic phase, remain unclear.Objective To classify levels of community reintegration and identify clinically interpretable cutoff values associated with restricted reintegration in individuals in the early chronic phase after stroke.Methods This cross-sectional study included 40 individuals 6–12 months post-stroke.Community reintegration was assessed using the Korean version of the Reintegration to Normal Living Index. Multidimensional clinical variables, including physical function, psychosocial and behavioral factors, social participation, and fall risk, were evaluated using validated instruments. Group comparisons, correlation analyses, receiver operating characteristic analyses, and multivariable logistic regression were performed.Results Several variables were associated with community reintegration, including physical, psychosocial, and behavioral factors. Among these, fall-related activity avoidance measured using the Survey of Activities and Fear of Falling in the Elderly showed the strongest association (r = −0.77, p = .001) and highest discriminative ability (AUC = 0.82), with a cutoff of ≥32.5. In multivariable analysis, activity avoidance remained independently associated (odds ratio = 0.883, 95% CI = 0.795–0.980, p = .020), whereas depressive symptoms were not significant (p = .052). The model explained 51% of the variance, with 75% accuracy.Conclusion Fear-related activity avoidance may be a key behavioral factor associated with community reintegration in individuals in the early chronic phase after stroke, with potential clinical utility for identifying those at risk of restricted reintegration.