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Prevention of bicycle-related injuries in children and youth: a systematic review of bicycle skills training interventions
  1. Sarah A Richmond1,
  2. Yu Janice Zhang1,
  3. Andi Stover1,
  4. Andrew Howard1,2,3,4,
  5. Colin Macarthur1,5
  1. 1Department of Child Health Evaluative Sciences, Research Institute, Hospital For Sick Children, Toronto, Canada
  2. 2Division of Orthopaedic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
  3. 3Department of Surgery, University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  5. 5Department of Paediatrics, University of Toronto, Toronto, Canada
  1. Correspondence to Dr Sarah A Richmond, Department of Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8; sarah.richmond{at}


Background Bicycling is a popular means of recreation and transportation for children; however, it is a leading cause of recreational injury. Bicycle skill development and safety education are important methods of bicycle injury prevention.

Objective To determine the effectiveness of bicycle skills training programmes in reducing bicycle-related injuries in children and youth.

Methods Sixteen databases were systematically searched to include studies involving children less than 19 years of age who participated in interventions that targeted bicycle skills and safety education. Outcome measures included injury, behaviour, knowledge and attitudes. Data extraction included study characteristics, intervention and outcomes. Quality of evidence was assessed using the Downs and Black criteria.

Results Twenty-five studies, including both observational (ie, case–control) and experimental (ie, randomised controlled trials) designs met the inclusion criteria. Overall, there was no statistically significant intervention effect on measures of injury. Eight of 16 studies measuring knowledge reported significant knowledge gains as a result of the intervention. Of 13 studies evaluating behavioural and attitude changes, five reported significant improvement. There was no significant difference in quality index scores between studies that showed an improvement in knowledge or behaviour (61%, 95% CI 49% to 74%) and studies that did not (57%, 95% CI 48% to 66%).

Conclusions There is a paucity of high-quality research in the area of bicycle skills training programmes. Educational and skills training bicycling programmes may increase knowledge of cycling safety, but this does not seem to translate into a decrease in injury rate, or improved bicycle handling ability and attitudes.

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