• Advanced age, normal sensory function, higher Barthel index, and Fugl-Meyer motor function score are protective factors against severe spasticity in stroke hemiplegic patients.
• Depression/anxiety, poor sleep quality, and pain are significant risk factors for increased spasticity severity.
• A logistic regression model incorporating these factors achieved an AUC of 0.969, demonstrating high predictive accuracy for spasticity severity.
• Multidimensional and individualized interventions are recommended to prevent and reduce spasticity, improving functional outcomes and quality of life.