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Safety education of pedestrian a systematic review. O. Duperrex, F. Bunn, I. Roberts Sources of support: Institut de m é decine sociale et préventive, Geneva, Switzerland Cochrane Injuries Grant, UK Medical Research Council, UK. Road Deaths. World 1,391,000.

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safety education of pedestrian a systematic review

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

road deaths
Road Deaths

World 1,391,000

global problem vulnerable pedestrians
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
slide4

Law enforcement

Environnement

Education

Driver

deaths

Pedestrian

crashes

Pedestrian

injuries

Pedestrian

behaviour

disabilities

attitude

knowledge

this cochrane systematic review
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
results
Results
  • Total hits 13 899
  • Elligible 674 (5%)
  • Excluded
    • cohort study 1
    • controlled non randomised 35
    • RCT 5
  • Included 15
methodological quality generally poor number of included rcts 15
Methodological quality - generally poor (number of included RCTs = 15)

adequate allocation concealment: 3 RCTs

blinding of outcome assessment: 8 RCTs

small study population (<200): 10 RCTs

large losses to follow up in many studies

included studies number of included rcts
Included studies(number of included RCTs)
  • conducted between 1976 to 1997
  • Australia, Japan, Germany, UK, USA, Canada

=> none in low & middle income countries

  • participants

14 children (3y to 13y)

1 adults (institutionalised)

0 elderly

interventions number of included rcts
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

outcomes
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 (<1 to 8 mo)

=> no meta-analysis

effect of pedestrian education on behaviour selection 5 9y
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)

slide12

Indirect education versus No education

Behaviour (observed) of 5 to 7 yr olds - post-test at 1 to 3 months

RR (95%CI random)

Stop & look at line of vision

no distraction

distraction (competition)

0.1

0.2

1

5

10

Favours control

Favours intervention

the effect of the intervention was lower in the later follow up period
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)

slide14

Law enforcement

  • Left out:
  • elderly
  • LMIC

Environnement

Education

Driver

deaths

Pedestrian

crashes

Pedestrian

injuries

Pedestrian

behaviour

disabilities

attitude

??

Education

of children

knowledge

limitations
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
challenges
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
thanks
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.
published as
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.