The recently published systematic review of the effectiveness of bicycle helmet legislation brings to a total of three published reviews on this topic in the Cochrane Database of Systematic Reviews:

1. Helmets for preventing head and facial injuries in bicyclists;¹

2. Non-legislative interventions for the promotion of cycle helmet wearing by children;² and

3. Bicycle helmet legislation for the uptake of helmet use and prevention of head injuries.³

Cycling is a cheap and efficient form of transport in many low and middle income countries, and is a common recreational activity in high income countries. With current concerns about global warming, the popularity of cycling, with both cardiovascular and environmental benefits, is likely to rise. However, bicycle-related head injury is a significant contributor to hospitalisations and death worldwide.

It seems intuitive that bicycle helmets would be an effective means of reducing head injury, and indeed helmet manufacturers and standards associations worldwide conduct rigorous tests to determine the impact absorption and other qualities of helmets. It is however, important to go beyond laboratory tests and understand whether helmets reduce injuries in the event of a crash in real-life; hence the review by Thompson et al.¹ This review included five well conducted …