Safety education of pedestrian a systematic review

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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

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Road Deaths
World 1,391,000
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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

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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

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Results

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

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Methodological quality - generally poor (number
of included RCTs 15)

• adequate allocation concealment 3 RCTs
• blinding of outcome assessment 8 RCTs
• small study population (lt200) 10 RCTs
• large losses to follow up in many studies

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Included studies(number of included RCTs)

• conducted between 1976 to 1997
• Australia, Japan, Germany, UK, USA, Canada
• gt none in low middle income countries
• participants
• 14 children (3y to 13y)
• 1 adults (institutionalised)
• 0 elderly

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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

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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 (lt1 to 8
  mo)
• gt no meta-analysis

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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)

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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)

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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

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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

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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.

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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.