Bicycle Injury Interventions

Bicycle Skills Training & Safety Courses

Background

Prevention of bicycle injuries can be approached through the use of bicycle helmets, educational programs to improve riding behavior and safet y, educational programs aimed at motor vehicle drivers, and environmental changes to decrease the likelihood of bicycle-motor vehicle collisions. An extensive review of educational programs and environmental changes is posted else where on our website. Click Training Programs for Bicycle Safety to access this review.

National Strategies for Advancing Bicycle Safety is available on the NBSN website. This document includes goals, strategies, and short-and long-term actions that can be taken to reduce injury and mortality associated with bicycle-related incidents. Efforts to change the cycling environment have five key goals: motorists will share the road, bicyclists will ride safely, bicyclists will wear helmets, the legal system will support safe bicycling, roads and paths will safely accommodate bicyclists.

The Institute of Transportation Engineers (ITE) created a pedestrian and bicycle task force in July 1999 to identify ways ITE could enhance its activities in this area. Survey results and recommendations are available on the organization web site at www.ite.org/councils/pbsurveyresults.htm.

Recently published evaluations are reviewed below.


Review of studies evaluating bicycle skills training & safety courses:

Author

Macarthur, 1998

Study design and target population

Randomized controlled trial

Suburb of Toronto, Canada

3 Intervention schools (n=73)

3 Contol school (n=68)

Intervention

Bicycle handling skills; Kids-CAN-BIKE playground based course for elementary school children.

Course length: 2 hours

Outcomes

Bicycle skills assessed on playground; straight line riding coming to a complete stop, shoulder checking prior to left turn. Also includes knowledge quiz.

Baseline & 3 month post intervention tests.

Results

High helmet ownership and use at baseline.

No difference in observed behavior between groups at baseline or follow-up.

Study quality and conclusions

Small sample size.

Brief skills training program was not effective in improving safe cycling behavior, knowledge, ot attitudes among 4th grade children.



Author

Carlin, 1998

Study design and target population

Population based case control study.

Children 9-14 years; Melbourne, Australia

Cases: bicycle injuries seen at 2 major hospital emergency departments. (ED) n=241

Controls:

RDD to select children who had bicycled in the past week. n=232

Intervention

School based bicycle safety education: "Bike ED", developed by Vic Roads.

Course covers safe riding skills traffic knowledge and skills, and basic bicycle mechanics.

Topics taught in classroom, practice exercises in schoolyard and supervised riding on local streets.

Outcomes

Injuries received while riding a bicycle that required emergency department visit.

Information collected by personal interview with child and parent.

Results

Cases= 148 Controls=130

16%of cases admitted to hospital.

Effect of Bike Ed program among participants and non-participants for bicycle related injuries of all types ORadj=1.64, (95% CI .98, 2.8); for boys OR=2.0, (95% CI 1.1, 3.8)

Multiple logistic regression used to adjust for sex, age, SES, cycling, exposure time or distance.

Bike Ed program appears to increase injuries among those exposed to program.

Negative effect stronger for low SES, younger children, and for children whose family members do not cycle.

Study quality and conclusions

Educational intervention dose NOT reduce risk of bicycle injuries.

Possibly harmful effect of exposure to bicycle safety course.



Author

Savill, et al, 1996

Study design and target population

Ecological study design.

School children (age 12) in the U.K. (N=1,974), 51% trained, 49% no training.

Intervention

8 bicycle training courses with curricula meeting Transportation Research Laboratory criteria.

Courses had 4-8 separate 1- 1(1/2) hour sessions and included training on public roads and playgrounds and off-road practice areas.

Outcomes

Knowledge quiz, practical skills test, cycling logs.

Children tested about 2 years after completing courses.

Group matched by age, sex, cycling experience and educational achievement.

Biases in instructor abilities randomized by selecting children from a range of primary schools.

Results

Trained children more likely to score a "safe" rating on skills test (p<0.001), score higher on knowledge test (p<0.005) and more likely to own or wear a helmet (p<0.001) than untrained children.

No difference found for cycling exposure.

Study quality and conclusions

Good quality study.

Training children to ride safely has a positive effect on their cycling practices at least 2 years post training.

Children trained with problem solving multi-stage course curricula demonstrated best results.

Summary of bicycle skills training studies

The studies reviewed above were unable to demonstrate a positive effect of bicycle skills training for changes in observed cycling behavior or reduction in injuries. Two studies reviewed above were unable to demonstrate a positive effect of bicycle skills training for changes in observed cycling behavior or reduction in injuries. The study by Savill and colleagues evaluated the long term effect of a number of skills training programs currently used in the U.K. and was able to demonstrate improvement in cycling skills, knowledge and helmet use in the group of children who received training.

The monograph "Training Programs for Bicycle Safety" reviewed 27 educational programs for children and adults. The most comprehensive programs have all incorporated helmet education, traffic rules, safety guidelines, and on-bike training into their curricula. Six of these programs have been evaluated and shown to be effective in increasing participant's knowledge and observed riding skills. There has been little evaluation of program effectiveness in reducing injuries, or evaluation of long-term program effects. The best study evaluating the effect of skill training on injuries (a population-based case control study from Melbourne, Australia) indicated that this type of education did not reduce injuries but appeared to actually increase injuries. This negative effect was stronger among children whose parents didn't cycle, among low SES groups and you nger children. The authors suggest skills training might produce harmful effects in some children, perhaps due to inadvertent encouragement of risk taking behavior or of bicycling without proper supervision.

Recommendations on bicycle skills training

There have not been sufficient evaluations of bicycle skills training programs so recommendations are premature. Program effectiveness evaluations should compare program participants to a comparable group that did not receive training. Outcomes assessed should include number and types of crashes, the number and/or severity of injuries, the level of helmet use, and the number of bicyclists in the area. An ideal assessment should also measure the extent to which the learned program skills are retained correctly and for the long term.

Recommendations for future research

Bicycle education programs should be thoroughly evaluated before their implementation. Plans and funding for proper evaluation should be set forth at the beginning of the program.