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Safety education of pedestrian a systematic review

Safety education of pedestrian a systematic review. O. Duperrex, F. Bunn, I. Roberts Sources of support: Institut de m é decine sociale et préventive, Geneva, Switzerland Cochrane Injuries Grant, UK Medical Research Council, UK. Road Deaths. World 1,391,000.

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Safety education of pedestrian a systematic review

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  1. Safety education of pedestriana systematic review O. Duperrex, F. Bunn, I. Roberts Sources of support: Institut de médecine sociale et préventive, Geneva, Switzerland Cochrane Injuries Grant, UK Medical Research Council, UK

  2. Road Deaths World 1,391,000

  3. Global problem: vulnerable pedestrians • over 1 million road deaths per year • fatality rate per billion passenger km: • pedestrians: 78 • car passengers: 5 • pedestrian deaths per year: • 280,000 children • 210,000 elderly

  4. Law enforcement Environnement Education Driver deaths Pedestrian crashes Pedestrian injuries Pedestrian behaviour disabilities attitude knowledge

  5. This Cochrane systematic review • is the result of a comprehensive search • in 10 transportation, educational and medical electronic databases • in 7 languages • contacts with authors & experts in the field • included only randomised controlled trials aimed at modifying pedestrian behaviour

  6. Results • Total hits 13 899 • Elligible 674 (5%) • Excluded • cohort study 1 • controlled non randomised 35 • RCT 5 • Included 15

  7. Methodological quality - generally poor (number of included RCTs = 15) adequate allocation concealment: 3 RCTs blinding of outcome assessment: 8 RCTs small study population (<200): 10 RCTs large losses to follow up in many studies

  8. Included studies(number of included RCTs) • conducted between 1976 to 1997 • Australia, Japan, Germany, UK, USA, Canada => none in low & middle income countries • participants 14 children (3y to 13y) 1 adults (institutionalised) 0 elderly

  9. Interventions(number of included RCTs) 8 direct education 7 indirect education - parents or teachers variety of settings: home - classroom - traffic situation variety of media: verbal - printed material - film - multi-media kit table-top model - mock intersection concert

  10. Outcomes • main outcomes: none crashes - deaths - injuries - disabilities • surrogate outcomes 6 behaviour - 5 attitude - 6 knowledge • big diversity • in the tools used to measure outcomes • in the conditions under which they were used • in the delays for post-test measurements (<1 to 8 mo) => no meta-analysis

  11. Effect of pedestrian education on behaviour - selection (5-9y) • Stop & look at the line of vision RR 1.79 (1.18 to 2.72) • Stop at the line of vision when crossing between parked cars RR 1.73 (1.39 to 2.14) • ’Safe behaviour' RR 2.13 (1.01 to 4.47) • Post-test Transfer Score SMD 0.83 (0.31 to 1.35)

  12. Indirect education versus No education Behaviour (observed) of 5 to 7 yr olds - post-test at 1 to 3 months RR (95%CI random) Stop & look at line of vision no distraction distraction (competition) 0.1 0.2 1 5 10 Favours control Favours intervention

  13. The effect of the intervention was lower in the later follow up period • 18 of the 24 behavioural outcomes, • 2 of the 4 attitude outcomes and • the 2 knowledge outcome measures. (6 RCTs)

  14. Law enforcement • Left out: • elderly • LMIC Environnement Education Driver deaths Pedestrian crashes Pedestrian injuries Pedestrian behaviour disabilities attitude ?? Education of children knowledge

  15. limitations • combined strategies overlooked • publication & other selection biases minimised but not excluded • poor quality of included trials • no trial from LMIC • outcomes of interest not usually measured • variety of interventions and outcomes: difficult to summarise

  16. challenges • identification of relevant studies - indexes • access to databases • search too sensitive • obtaining papers • variety of interventions and outcomes: difficult to summarise • time management - keep motivation for a marathon

  17. Thanks • to Frances Bunn and Ian Roberts for their support and participation as co-reviewers, • to authors who kindly replied to my requests, • to Reinhard Wentz and Irene Kwan for help with database searching and obtaining papers, • to Angela Huertas, Maaike Kruseman, Valdo Pezzoli and Finn Johnsen for help with translation, • to Marjan Loep from the Dutch Cochrane Centre for help with the Dutch titles, • to Toshihiko Yanagawa for help with translation and contacting Japanese experts.

  18. Published as: • Duperrex O, Roberts I, Bunn F. Safety education of pedestrians for injury prevention (Cochrane Review). In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software. • Duperrex O., Bunn F. and Roberts I. Safety education of pedestrians for injury prevention: a systematic review of randomised controlled trials. BMJ. 2002 May 11; 324(7346):1129.

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