Motorcycle rider training for the prevention of road traffic crashes: Cochrane systematic review
Assessed as up to date: 2010/08/08
Riding a motorcycle (a two-wheeled vehicle that is powered by a motor and has no pedals) is associated with a high risk of fatal crashes, particularly in new riders. Motorcycle rider training has therefore been suggested as an important means of reducing the number of crashes, and the severity of injuries.Objectives
To quantify the effectiveness of pre- and post-licence motorcycle rider training on the reduction of traffic offences, traffic crash involvement, injuries and deaths of motorcycle riders.Search strategy
We searched the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2008, Issue 3), TRANSPORT, MEDLINE, EMBASE, CINAHL, WHOLIS (World Health Organization Library Information System), PsycInfo, LILACS (Latin American and Caribbean Health Sciences), ISI Web of Science: Social Sciences Citation Index (SSCI), ERIC, ZETOC and SIGLE. Database searches covered all available dates up to October 2008. We also checked reference lists of relevant papers and contacted study authors in an effort to identify published, unpublished and ongoing trials related to motorcycle rider training.Selection criteria
We included all relevant intervention studies such as randomised and non-randomised controlled trials, interrupted time-series and observational studies such as cohort and case-control studies.Data collection and analysis
Two review authors independently analysed data about the study population, study design and methods, interventions and outcome measures as well as data quality from each included study, and compared the findings. We resolved differences by discussion with a third review author.Main results
We reviewed 23 studies: three randomised trials, two non-randomised trials, 14 cohort studies and four case-control studies. Five examined mandatory pre-licence training, 14 assessed non-mandatory training, three of the case-control studies assessed ‘any’ type of rider training, and one case-control study assessed mandatory pre-licence training and non-mandatory training. The types of assessed rider training varied in duration and content.
Most studies suffered from serious methodological weaknesses. Most studies were non-randomised and controlled poorly for confounders. Most studies also suffered from detection bias due to the poor use of outcome measurement tools such as the sole reliance upon police records or self-reported data. Small sample sizes and short follow-up time after training were also common.Authors' conclusions
Due to the poor quality of studies identified, we were unable to draw any conclusions about the effectiveness of rider training on crash, injury, or offence rates. The findings suggest that mandatory pre-licence training may be an impediment to completing a motorcycle licensing process, possibly indirectly reducing crashes through a reduction in exposure. It is not clear if training (or what type) reduces the risk of crashes, injuries or offences in motorcyclists, and a best rider training practice can therefore not be recommended. As some type of rider training is likely to be necessary to teach motorcyclists to ride a motorcycle safely, rigorous research is needed.
Kardamanidis Katina, Martiniuk Alexandra, Ivers Rebecca Q, Stevenson Mark R, Thistlethwaite Katrina
Motorcycle rider training for preventing road traffic crashes
Riders of motorcycles (a two-wheeled vehicle that is powered by a motor and has no pedals - Oxford English Dictionary Online), especially novice riders, have an increased risk of being involved in fatal crashes compared to other road users. Motorcycle rider training could be an important way of reducing the number of crashes and the severity of injuries.
The authors of this review examined all research studies that report an evaluation of the effectiveness of motorcycle rider courses in reducing the number of traffic offences, motorcycle rider crashes, injuries and deaths. This review included 23 research studies, including three randomised trials, two non-randomised trials, 14 cohort studies and four case-control studies. The types of rider training that were evaluated varied in content and duration. The findings suggest that mandatory pre-licence training may present a barrier to completing a motorcycle licensing process, thus possibly indirectly reducing crash, injury, death and offence rates through a reduction in exposure to riding a motorcycle. However, on the basis of the existing evidence, it is not clear if (or what type of) training reduces the risk of crashes, injuries, deaths or offences in motorcyclists and the selection of the best rider training practice can therefore not be recommended.
It is likely that some type of rider training is necessary to teach motorcyclists basic motorcycle handling techniques and to ride a motorcycle safely. It is therefore important that further research work be conducted to rigorously evaluate motorcycle rider training courses, particularly in low income countries where the main burden of motorcycle injuries and deaths occur.
Implications for practice
Due to the poor quality of studies included in this review, we were unable to draw any conclusions about the effectiveness of rider training on crash rates, injurious or fatal, or offence rates. The findings do suggest that mandatory pre-licence training may be an impediment to completing a motorcycle licensing process, thus possibly indirectly reducing crash, injury, death and offence rates through a reduction in exposure to riding a motorcycle. On the basis of the existing evidence it is not clear if, and what type of training reduces the risk of crashes, injuries, deaths or offences in motorcyclists and the selection of the best rider training practice can therefore not be recommended. The suggestion that mandatory pre-licence training indirectly reduces exposure to riding the motorcycle because trainees are impeded from completing the licensing process does not help those motorcyclists who persist in obtaining their licence and riding the motorcycle. Some type of rider training is likely necessary to teach motorcyclists to ride a motorcycle safely. Good policy is based on sound evidence and evaluation but such evidence for motorcycle rider training is seriously lacking. Policy makers are therefore encouraged to include a rigorous evaluation component to any new or existing rider training programme. Such an evaluation should ideally be randomized and assess whether the training programme is effective and if so, which component(s) of the programme work best.
Implications for research
Given the results of this review, which found little reliable evidence about the effectiveness of motorcycle rider training, it is necessary to build up an evidence base of the effectiveness of motorcycle rider training in the reduction of crash, injury, death and offence rates. To this end, well designed randomised controlled trials need to be conducted that examine the impact of rider training on crashes and offences. A randomised controlled trial is the preferred method as it would significantly reduce most biases described in this review. To minimise the impact of participants delaying or never attaining their licence and therefore exposure, as found in the randomised trials in this review, such a trial should include riders who are already licensed, and reliable measures of riding exposure in a reasonably lengthy follow up period. It is expected that a randomised controlled trial of sufficient sample size would observe equal balance on possible confounders by study arm, however an assessment of potentially important confounders (such as helmet wearing) by study group would enable control for these variables in the analyses if necessary. It is imperative that the effectiveness of each component of the rider training (such as theory, practice, knowledge, skills and modification of behaviour) and the synergy of such components are evaluated. Outcomes should be objective, ideally those that are routinely collected rather than self-reported outcomes. Even though riding the motorcycle poses different challenges and incurs different risks, lessons may be learned from research into the effects of car driver training.
Motorcycles are a common means of transport in low- and middle income countries and usage is increasing. As the burden of motorcycle crash victims is mostly borne in such countries, research should be focused on the effectiveness of types of rider training on the reduction of crashes, injuries and fatalities in such countries, and be supported by higher income countries. This review found only one study conducted in a middle income country that suggested decreasing injury rates. It would be beneficial to conduct additional research to confirm this suggestion and to enhance our knowledge of the role of rider training in low- and middle-income settings.
March 2006 saw the launch of the University of North Carolina Highway Safety Research Centre partnership with the Motorcycle Safety Foundation (MSF), and plans were revealed to conduct a study of the potential benefits of motorcycle rider training. The study is funded by the MSF and the National Highway Traffic Safety Administration (NHTSA). Called 'The Discovery Project', it will compare data on crash rates from riders participating in a basic motorcycle safety class with riders participating in a basic motorcycle safety class as well as a variety of continuing education classes. The collection of pilot data was due to start in March 2007 and the data collection portion of the study is expected to take three years (Highway Safety Research Center). It is vital that researchers and policy makers collaborate to develop further high quality evaluations of motorcycle rider training programmes to help inform development of new and effective training programmes.Get full text at The Cochrane Library
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