Abstract for: Expanded digital prosthetic services: Health policy insights from a system dynamics simulation model

Digital prosthetics offer potential to improve accessibility and mobility outcomes for major lower-limb amputees, yet evidence on system-level impacts and policy levers remains sparse. This study uses system dynamics modelling to examine the influence of digital prosthetics on amputee mobility and identify leverage points for health policy. Using variance-based global sensitivity analysis, we sampled uncertainty parameters to simulate two scenario ensembles: one under demographic equilibrium and another under demographic growth. Sensitivity indices were then computed at mid- and end-points of the simulation horizon to identify dominant drivers and interaction effects. Sensitivity analysis revealed strong interaction effects and temporal shifts in parameter influence. Service capacity parameters dominated early phases, while market formation parameters governed long-term market growth and mobility outcomes. Resources-related parameters shifted from early reliance on external resources to later endogenous generation. Upstream prevention emerged as a significant lever only under growth scenarios, moderating amputee inflows and alleviating systemic bottlenecks. Policy interventions should prioritize phased strategies: (1) expand prosthetic service capacity to address early bottlenecks; (2) accelerate market legitimacy and infrastructure development to sustain digital prosthetics growth; and (3) strengthen upstream prevention given projected rises in amputations. Based on these leverage points, we further outline actionable policy measures for improving amputee mobility.