title: A systematic review on the effectiveness of back protectors for motorcyclists.
abstract: BACKGROUND
  Motorcyclists are a vulnerable road-user population who are overrepresented in traffic injuries. Utilisation of back protectors may be an effective preventive measure for spine injuries in motorcyclists. Since use of back protectors is increasing it is important that clinical evidence supports their use. The study aimed to investigate the current evidence on the ability of back protectors to reduce the rate of back injuries and patient mortality in motorcycle crashes.
  
  
  METHODS
  A systematic literature search was conducted using various electronic databases. Systematic reviews, randomised controlled trials, controlled clinical trials, cohort studies, case series and case reports were included Opinion pieces and laboratory or biomechanical studies were excluded. Back protectors and spine protectors were included as the intervention; neck braces and speed humps were excluded. The target outcomes were any injuries to the back or death. Only English language studies were included.
  
  
  RESULTS
  The search strategy yielded 185 studies. After excluding 183 papers by title and abstract and full-text evaluation, only two small cross-sectional studies were included. Foam inserts in motorcycle jackets and non-standard clothing may possibly be associated with higher risk of injuries, while hard shell and standard back protectors may possibly be associated with a reduced rate of back and spinal injury.
  
  
  CONCLUSIONS
  This systematic review highlighted lack of appropriate evidence on efficacy of back protectors. Based on limited information, we are uncertain about the effects of back protectors on spinal injuries. Further research is required to substantiate the effects of back protectors on mortality and other injuries to the back.
authors.affiliation: South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, Australia.
authors.forename: Rafael
authors.initials: R
authors.lastname: Ekmejian
authors.affiliation: South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, Australia. pooria.sarrami@health.nsw.gov.au.|Institute of Trauma and Injury Management, New South Wales Agency for Clinical Innovation, Sydney, Australia. pooria.sarrami@health.nsw.gov.au.
authors.forename: Pooria
authors.initials: P
authors.lastname: Sarrami
authors.affiliation: South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, Australia.|South Western Sydney Local Health District, Liverpool Hospital, Liverpool, Australia.
authors.forename: Justine M
authors.initials: JM
authors.lastname: Naylor
authors.affiliation: South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, Australia.|South Western Sydney Local Health District, Liverpool Hospital, Liverpool, Australia.
authors.forename: Ian A
authors.initials: IA
authors.lastname: Harris
mesh_terms: D000063:Accidents, Traffic; D006801:Humans; D009049:Motorcycles; D011481:Protective Clothing; D013124:Spinal Injuries / Q000517:prevention & control*
keywords: Back protector; Motorbike; Motorcycle; Protective armour; Protective clothing; Spine protector