title: Prevention of bicycle-related injuries in children and youth: a systematic review of bicycle skills training interventions.
abstract: 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.
authors.affiliation: Department of Child Health Evaluative Sciences, Research Institute, Hospital For Sick Children, Toronto, Canada.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Richmond
authors.affiliation: Department of Child Health Evaluative Sciences, Research Institute, Hospital For Sick Children, Toronto, Canada.
authors.forename: Yu Janice
authors.initials: YJ
authors.lastname: Zhang
authors.affiliation: Department of Child Health Evaluative Sciences, Research Institute, Hospital For Sick Children, Toronto, Canada.
authors.forename: Andi
authors.initials: A
authors.lastname: Stover
authors.affiliation: Department of Child Health Evaluative Sciences, Research Institute, Hospital For Sick Children, Toronto, Canada Division of Orthopaedic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada Department of Surgery, University of Toronto, Toronto, Ontario, Canada Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Howard
authors.affiliation: Department of Child Health Evaluative Sciences, Research Institute, Hospital For Sick Children, Toronto, Canada Department of Paediatrics, University of Toronto, Toronto, Canada.
authors.forename: Colin
authors.initials: C
authors.lastname: Macarthur
mesh_terms: D000056:Accident Prevention / Q000379:methods; D000063:Accidents, Traffic / Q000517:prevention & control*; D000293:Adolescent; D001642:Bicycling; D002648:Child; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D011930:Reaction Time; D018570:Risk Assessment; D012449:Safety; D014947:Wounds and Injuries / Q000453:epidemiology / Q000517:prevention & control*