kardamanidis et al (2010) - motorcycle rider training for the prevention of road traffic crashes

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Motorcycle rider training for the prevention of road traffic

crashes (Review)

Kardamanidis K Martiniuk A Ivers RQ Stevenson MR Thistlethwaite K

This is a reprint of a Cochrane review prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2010 Issue 10

httpwwwthecochranelibrarycom

Motorcycle rider training for the prevention of road traffic crashes (Review)

Copyright copy 2010 The Cochrane Collaboration Published by John Wiley amp Sons Ltd



T A B L E O F C O N T E N T S

1HEADER 1ABSTRACT

2PLAIN LANGUAGE SUMMARY

2BACKGROUND

3OBJECTIVES

3METHODS

11RESULTS

20DISCUSSION

23AUTHORSrsquo CONCLUSIONS

24ACKNOWLEDGEMENTS

24REFERENCES

29CHARACTERISTICS OF STUDIES

46DATA AND ANALYSES

46APPENDICES

46HISTORY

46CONTRIBUTIONS OF AUTHORS

47DECLARATIONS OF INTEREST

47SOURCES OF SUPPORT

47DIFFERENCES BETWEEN PROTOCOL AND REVIEW

47INDEX TERMS

iMotorcycle rider training for the prevention of road traffic crashes (Review)




[Intervention Review]

Motorcycle rider training for the prevention of road trafficcrashes

Katina Kardamanidis1 Alexandra Martiniuk 1 Rebecca Q Ivers1 Mark R Stevenson1 Katrina Thistlethwaite1

1The George Institute for Global Health Sydney Australia

Contact address Rebecca Q Ivers The George Institute for Global Health PO Box M201 Missenden Road Sydney NSW 2050

Australia riversgeorgeorgau

Editorial group Cochrane Injuries GroupPublication status and date New published in Issue 10 2010

Review content assessed as up-to-date 8 August 2010

Citation Kardamanidis K Martiniuk A Ivers RQ Stevenson MR Thistlethwaite K Motorcycle rider training for the

prevention of road traffic crashes Cochrane Database of Systematic Reviews 2010 Issue 10 Art No CD005240 DOI

10100214651858CD005240pub2


A B S T R A C T

Background

Riding a motorcycle (a two-wheeled vehicle that is powered by a motor and has no pedals) is associated with a high risk of fatal crashes

particularly in new riders Motorcycle rider training has therefore been suggested as an important means of reducing the number of

crashes and the severity of injuries

Objectives

To quantify the effectiveness of pre- and post-licence motorcycle rider training on the reduction of traffic offences traffic crash

involvement injuries and deaths of motorcycle riders

Search strategy

We searched the Cochrane Injuries Group Specialised Register CENTRAL (The Cochrane Library 2008 Issue 3) TRANSPORT

MEDLINE EMBASE CINAHL WHOLIS (World Health Organization Library Information System) PsycInfo LILACS (LatinAmerican and Caribbean Health Sciences) ISI Web of Science Social Sciences Citation Index (SSCI) ERIC ZETOC and SIGLE

Database searches covered all available dates up to October 2008 We also checked reference lists of relevant papers and contacted study

authors in an effort to identify published unpublished and ongoing trials related to motorcycle rider training

Selection criteria

We included all relevant intervention studies such as randomised and non-randomised controlled trials interrupted time-series and

observational studies such as cohort and case-control studies

Data collection and analysis

Two review authors independently analysed data about the study population study design and methods interventions and outcome

measures as well as data quality from each included study and compared the findings We resolved differences by discussion with a

third review author

1Motorcycle rider training for the prevention of road traffic crashes (Review)




Main results

We reviewed 23 studies three randomised trials two non-randomised trials 14 cohort studies and four case-control studies Five

examined mandatory pre-licence training 14 assessed non-mandatory training three of the case-control studies assessed lsquoanyrsquo type of

rider training and one case-control study assessed mandatory pre-licence training and non-mandatory training The types of assessed

rider training varied in duration and content

Most studies suffered from serious methodological weaknesses Most studies were non-randomised and controlled poorly for con-

founders Most studies also suffered from detection bias due to the poor use of outcome measurement tools such as the sole reliance

upon police records or self-reported data Small sample sizes and short follow-up time after training were also common

Authorsrsquo conclusions

Due to the poor quality of studies identified we were unable to draw any conclusions about the effectiveness of rider training on crash

injury or offence rates The findings suggest that mandatory pre-licence training may be an impediment to completing a motorcycle

licensing process possibly indirectly reducing crashes through a reduction in exposure It is not clear if training (or what type) reducesthe risk of crashes injuries or offences in motorcyclists and a best rider training practice can therefore not be recommended As some

type of rider training is likely to be necessary to teach motorcyclists to ride a motorcycle safely rigorous research is needed

P L A I N L A N G U A G E S U M M A R Y

Motorcycle rider training for preventing road traffic crashes

Riders of motorcycles (a two-wheeled vehicle that is powered by a motor and has no pedals - Oxford English Dictionary Online)

especially novice riders have an increased risk of being involved in fatal crashes compared to other road users Motorcycle rider training

could be an important way of reducing the number of crashes and the severity of injuries

The authors of this review examined all research studies that report an evaluation of the effectiveness of motorcycle rider coursesin reducing the number of traffic offences motorcycle rider crashes injuries and deaths This review included 23 research studies

including three randomised trials two non-randomised trials 14 cohort studies and four case-control studies The types of rider training

that were evaluated varied in content and duration The findings suggest that mandatory pre-licence training may present a barrier to

completing a motorcycle licensing process thus possibly indirectly reducing crash injury death and offence rates through a reduction

in exposure to riding a motorcycle However on the basis of the existing evidence it is not clear if (or what type of) training reduces

the risk of crashes injuries deaths or offences in motorcyclists and the selection of the best rider training practice can therefore not be

recommended

It is likely that some type of rider training is necessary to teach motorcyclists basic motorcycle handling techniques and to ride a

motorcycle safely It is therefore important that further research work be conducted to rigorously evaluate motorcycle rider training

courses particularly in low income countries where the main burden of motorcycle injuries and deaths occur

B A C K G R O U N D

Each year anestimated 12million peopleare killedin road crashes

worldwide and an additional 50 million people are injured Of

these deaths 85 occur in low-income and middle-income coun-

tries It has been predicted that between the year 2000 and 2020

without increased efforts the number of road traffic deaths in

high-income countries will decrease by approximately 30 yet

in low- and middle-income countries the number is expected to

increase by over 80 (Kopits 2003 Peden 2004) Road traffic

injuries are likely to become the third leading cause of a global

burden of disease and injury by 2020 if further action is not taken

(Peden 2004)

Riding a motorcycle (a two-wheeled vehicle that is powered by a

motor and has no pedals - Oxford English Dictionary Online) is

associated with a higher risk of fatalities compared with driving a

car (Leung 1983 Bjornstig 1985 Radin Umar 1995 Tsai 1995

FORS 1999 Yuan 2000 Johnston 2008) In Australia motorcy-





clesaccounted for45 of allAustralian passenger vehicle registra-

tions and 09 of vehicle kilometres travelled in 2007 Howevermotorcycle riders accounted for approximately 15 of all road

crash deaths and an even higher proportion of serious injuries

Per distance travelled the Australian rate of motorcyclist deaths

was approximately 30 times the rate for car occupants The cor-

responding rate for a serious injury was approximately 41 times

higher Similar elevated rates were also found in other developed

countries (Johnston 2008) In low and middle-income countries

the motorcycle is one of the most frequently used means of trans-

port and consequently motorcyclists constitute a large proportion

of road crash victims (Mohan 2002)

The lack of experience of many motorcycle riders has been cited

as one potential cause of motorcycle crashes (Winn 1987 Mullin1997) Training of motorcycle riders has therefore been suggested

as an important countermeasure for reducing both the number of

crashes and the severity of injury (Vis 1995 Noordzij 2001)

Pre-licence motorcycle rider trainingcourses have been made com-

pulsory in several countries (Mullin 1997) Pre-licence training

courses are aimed at providing motorcycle riders with the skills

and knowledge needed to improve control of the motorcycle and

to identify and avoid critical situations in traffic (Elliot 2003)

Many pre-licence motorcycle rider training courses are aimed at

novice riders and in many jurisdictions in high-income countries

such as Australia the USA and Canada the completion of such

courses is a mandatory requirement of licensing

Post-licence rider training is not linked with licensing and such

training is generally not compulsory It usually focuses on riding

skills and other topics that have not been covered or dealt with

sufficiently in pre-licence rider training Post-licence rider train-

ing is used to reinforce fundamental skills and knowledge or to

provide some training for motorcyclists who are self-taught and

have never received formal training (Anderson 1980)

Estimates of the number of motorcyclists attending post-licence

rider training are not readily available but existing data suggest

such courses are not well attended although attendance varies by

country In the USA 24 of the total number of motorcyclists

trained in 1988 and 1989 attended an experienced rider course

(Weaver 1990)

The aim of this systematic review is to quantify the effectiveness

of pre-and post-licence rider training for motorcycle riders in re-

ducing traffic offences road traffic crash involvement injury and

death

O B J E C T I V E S

To quantify the effectiveness of pre- and post-licence motorcycle

rider training on the reduction of traffic offences traffic crash


M E T H O D S

Criteria for considering studies for this review

Types of studies

All relevant intervention studies such as randomised and non-ran-

domised controlled trials and interrupted time series studies and

observational studies including cohort and case-control studies

Types of participants

Motorcyclists and riders of mopeds or motor scooters of all ages

Types of interventions

Motorcycle ridertraining (pre-or post-licence mandatory or non-

mandatory) versus no training

One form of pre-licence rider training versus another form (eg

on-road off-road theory or a combination)

One form of post-licence rider training versus another form (eg


Types of outcome measures

Offences crashes injuries and death

Search methods for identification of studies

We did not restrict the searches by date language or publication

status

Electronic searches

We searched the following electronic databases

bull Cochrane Injuries Group Specialised Register (searched 22

Sept 2008)

bull CENTRAL (The Cochrane Library 2008 Issue 3)bull TRANSPORT 1988 to 200706 (latest date available)

bull ATRI Australian Transport Index (to Sept 2008)

bull MEDLINE (Ovid SP) 1950 to Sept 2008

bull EMBASE (Ovid SP) 1980 to Sept 2008

bull CINAHL (EBSCO) 1982 to Sept 2008

bull WHOLIS (World Health Organization Library

Information System) (to Sept 2008)

bull PsycINFO (Ovid SP) 1806 to Sept 2008

bull LILACS (BIREME) (Latin American and Caribbean

Health Sciences) (1982 to Sept 2008)

bull ISI Web of Science Social Sciences Citation Index (SSCI)

1970 to Sept 2008







Table 1 Risk of selection bias (Continued)

Osga 1980 Differences at baseline reported on sex and age

Confounding factors were not dealt with in univariate analysis Riding exposure was accounted for in the

cumulative survival analysis

Selection intervention group were all training participants on the register and the control group were

respondents to a diverse range of recruitment strategies

Satten 1980 Differences at baseline reported on age sex helmet use riding experience and exposure and previous

training

Confounding factors were not dealt with in design or analysis

Selection intervention group was selected from a list of training graduates and the control group was

partly selected from a state register of motorcyclists

Jonah 1982 Differences at baseline reported on age sex riding experience time licensed previous training and alcohol

use

Confounding factors were dealt with through multivariate analysis


randomly selected from the Ontario motorcycle operator file

Mortimer 1984 Differences reported at baseline on age licence status riding experience years licensed and helmet use

Confounding factors age years licensed and rider experience were dealt with through stratification and

riding exposure through standardisation

Selection intervention group was selected from a list of training enrolees and the control group was

selected from motorcycle dealerships during three successive Saturdays

Cooper 1988 Differences reported at baseline on age gender licensure and highway experience

Confounding factors age gender riding exposure rider characteristics rider attitudes and behaviour were

accounted for in a multivariate analysis

Selection there was no information on how the intervention and control groups were selected and from

where

Mortimer 1988 Differences reported at baseline on years licensed riding experience and helmet use


standardisation of riding exposure A regression analysis was also conducted but poorly reported and not

usable


selected from motorcycle dealerships

Adams 1985 Differences at baseline reported on previous crash rates

Confounding factors not controlled for in analysis

Selection the intervention group was a non-random sample of those offered training within the Australia

Post motorcycle delivery riders the control group were the remaining Post riders

Leung 1987 Differences at baseline reported on age and sex

Confounding factors age and sex controlled for in analysis by stratification

Selection those exposed to training were MRC graduates those unexposed were taken from the licensing

records






McDavid 1989 Differences at baseline other than matched characteristics were not reported

Confounding factors age ownership of car licence years licensed previous crashesand offences accounted

for through matching Other confounding effects not controlled


selected from Bureau of Motor Vehicle records

Kloeden 1994 Differences at baseline reported were in geographical area of residence and in riding exposure

Confounding factors were accounted for through exclusion of participants from rural areas

Other confounding factors were not reported

Selection the Ridersafe course was phased in based on postcode of riderrsquos home address analyses were

based on a database of those who obtained motorcycle rider learnerrsquos permits of which about 2000 were

Ridersafe riders and about 5000 were control riders

Billheimer 1998 Differences at baseline reported on age and previous riding experience

Other potential confounding factors assessed were riding exposure primary purpose of riding and helmet

use

Confounding factors accounted for by matching (age sex primary purpose of riding) standardisation

(riding exposure) and stratification (previous riding experience)

Selection the intervention group were those who had taken the rider training programme the control

group were California motorcycle riders matched on the above variables but who had not taken a riding

course

Perrino 2002 Differences at baseline reported were a higher number of females in the trained group and a higher

proportion of experienced riders in the untrained group

Confounding factors were not accounted for in the analysis

Selection the intervention group were those who had done the Motorcycle Riding Course the control

group had not done the course Both groups were identified through a register of licensed motorcyclists

Kraus 1975 Population based case-control study

Cases all motorcycle riders with a confirmed medically treated motorcycle injury (including fatalities)

from all hospitals in study base and peripheral area hospitals and all deaths due to motorcycle crashes in

the study base All serious injuries (leading to hospitalisation) and fatalities likely to be included

Community controls a random sample of registered motorcycle owners in the study base

Potential confounders assessed were age sex weight height riding experience motorcycle use charac-

teristics of motorcycle and previous crashes and offences

Confounding factors were accounted for through exclusion of females and stratification by age and

motorcycle useSelection cases and controls drawn from the same population

Hurt 1981 Population based case-control study

Cases and controls not drawn from the same population

Cases motorcycle riders who had a motorcycle crash Not all reported cases included

Community controls motorcycle riders who passed the crash site at the same time of day and day of week

that the crash occurred but 2 years later

Potential confounders assessed were age sex time type of motorcycle roadway alignment helmet use

weather conditions road surface conditions

Confounding factors were accounted for through matching for time of day and day of week that crash

occurred and stratification

Selection cases were recruited from police reports not all cases were included controls were matched






community controls from randomly selected sites matched for same time of dayday of week as the crash

occurred

Haworth 1997 Population based case-control study

Cases and controls drawn from the same population

Cases motorcycle riders or pillion riders with an injury from a motorcycle crash from hospital and police

records Not clear whether all cases were included

Community controls motorcycle rider or pillion who passed the crash site at the same time of day and

day of week that the crash occurred

Potential confounders assessed were rider factors age marital status licence status riding experience

and exposure alcohol and drugs use of protective gear including helmet use pillion factors motorcycle

factors trip factorsConfounding factors were accounted for through matching for time of day and day of week that crash

occurred and stratification for age blood alcohol level and licence status

Selectioncases were riders or pillions involved in on-road crash recruited from hospitals and police records

not sure if all cases were included controls were matched community controls who passed the crash site

at the same time of dayday of week as the crash

Savolainen 2007 Differences at baseline reported on sex safety helmet use riding ability riding experience and licence

status

Adjusted for these confounders through statistical modelling although exact process unclear

Selection intervention group from list of trainees control group from Indiana Bureau of Motor Vehicles

database Trainees and the control group were invited to participate in surveys

Davis 1997 Differences at baseline not reported but likely No adjustment for any confounders at baseline or during analysis

Selection intervention group from list of riders involved in crashes who were also on a list of training

graduates control group from the same list of riders involved in crashes who were not also on a list of

training graduates

Waller 1992 Differences at baseline not reported but likely

Adjusted for confounders through exclusion of riders younger than 18 years riders without a motorcycle

operator driver license riders with location of residence outside of the Texas metropolitan areas of Austin

through matching by age sex and location of residence through stratification by age and sex and through

standardisation (number of crashes by person-days at risk)

Selection intervention group from the Motorcycle Operator Training class roster (number of trained

riders that the sample was selected from is unclear) control group through a random number generator

generating driver license numbers until an equal sample size was selected as the intervention group

MAIDS 2004 Population based case-control study

Unclear whether cases and controls not drawn from the same population

Cases motorcycle riders who had a motorcycle crash Unclear whether all cases included

Community controls motorcycle riders recruited at petrol stations Unclear whether and how matched

to cases

No potential confounders were reported

There was no report of whether and how potentially confounding factors were accounted for in the study





Table 2 Risk of allocation bias

Anderson 1980 Allocation concealment unclear

Hall 1988 Allocation concealment unclear

Swaddiwudhipong 1998 Allocation concealment unclear

Table 3 Risk of detection bias

Anderson 1980 Blinding of outcome assessors not reported

Driver records holding police recorded crashes and offences not validated

Hall 1988 Blinding of outcome assessors not reported


Swaddiwudhipong 1998 Blinding of outcome assessors not reported

Police and hospital records Post mortem examination for deaths not validated

Adams 1985 Blinding of outcome assessors not reported

Australia Post crash records not validated but argued that underreporting is unlikely

Leung 1987 Blinding of outcome assessors not reported

Driver records holding police recorded crashes and offences

Raymond 1979 Blinding of outcome assessors not reported

Self-report through personal interviews or questionnaires - both methods validated

Osga 1980 Blinding of outcome assessors not reported

Self-report through structured questionnaires validated by cross-checking with police

recorded crash records

Satten 1980 Blinding of outcome assessors not reported

Self-report through structured interviews or questionnaires - both methods were not

validated

Intervention group were given telephone interviews but the control group mailed ques-

tionnaires

Jonah 1982 Blinding of outcome assessors not reported

Self-report through structured interviews not validated Driver records holding police

recorded crashes and offences

Mortimer 1984 Blinding of outcome assessors not reported

Self-report through questionnaires not validated

Intervention group received mailed questionnaires but the control group received ques-

tionnaires personally at the motorcycle dealership

Cooper 1988 Blinding of outcome assessors not reported






Table 3 Risk of detection bias (Continued)





McDavid 1989 Blinding of outcome assessors not reported


Kloeden 1994 Blinding of outcome assessors not reported


Billheimer 1998 Blinding of outcome assessors not reported

Police recorded crashes and offences

Perrino 2002 Blinding of outcome assessors not reported

Self-report through mailed out questionnaires police records not validated

Kraus 1975 Blinding of intervention assessors to case or control status not reported

Intervention measured police records self-report though questionnaires not validated

Length of follow up not specified

Hurt 1981 Blinding of intervention assessors to case or control status not reported

Intervention measured face-to-face in-depth interviews (ie no structured question-

naires) Validity and reliability of data ensured by reported high level of quality controlLength of follow up not specified

Haworth 1997 Blinding of intervention assessors to case or control status not reported

Intervention measured self-report either by personal or by telephone interview for

both cases and controls not validated

Length of follow up in the 2 years prior to the interview or more than 2 years ago

Savolainen 2007 Blinding of outcome assessors not reported

Source of outcome data not reported

Length of follow up up to 5 years

Davis 1997 Blinding of outcome assessors not reported

Source of outcome data police records

Length of follow up 1 year

Waller 1992 Blinding of outcome assessors not reported

Source of outcome data Department of Public Safety driver history file and official

accident reports

Length of follow up 3 years

MAIDS 2004 Blinding of intervention assessors to case or control status not reported


naires) No report on whether and how validity and reliability of data was ensured






Table 4 Risk of attrition bias

Anderson 1980 Percentage of participants in analysis 99 forthe total group Unclear forintervention andcontrol groups

separately

Hall 1988 Percentage of participants in analysis 96-97 forall intervention groups and 98for the control group

Swaddiwudhipong 1998 Percentage of participating sub-districts in analysis 100 for both intervention and control sub-districts

Raymond 1979 Percentage of participants in analysis 74 for the intervention group and less than 57 for the control

group

Osga 1980 Percentage of participants in analysis 73 for the intervention group and 100 for the control group

Satten 1980 Percentage of participants in analysis is unknown Initial sample size is unclear

Jonah 1982 Percentage of participants in analysis 23 for the intervention group and 45 for the control group

Mortimer 1984 Percentage of participants in analysis 35 for the intervention group and 84 for the control group

Cooper 1988 Percentage of participants in analysis 98 for the total group Unclear for intervention and control

groups separately

Mortimer 1988 Percentage of participants in analysis 40 for the intervention group and 90 in the control group

Adams 1985 Percentage of participants in analysis 61 forthe total group Unclear forintervention andcontrol groups

separately

Leung 1987 Percentage of participants in analysis unclear because initial sample size was not reported

McDavid 1989 Percentage of participants in analysis 40 of final matched cohort

Kloeden 1994 Percentage of participants in analysis 39 for the intervention group and 6 for the control group

Billheimer 1998 Percentage of participants in analysis unclear percentage of the initial sample size

Perrino 2002 Percentage of participants in analysis unclear percentage of the initial sample size

Kraus 1975 Percentage of participants in analysis 58 of cases 59 of controls

Hurt 1981 Percentage of participants in analysis 18 of cases lt 29 of controls

Haworth 1997 Percentage of participants in analysis 70 of cases 47 of controls

Savolainen 2007 Percentage of participants in analysis 18 for the intervention group and 15 for the control group

Davis 1997 Percentage of participants in analysis 100 for the intervention group and unclear for the control group





Table 4 Risk of attrition bias (Continued)

Waller 1992 Percentage of participants in analysis unclear percentage for the intervention group and 100 for the

control group

MAIDS 2004 Percentrage of participants in analysis unclear for both cases and controls

R E S U L T S

Description of studies

See Characteristicsof included studies Characteristics of excluded

studies Characteristics of ongoing studies

Our search resulted in 102 studies that seemed relevant of which

we excluded 79 studies because they did not meet the criteria for

considering studies for this review (see Characteristics of excluded

studies)

Basedon ourcriteriawe includeda total of 23 studies in this review

There were three randomised trials (Anderson 1980 Hall 1988

Swaddiwudhipong 1998) two non-randomised trials (Adams

1985 Leung 1987) 14 cohort studies (Raymond 1979 Osga

1980 Satten 1980 Jonah 1982 Mortimer 1984 Cooper 1988

Mortimer 1988 McDavid 1989 Waller 1992 Kloeden 1994

Davis 1997 Billheimer 1998 Perrino 2002 Savolainen 2007)

and four case-control studies (Kraus 1975 Hurt 1981 Haworth

1997 MAIDS 2004)

Over half of the studies were conducted 20 or more years

ago and the oldest was conducted 31 years ago Only three

studies were from this decade (Perrino 2002 MAIDS 2004

Savolainen 2007) Over 60 of the studies were conducted in

the USA (Kraus 1975 Anderson 1980 Osga 1980 Satten 1980

Hurt 1981 Mortimer 1984 Leung 1987 Hall 1988 Mortimer

1988 Waller 1992 Davis 1997 Billheimer 1998 Perrino 2002

Savolainen2007) three inAustralia (Adams 1985 Haworth 1997

Kloeden 1994) three in Canada (Jonah 1982 Cooper 1988

McDavid 1989) onefromthe United Kingdom (Raymond 1979)one from Europe (with sampling areas located in France Ger-

many Netherlands Spain and Italy) (MAIDS 2004) and one

in Thailand (Swaddiwudhipong 1998) Only seven studies were

published in peer reviewed journals (Kraus 1975 Jonah 1982

Mortimer 1984 Cooper 1988 Mortimer 1988 McDavid 1989

Swaddiwudhipong 1998) The other studies were reports forhigh-

way safety and road traffic organisations

The studies by Anderson 1980 Hall 1988 Kloeden 1994

Billheimer 1998 (the basic California Motorcyclist Safety Program

component of the study) and Perrino 2002 examined manda-

tory pre-licence training Cooper 1988 McDavid 1989 and

Swaddiwudhipong 1998 assessed non-mandatory training that

when passed resulted in a licence Raymond 1979 Osga 1980

Satten 1980 Jonah 1982 Mortimer 1984 Adams 1985 Leung

1987 Mortimer 1988 Waller 1992 Davis 1997 Billheimer 1998

(the Experienced Rider Course component of the study) andSavolainen 2007 assessed non-mandatory training that could be

taken by motorcycle riders with and without a licence The case-

control studies (Kraus 1975 Hurt 1981 Haworth 1997) assessed

lsquoanyrsquo type of rider training and therefore could not be grouped by

pre- or post-licence rider training The MAIDS 2004 case-control

study did make a distinction between participants having received

compulsory pre-licence training or additional (non-compulsory)

training We did not find a study that compared one form of pre-

or post-licence training (eg on-road off-road theory or a com-

bination) versus another form of training All studies compared

eithermandatory or non-mandatory formal training versus no for-

mal training with the exception of Haworth 1997 who compared

different levels of training courses (beginner intermediate and ad-vanced)

We have presented a more detailed description of the individual

studies in Characteristics of included studies We have provided

a description below of the types of motorcycle rider training that

were evaluated in the included studies

Types of motorcycle rider training evaluated in the

studies

The types of training were varied Duration of training ranged

from two or three hours to 24 hours administered over two or

three days Most training consisted of a theoretical and a practical

component usually off-road The content ranged from provid-ing riders with manuals lectures discussions showing films and

administering knowledge and skill tests Little information was

provided about the qualifications of trainers who conducted the

training

Six studies (Osga 1980 Satten 1980 Mortimer 1984 Mortimer

1988 Waller 1992 Savolainen 2007) assessed the effectiveness of

the USA-based Motorcycle Safety Foundationrsquos Motorcycle Rider

Course (MSF MRC) This course was released in 1976 It com-

prises eight hours of theory (lectures discussions films and multi-

plechoice tests) a textbook and 12 hours of off-road practice The

Motorcycle Safety Foundation is a national not-for-profit organ-





isation sponsored by manufacturers and distributors of motorcy-

cles Many USA states have adopted the MSF Basic Rider Courseand Experienced Rider Course (wwwmsf-usaorg) since its release

in 1976

The Motorcycle Operators Skill Test was also developed

by the USA Motorcycle Safety Foundation in coopera-

tion with others (httpwwwwebbikeworldcommotorcycle-

trainingmotorcycle-test) The MOST is a licensing test consist-

ing of a manual knowledge and skill test (comprising eight exer-

cises of increasing difficulty and skill requirements) and a mini-

skill test conducted with a simulator Some studies compared this

alternative licensing test to the standard licensing test However

as the MOST is not a type of rider training we have included only

the two studies that assessed the MOST in combination with one

or more training components in this review Both Anderson 1980and Hall 1988 assessed the MOST in combination with a train-

ing component of three hoursrsquo duration consisting of instructions

about the skills needed to pass the MOST (30 minutes of the-

ory and two and a half hours on the motorcycle) Hall 1988 also

assessed the MOST in combination with the Motorcycle Safety

Foundationrsquos Motorcycle Rider Course as described above

Other USA studies evaluated the Wisconsin motorcycle rider

course a 22-hour off-street programme that teachesthe basic rules

of safe motorcycling (Leung 1987) the USA Maryland Motorcy-

cle Rider Course (MRC) a mandatory (for those younger than 18

years)pre-licence 20-hour coursecomprising eight hours of theory

and12 hours of practice and created by the Maryland Motor Vehi-

cle Administration in 1985 (Perrino 2002) the California Motor-cyclist Safety Program (CMSP) a mandatory (for those younger

than 18 years) pre-licence 16-hour basic course (Billheimer 1998)

and Experienced Rider Course (ERC) of eight hoursrsquo duration

(Billheimer 1998) The CMSP still offers these courses ( http

wwwca-msporg) but they are now MSF courses as described

above Davis 1997 did not give any information about the assessed

rider training

The Canadian studies evaluated the British Colombia Safety

Councilrsquos 37-hour motorcycle safety programme (no further in-

formation on the content was provided) (McDavid 1989) and

the Canada Safety Council Motorcycle Training Program (MTP)

comprising four hours of theory and 16 hours of practice (six

hours on-road) over twoweekends (Jonah 1982) The MTPcoursewas made available in 1974 and is still being offered in Canada

(httpwwwsafety-councilorgtrainingmtpmtphtm) Cooper

1988 did not give any information about the assessed rider train-

ing However the study was conducted in British Colombia in

Canada in 1988 the same time as the McDavid 1989 study was

conducted

In the United Kingdom Raymond 1979 assessed the non-manda-

tory RACACU (Royal Automobile ClubAuto-Cycle Union)

training scheme The training programme consisted of either 24

one-hour sessions or 13 two-hour sessions Twelve hours of the

training focused on theory about basic operational procedures

traffic laws and highway codes The practical session focused on

basic operational skills riding on a training area and riding in traf-fic with an instructor A proficiency test was administered at the

end of the course

One study from rural Thailand (Swaddiwudhipong 1998) evalu-

ated a community-based rider education programme consisting of

theory on motorcycle injury risk helmet use traffic laws vehicle

regulations and traffic signs and a written and skill test leading to

a licence

TheAustralian studies evaluateda rider trainingcourse of 12 hours

over two consecutive days (four hours of theory and eight hours of

practice)administeredto AustraliaPosttelegram deliverers(Adams

1985) and a mandatory pre-licence Ridersafe course consisting

of two tiers the first tier being a training course on the basics

of motorcycle riding where a pass entitled the rider to obtain alearnerrsquos permit and the second tier being a skill test where a pass

entitled the riderto obtain a probationary motorcycle licence The

training course consisted of two four-hour training sessions on

separate days involving instruction videos and actual riding on

motorcycles The skill test consisted of a four-hour preparation

course of 74 minutes of lecturediscussion 38 minutes of video

and 75 minutes of on-course riding which was the testing phase

(Kloeden 1994) The Rider Safe course is still being provided by

Transport South Australia a state government organisation (http

wwwtransportsagovau )

The duration or content of rider training in the four case-control

studies (Kraus 1975 Hurt 1981 Haworth 1997 MAIDS 2004)

was not described

Risk of bias in included studies

We describe the methodological quality of the included studies

by study type below More detailed information can be found in

Table 1 Table 2 Table 3 and Table 4

When considering the findings from these studies it is important

to note the quality (or lack thereof) of reporting of the studies

Quality of reporting is the extent to which a report provides in-

formation about the design conduct and analysis of a study ( Juumlni2001) Huwiler-Muumlntener 2002 found that even though trials

may be well reported it does not mean that the methodological

quality is of equal standard and well-conducted trials may never-

theless be reported badly The reporting quality of most studies in

this review was poor Most studies were old and did not meet con-

temporary reporting standards This made data extraction com-

plicated It also made it difficult to contact authors for additional

information

Because of significant heterogeneity between studies as well as the

poor quality of most studiespooling of studyresults to calculatean

overall measure of effect was not appropriate Instead we provided

a description of our judgement of risk of bias in the text





Risk of bias in the randomised trials

There were three randomised trials (Anderson 1980 Hall 1988Swaddiwudhipong 1998) Anderson 1980 and Hall 1988 had an

initial sample size of 41188 and 26464 motorcycle licence ap-

plicants respectively Both studies assessed the effectiveness of the

pre-licence MOST with a trainingcomponent Swaddiwudhipong

1998 evaluated the effectiveness of a community-based rider ed-

ucation programme in six districts

Allocation bias

Anderson 1980 reported using random birth date tables to allocate

participants to either the intervention or control group Hall 1988

reported the use of a computerised algorithm set in a central of-

fice but also used manual random assignment when the computer

went down Swaddiwudhipong 1998 reported lsquosimple random

samplingrsquo for the delivery of the intervention where the sampling

frame included nine districts Three districts were excluded since

they were too hard to access The remaining six districts were ran-

domly allocated to the intervention (three) and the control (three)

groups Systematic sampling wasthen used ordered by village size

for the villages within districts Allocation concealment was not

reported in any of the studies The descriptions of randomisation

in these studies suggest that there may have been limitations to

the process resulting in a lack of equivalence of the intervention

and control groups at baseline and therefore the possibility of

allocation bias Swaddiwudhipong 1998 reported that before theintervention the annual incidence rate of motorcycle-related in-

juries was slightly (but not statistically significant) higher in the

intervention areas than in the control areas Participants in the

intervention districts were also more likely to have a valid licence

and to wear a helmet more often than participants in the control

districts Anderson 1980 measured differences at baseline on the

participant and prior driving record variables and found these to

be negligible Hall 1988 did not report on baseline differences

between the intervention and control groups As the Anderson

1980 and Hall 1988 studies had sample sizes of over 40000 and

26000 respectively and used some form of randomisation it is

likely that any confounding factors at baseline would have been

equally distributed between comparison and intervention groups

Selection bias

After randomisation Anderson 1980 and Hall 1988 excluded

08 and 3 participants respectively because of assignment to

the wrong group administration of the wrong intervention or

other reasons The resulting lack of analysis by rsquointention-to-treatrsquo

can introduce biasby removing the effectivenessof randomisation

Nonetheless the percentage excluded was small and the number

of overall participants large so it is unlikely to have had a major

effect on the final results In the Swaddiwudhipong 1998 study

villages were systematically sampled into intervention or control

groups The intervention was implemented and outcomes of in-

jury and death were measured at a community level Interventionand control districts were randomly selected however there were

only three intervention and three control communities

Detection bias

None of the randomised trials reported blinding of outcome as-

sessors Data collection tools used by Anderson 1980 and Hall

1988 were driver records holding police recorded crashes and of-

fences Swaddiwudhipong 1998 used police and hospital records

at a district level and post-mortem examination for deaths None

reported on validity or reliability for any of the instruments

Attrition bias

Anderson 1980 and Hall 1988 had driver records available for

96 to 100 of participants They also collected self-reported

data but the response rate to the questionnaires was very low (low-

est response rate 42 and 30 respectively) Attrition bias in

Swaddiwudhipong 1998 was not an issue as outcome data were

available for all sub-districts included in the trial

The intervention reported in Anderson 1980 and Hall 1988 tri-

als had an unanticipated effect on the participants In both trials

an average of only 28 of licence applicants in the intervention

group eventually obtained their licence compared to 35 in the

control group This indicates that the licensing process in generalseems to have deterred applicants from obtaining a licence and

although no statistical tests of the difference were conducted this

deterrence appears even greater for those who had rider training

This is not true attrition bias as the studies did not experience

differential loss to follow up from outcome measurement Instead

differential attainment of the intermediary step of licensure pre-

cluded participants from being at risk for the outcomes of interest

they are not driving a motorcycle hence they are not at risk for

motorcycle-related crashes injury death or offences In short it is

not possible to assess whether a reduction in crashes in the inter-

vention group would be due to changes in riding habits as a result

of training or simply due to delayed or never attained licensure

Intervention integrity

Neither Anderson 1980 nor Hall 1988 reported on the consis-

tency in the way the intervention was administered the possible

lsquocontaminationrsquo of participants in the intervention group by other

types of formal or informal rider training or of participants in the

control group by the intervention Swaddiwudhipong 1998 did

not report on the number of villagers in each group that actually

attended the intervention However they did report on a number

of other potential training courses that were being implemented

at the same time





Analysis

Anderson 1980 and Hall 1988 acknowledging the lsquodeterrent ef-fectrsquo described above conducted two separate analyses The first

analysis included the total study population of licence applicants

over two years from the time of their application (the population

denominator) The second analysis was performed on the licensed

(intervention and control) subgroups only two years from the

time of obtaining their licence (the licensed rider denominator)

As only a third were licensed and exposed to riding the motorcy-

cle it was impossible to determine whether reported differences

in crash rates across groups were due to the intervention or to

other lsquoconfoundingrsquo characteristics of those who were determined

in their efforts to obtain the licence When analysis was restricted

only to those who gained their licence the same difficulties re-

mained The benefits of the randomisation process were thus lost

due to this lack of licensure of riders during the process As there

were only three intervention and three control groups in the study

reported by Swaddiwudhipong 1998 analyses were hindered by

smallnumbers for outcome comparisons betweenthe intervention

and the control districts

Risk of bias in the cohort studies and non-randomised

trials

We discuss the methodological quality of cohort studies (seven

prospective studies (Raymond 1979 McDavid 1989 Waller 1992

Kloeden 1994 Billheimer 1998 Perrino 2002 Savolainen 2007)and seven retrospective studies (Osga 1980 Satten 1980 Jonah

1982 Mortimer 1984 Cooper 1988 Mortimer 1988 Davis

1997)) and non-randomised trials (Adams 1985 Leung 1987) in

the one section as the biases for the two study types are similar

The quality of these studies was in general poor

Selection bias

The confounding factors expected to have been addressed in the

studies were sex age riding experience prior driving records (of-

fences crashes) previous training and the following proxies for

risk taking behaviour helmet use speed and alcoholdrug use All

of these factors have been shown to be associated with an increasedrisk of motorcycle crash (Peden 2004 Zambon 2006) The pos-

sible source of bias in cohort studies and non-randomised trials

is that groups may differ on important characteristics at baseline

participants lsquoself-selectrsquo into either the rider training group by de-

ciding to undertake a rider training course or into the lsquocontrol

grouprsquo by deciding not to undertake a course Participants who

undertake a non-mandatory rider training course may differ from

those who choose not to on characteristics such as age sex rid-

ing experience and riding behaviour as well as other possible con-

founders For example riders who take a training course may be

more safety-conscious or on the contrary may do so because they

have previously experienced a crash or because they perceive that

they have poor riding skills Therefore ideally all participants in

the intervention group need to be included in the study as wellas a random sample of controls taken from the same population

as the intervention group If that is not possible intervention and

control groups either need to be carefully matched to make them

comparable or differences at baseline need to be adjusted for in

the analysis

Most of the studies using a non-randomised trial or cohort design

compared an intervention group to a control group that differed

on a number of important factors The studies in general failed to

adjust for important differences found at baseline and their results

cannot be meaningfully interpreted Ten studies (Raymond 1979

Osga 1980 Satten 1980 Jonah 1982 Mortimer 1984 Mortimer

1988 McDavid 1989 Waller 1992 Davis 1997 Savolainen 2007)

assessed intervention and control groups that were not drawnfrom the same population In most of these cases the intervention

group was selected from a list of training graduates who were usu-

ally young female and less experienced riders whereas controls

were recruited from a general population of motorcycle riders who

were usually older male and experienced riders For three stud-

ies it was unclear how they were selected (Leung 1987 Cooper

1988 Perrino 2002) Only Kloeden 1994 recruited groups from

the same population of motorcycle applicants and Adams 1985

from a group of professional riders Nevertheless due to non-ran-

dom selection of intervention and control groups differences at

baseline are likely even though study groups were from the same

population Three studies adjusted for some confounding fac-

tors found at baseline through matching (McDavid 1989 Waller1992 Billheimer 1998) However matching has limitations in

termsof controlling for multiple confounders especially those that

are unknown to influence the effect of rider training on the out-

comes One study matched the control and intervention groups

by excluding controls (approximately 3500 (66 of initial con-

trol group) that differed from the intervention group) (Kloeden

1994) Five studies (Osga 1980 Satten 1980 Adams 1985 Davis

1997 Perrino 2002) did not adjust for differences between study

groups at baseline either in the study design or analysis Results

from these studies are therefore not reliable The other six stud-

ies (Raymond 1979 Jonah 1982 Mortimer 1984 Cooper 1988

Mortimer 1988 Leung 1987 McDavid 1989 Billheimer 1998)

adjusted for some differences between groups at baseline by eitherbi-variate or multi-variate analyses or stratification and standardi-

sation of riding exposure (outcomemiles driven) or stratification

by age group The limitation of stratification is that it is difficult to

control for many variables simultaneously because a large number

of strata will need to be generated resulting in small numbers that

cannot be meaningfully analysed Savolainen 2007 developed sta-

tistical models to assess the probability of a crash after taking the

rider training course in an intervention and control group while

examining differences by sub-groups (eg age) Participation rates

were also very low in this study with only 5584000 (1395)

in the eligible intervention group and 5884000 (147) for the





control group completing surveys

Detection bias

None of the studies reported blinding of outcome assessors to the

intervention or control status of the participants Seven studies

used driver records containing police recorded data as their main

measure of outcome (Leung 1987 Cooper 1988 McDavid 1989

Waller 1992 Kloeden 1994 Davis 1997 Billheimer 1998) An-

other four studies (Raymond 1979 Satten 1980 Mortimer 1984

Mortimer 1988) only used self-report Raymond 1979 was the

only study using self-report as the main outcome measurement in

which study instruments were validated Self-report might prevent

the underreporting that has been described for the use of police-

driver records (see rsquoRisk of biasrsquo in the randomised trials above)but has other risks of bias especially if questionnaires or inter-

view methods have not been validated and tested for reliability

Recall bias arises from mistakes in recollecting events both be-

cause of failures of memory and because of looking at things lsquowith

hindsightrsquo and possibly changed views (httpwwwcochraneorg

resourcesglossaryhtm) As many studies were retrospective risk

of recall bias is likely and may have increased with length of follow

up For studies that used self-reported outcomes only it is also

possible that social desirability response bias played a role where

participants in the training group may have felt it was lsquoexpectedrsquo

to report good driving histories Multiple methods to measure the

same outcome for both groups decreases the risk of detection bias

for example because self-reported answers can be cross checkedwith other sources of information such as driver records

In this regard three studies (Osga 1980 Jonah 1982 Perrino

2002) used both self-report and driver records Osga 1980 found

that for both intervention and control groups more crashes were

reported through self-report than on state crash records an aver-

age of 54 of self-reported crashes could be found back on state

crash records One industry-based study (Adams 1985) used oc-

cupational health records which were not validated but which are

unlikely to suffer from underreporting due to work cover claims

Savolainen 2007 used information on rider crashes for a five-year

period but did not specify from where this information was ob-

tained

Attrition bias

The majority of studies (Raymond 1979 Satten 1980 Adams

1985 Leung 1987 Kloeden 1994 Davis 1997 Billheimer 1998

Perrino 2002) inadequately reported on losses of participants to

the study We can therefore not be certain that there were no sys-

tematic differences in the characteristics between the intervention

and control group participants Savolainen 2007 reported the re-

sponse rates to their baseline survey but did not report on the per-

centage of outcome data that was available for their study sample

A similar deterrent effect of rider training as described for the ran-

domised trials (Anderson 1980 Hall 1988) occurred in two stud-

ies Jonah 1982 reported that 65(14992310) of the trained rid-

ers stopped riding compared to 47 (9492029) of the untrainedriders They excluded non-active and non-licensed riders before

the study commenced so the differential choice to continue riding

after training did not affect their analyses Leung 1987 reported

that the percentage of participants in the intervention group ob-

taining their licence was 50 (no number provided by authors)

lower than in the control group This may have biased the mea-

surement of outcomes because unlicensed participants will not be

exposed to riding the motorcycle and therefore not be at risk of

being involved in a crash or violation As explained above this

makes it difficult to assess whether the reduction in crashes in the

intervention group is due to a change in driving habits or simply

due to delayed licensure

Mortimer 1984 and Mortimer 1988 describe that about 44 and30 of course graduates respectively were excluded from analysis

because they had not ridden a motorcycle in the previous year

However because these studies were retrospective and the controls

were activeriders at the time of recruitment a decision on whether

the deterrent effect was differential between the two groups could

not be made Though not reported quantitatively Kloeden 1994

also describes the effectof rider training deterringindividuals from

becoming licensed and hence exposure to riding and risk of crash

death or offences involving a motorcycle Osga 1980 reported

that 27 of the trained riders did not ride after the course and

excluded these from the analysis

Use of different data collection strategies may have contributed to

differential loss to follow up in the cohort studies Satten 1980for example interviewed the intervention group over the tele-

phone but mailed questionnaires to the control group Mortimer

1984 and Mortimer 1988 distributed questionnaires in person to

the control group but mailed them to the intervention group

This may have played a role in the observed differential response

rates where more subjects responded in the personally approached

groups

Survival bias

For those studies that assessed offences crashes and injuries but

not death survival bias may have also played a role Motorcyclists

who were fatally or seriously injured in crashes during the follow-

up period after the intervention would have been less likely or

unable to respond to surveys This could bias the effect measures

towards or away from the null None of the studies wrote about

this issue or examined the characteristics of those lost to follow up

in order to address the possibility of survival bias


Although the interventions were intended for the entire lsquoexposedrsquo

groups most studies reported difficulty in tracking participants

whoreceivedthe interventionand those whodid not Adams 1985





estimatedthat 62of thetotalstudysample received the interven-

tion The remaining studies did not report the percentage of thestudy population that received the intervention as was intended

or reported that this percentage was unknown (Raymond 1979

Kloeden 1994 Satten 1980 Jonah 1982 Mortimer 1984 Leung

1987 Cooper 1988 Mortimer 1988 Billheimer 1998 Perrino

2002 Savolainen 2007) Only Raymond 1979 reported the degree

to which their intervention was delivered as intended No studies

reported on possible lsquocontaminationrsquo of participants by other inter-

ventions than the one to which they were allocated Because Osga


Mortimer 1988 Waller 1992 and Davis 1997 were retrospective

studies and participants were recruited from a list of graduates it

was known that they had completed and passed the course

Analysis

In some studies some participants who reported at baseline that

they were untrained decided to enroll in a rider training pro-

gramme after the baseline survey The non-randomised trial by

Adams 1985 experienced this move of subjects from the untrained

to the trained group but failed to conduct analyses by lsquointention-

to-treatrsquo This can bias the results in randomised and non-ran-

domised trials if participants who changed groups differ signifi-

cantly with regard to potentially confounding characteristics On

the other hand Perrino 2002 also experienced this move of sub-

jects from theuntrained to the trained groupmore than 100riders(5 of the total sample) originally stated that they were untrained

at baseline but then received training between the baseline and

follow-up surveys Yet since the Perrino 2002 study was a cohort

their analyses then proceeded by including those riders who were

lsquonewlyrsquo trained as exposed Riders who were lsquonewlyrsquo trained since

baseline but with a programme other than the one under study

were excluded from the analysis Nevertheless confounding fac-

tors were not accounted for in the analyses

McDavid 1989 matched exposed with unexposed subjects but

could not find suitable matches for the majority (60) of their

subjects They could therefore only conduct analysis on the result-

ing40 (139346) which is an inappropriate andinefficient anal-

ysis Some studies that reported on the issue of non-active licensedriders(Satten 1980 Jonah 1982 Mortimer 1984 Mortimer 1988

Kloeden 1994) excluded non-active riders from analysis intro-

ducing selection bias as it is likely that riders who continued to

ride differed with regards to potentially confounding character-

istics across intervention and control groups Kloeden 1994 for

example conducted several analyses to assess the effect of various

sub-sets of the control group Original analyses included all con-

trols and led to erroneous results since only a small proportion of

controls hadgone on to get a licence after their learnerrsquos permitand

were actually exposed to the possibility of experiencing a crash

Subsequent analyses compared only intervention and control sub-

jects who had a licence Waller 1992 reported crashes by person-

days of exposure but did not explain how they could be sure that

each study intervention and control participant was an active riderand actually exposed to the risk of experiencing a crash

Potential confounders that are unequally distributed by study arm

at baseline need to be dealt with in the analysis Satten 1980

Adams 1985 and Davis 1997 did not take into account any con-

founding factors either by design or in the analysis McDavid

1989 Waller 1992 and Billheimer 1998 accounted for potential

confounding factors at the design stage by matching the subjects

in the intervention and control groups Other studies (Raymond

1979 Mortimer 1984 Mortimer 1988 Perrino 2002 and also

Waller 1992) adjusted for one or two confounders by stratifica-

tionor standardisation (eg crashesmiles driven age group) Osga

1980 conducteda univariate analysis of crash rates in which no po-

tential confounders were accounted for but also calculated cumu-lative crash rates by mileage travelled Only Jonah 1982 Cooper

1988 and Savolainen 2007 conducted a multivariate analysis

Risk of bias in the case-control studies

A case-control design is suitable for the assessment of risk fac-

tors for outcomes such as motorcycle crashes injuries or deaths

but not appropriate for the evaluation of an intervention such

as motorcycle rider training It can potentially result in spurious

conclusions regarding the efficacy of the intervention because the

intervention has not been applied at random to an intervention

and control group Even with the control of possible confounders

using a case-control design to evaluate an intervention can lead tothese kinds of results since those who choose to undertake rider

training may differ on important prognostic factors that affect the

outcome compared to those who do not choose to participate in

rider training

Selection bias

A potential source of bias in case-control studies as with all other

study types where the intervention is not randomly allocated to

participants is that comparison groups are likely to differ on po-

tentially confounding characteristics This means that ideally all

cases need to be included in the study as well as a random sample

of controls taken from the population that gave rise to the cases If that is not possible cases and controls either need to be carefully

matched to make themcomparable or differences at baseline need

to be adjusted for in the analysis All four case-control studies were

population based Kraus 1975 included all fatalities and injured

cases leading to hospitalisation and appropriately recruited a ran-

dom sample of controls from the same population Hurt 1981 did

not manage to recruit all or a random sample of cases Only half

of the notifications of crashes to the police were received in time

by the researchers the research team for unreported reasons was

only able to respond to half of those again Data collection was

therefore completed for only about a fifth of all cases Neverthe-

less this was still a large sample of 900 cases Haworth 1997 using





a similar study design was more likely to have included all cases

but this is not entirely clear from the study reported It is unclearfor example whether fatalities were included as they did not use

coronerrsquos reports for the recruitment of cases The MAIDS 2004

study was conducted in five European countries but it was unclear

how cases were recruited whether they were all cases during the

two years that the study lasted or a random sample of all cases

what the response rates were etc Controls were recruited from

randomly selected petrol stations but it was likewise not clear what

the eligibility criteria for inclusion in the study were how they

were recruited (eg randomly) and what the response rate was

Hurt 1981 and Haworth 1997 both matched controls to cases by

recruiting themat the sametime ofdayandsamedayof weekas the

crash occurred Hurt 1981 however recruited controls two years

later andit is likelythat there would have beendifferences betweenthe two comparison groups One important difference was that

during data collection for cases there was very little specialised

motorcycletrainingavailable in the studyregionwhereas two years

later when control data were collected there was some training

available

These four case-control studies also suffered from selection bias

due to potential differences between those that gave consent to

participate in the study and responded to interviews andquestion-

naires and those that did not None of the studies have assessed

such differences although Hurt 1981 did acknowledge that con-

trols giving consent to cooperate may have differed from those

motorcyclists who did not

Detection bias

Measures that can be taken to reduce detection bias in case-con-

trol studies are blinding of interviewers for case or control status

blinding of the participant for the study factor of interest validat-

ing measurement instruments and using these in an identical way

for cases and controls and cross checking self-reported informa-

tion with other more objective sources such as registers None of

the studies reported blinding of the intervention assessors to case

or control status but all used consistent measurement methods for

both case and control groups

All case-control studies used self-report as their main measure toassess whether cases and controls had received rider training and

if so the type of training The major potential source of bias in

case-control studies when self-report is used as a measure is recall

bias One way of reducing recall bias is by double-checking self-

reported data with more objective data Kraus 1975 also used po-

lice accident reports for information on rider characteristics but

such information was not available about rider training Haworth

1997 and MAIDS 2004 did not report on any measures to limit

recall bias Hurt 1981 reported further questioning of cases by

the interviewer when answers did not make sense or when par-

ticipants seemed to contradict themselves as part of the in-depth

unstructured interview technique This qualitative research tech-

nique can result in valuable information but as interviewers were

not blinded to case or control status of the participants it may have led to more thorough examination of cases compared to the

controls and thus differential detection bias


The level of detail about the rider training provided in the case-

control studies differed significantly but was minimal for each

Kraus 1975 simply asked whether lsquoanyrsquo motorcycle rider training

had lsquoeverrsquo been carried out Hurt 1981 asked participants whether

they hadbeen self taught informally taught or completed formally

taught rider training courses MAIDS 2004 asked whether partic-

ipants had had pre-license training additional (non-compulsory)

training other training or no training whereas Haworth 1997asked about the number of courses that a participant had com-

pleted whetherthey were basic intermediate or advanced courses

and how long ago the training had been done None of the case-

control studies reported collecting information about further de-

tails about any training programmes (eg type of training cur-

riculum duration of training)

Analysis

Kraus 1975 accounted for confounding factors through the exclu-

sion of females and stratification by age and frequency of motor-

cycle use Hurt 1981 matched cases and controls for time of day

and day of the week that the crash occurred and did not adjust forany confounding factors in the analysis Haworth 1997 matched

groups for time of day and day of the week that the crash occurred

and stratified by age blood alcohol level and licence status in the

analysis None of the studies used multivariate methods MAIDS

2004 did not provide any information about any participant char-

acteristics other than the study exposures of interest and did not

describe any methods to adjust for potential confounding factors

Effects of interventions

We have presented the results in a descriptive manner due to the

substantial heterogeneity in study types interventions and out-comes and the generally poor quality of the studies We have

grouped the interventions by mandatory and non-mandatory pre-

licence rider training and post-licence rider training and further

by study type and by outcome (crashes injurious and fatal crashes

and offences) We discuss results that are reported as statistically

significant (whether a P value was reported or not)

Pre-licence rider training - mandatory

Randomised trials





Crashes

Total group of participants

Anderson 1980 found a reduction in motorcycle crash rates in

the intervention group (MOST skill test with remedial training)

compared to the control group (who received the skill testwithout

a training component) The percent differenceranged from 143

six months after the programme (P lt 005) to 211 (P lt 0001)

after one year and 127 (P lt 001) after two years Hall 1988

found no statistically significant difference in crash rates between

intervention groups at any point in time

Subgroup of participants who obtained their licence only

Anderson 1980 found a reduction in motorcycle crash rates in the

intervention arm but this was statistically significant at one year

only (24 to 218 reduction P lt 005) Hall 1988 found no

statistically significant differences

Offences


The percentage of offences in Anderson 1980 after six months

and one and two years was slightly higher in the intervention

arm compared to the control group but these differences were

not statistically significant Likewise the study by Hall 1988 did

not find a statistically significant difference in offences between

groups


Hall 1988 found no significant difference in offence rates between

the intervention and control groups Anderson 1980 found thatthe percentage of offences increased in the intervention arms com-

pared to the control group This difference was statistically signif-

icant after two years (51 to 115 increase P lt 005)

Cohort studies

Crashes

Neitherof the cohort studies (Kloeden1994 and Billheimer1998)

found a statistically significant difference in crash rates between

the intervention and control groups

Offences

Billheimer 1998 (for the California Motorcyclist Safety Program

course) and Perrino 2002 did not find a statistically significant

difference in offence rates between the intervention and control

groups

Case-control studies

Crashes

MAIDS 2004 found that a slightly higher percentage of controls

(not involved in a crash) had had pre-license rider training than

cases (involved in a crash) This difference was not statistically significant (50 of controls vs 477 of cases OR 091 95 CI

076 to 110)

Pre-licence rider training - non-mandatory

Randomised trial

Injuries and deaths

Swaddiwudhipong 1998 found a significantly lower injury ratein the intervention villages (1051000 population 95 CI 92

to 120) compared to the control villages (1691000 population

95 CI 152 to 185) one year after the intervention This differ-

ence was not maintained two years after the intervention (127

95 CI 112 to 143 intervention 151 95 CI 135 to 167

control) There was no significant difference in death rates be-

tween groups

Cohort studies

Crashes

Cooper 1988 foundno statistically significant differencein crashes

between the intervention and control groups McDavid 1989

found a lower crash rate in the intervention group (14139) com-

pared to the control group (23139) but no test of statistical sig-

nificance was undertaken

Injuries and deaths

McDavid 1989 found that the intervention group had fewer in-

jurious crashes (814 crashes) compared to the control group (16

23 crashes) but no statistical significance test was reported





Offences

Cooper 1988 foundno statistically significantdifference in offencerates between the intervention and control groups McDavid 1989

foundno statistically significantdifference in offence ratesbetween


Non-mandatory rider training

Non-randomised trials

Crashes

Neither Adams 1985 nor Leung 1987 found a statistically signif-icant effect of rider training on crash rates

Offences

Leung 1987 found a statistically significant lower offence rate in

the intervention group compared to the control group for both

males and females and for all age groups except for women 35

years or older (P values not reported)

Cohort studies

Crashes

Osga 1980 in the univariate analysis reported a lower percentage

of crashesin theintervention group (that continued to ride) (28

168595) than in the control group (34 112329) In the cu-

mulative crash rate analysis however Osga1980 found statistically

significant (at the P lt 001 level) higher crash rates in the interven-

tion group than in the control group at allmileage intervals (1000

to 29999 miles) travelled After riding more than 30000 miles

(when over 50 of the trained riders had been involved in a crash

compared to approximately 40 in untrained riders) this differ-

ence was no longer statistically significant Satten 1980 found a

lower percentage of crashes in the intervention group (13 969)

compared to the control group (25 2079) but the differencewas not assessed statistically Davis 1997 found a lower crash rate

in trained riders but it was unclear how this was calculated be-

cause the size of the control group was not reported Jonah 1982

and Billheimer 1998 (for the Experienced Rider Course) found no

statistically significant difference in crashes between the interven-

tion and control groups Although the difference between those

who completed the Experienced Rider Course and no course in

Billheimer 1998 neared significance at six months after the course

(P = 007) large P values were observed for one year after (P =

030) Raymond 1979 found a statistically significant higher crash

rate for the intervention group (1861000 miles ridden) com-

pared to the control group (1181000 miles ridden) in both males

and females (P lt 0001) especially during the first 5000 miles of

riding Waller 1992 found a statistically significant higher crashrate for the intervention group (27 crashes in three years or 070

crashes10000 person days) compared to the control group (5

crashes in three years or 013 crashes10000 person days) with a

crude relative risk of 538 (X 2=1513 plt005) Mortimer 1984

and Mortimer 1988 found no statistically significant difference in

crashes between the intervention and control groups

Savolainen 2007 found that the intervention group (those who

completed the Basic Rider Course) was 44 more likely to be

involved in crashes than the control group and those who com-

pleted the course multiple times were an additional 180 more

likely to be involved in a crash This finding was based on low

numbers and no P value or confidence level was given for either

result

Injuries and deaths

Satten 1980 also found a lower percentage of injurious crashes

(33 39) in the intervention group compared to the control

group(60 1220) although again no statistical significance test

was reported

Offences

Jonah 1982 did find a significantly lower self-reportedoffence rate

in the intervention group (15) compared to the control group(34 P lt 001) (no numbers given) Satten 1980 also found

a lower self-reported offence rate in the intervention group (1

71 versus 19100) but again this was not tested for statistical

significance Mortimer 1984 Mortimer1988 and Billheimer 1998

found no statistically significant differencein offence ratesbetween



CrashesMAIDS 2004 found that a slightly higher percentage of cases

(involved in a crash) had had additional non-mandatory rider

training than controls (not involved in a crash) This difference

was not statistically significant (17 of cases vs 12 of controls

OR 146 95 CI 064 to 337)

Rider training unspecified






Injuries and deaths

Hurt 1981 found that the odds of injurious crashes were lower inthose who had received professional training compared to those

who had not Kraus 1975 found that in the younger age group

(less than 20 years) and the older age group (over 35 years) a larger

percentage of injured riders (12 and 21 respectively) reported

prior motorcycle rider training compared with the uninjured con-

trol group (6 and 5 respectively) (P lt 001) (no numbers

given) Haworth 1997 reported several different outcomes one

beingthat having completed at leastone trainingcoursecompared

to no training courses at all had no significant effect on the odds

of crashing (afteradjustment for age blood alcohol level or licence

status (learner permitprobationaryfull)) When comparing three

different levels of training courses (beginner intermediate and ad-

vanced) with no training no significant differences were found

in the odds of crashing However after adjustment for age and

blood alcohol level completing an advanced course as compared

to a beginners course was associated with a significant decrease in

the odds of severe motorcycle crashes resulting in serious injury or

death (OR 02 95 CI 01 to 08)

D I S C U S S I O N

The objective of this review was to quantify the effectiveness of

pre- andpost-licence motorcycle rider training on the reduction of

traffic crash involvement injuries deaths and offences committedby motorcycle riders Most included studies were cohort studies

There were a few randomised and non-randomised trials and case-

control studies

All studies compared either mandatory or non-mandatory formal

training with no formal training except for Haworth 1997rsquos case-

control study that compared levels of training (beginner interme-

diate and advanced) to each other

We found studies that evaluated the effectiveness of manda-

tory pre-licence training in reducing crash and offence rates

(Anderson 1980 Hall 1988 Kloeden 1994 Billheimer 1998

(the basic California Motorcyclist Safety Program component of

the study) Perrino 2002) non-mandatory training that when

passed resulted in a licence (Cooper 1988 McDavid 1989

Swaddiwudhipong 1998) non-mandatory training that could be

taken by motorcycle riders with or without a licence (Raymond

1979 Osga 1980 Satten 1980 Jonah 1982 Mortimer 1984

Adams 1985 Leung 1987 Mortimer 1988 Waller 1992 Davis

1997 Billheimer 1998 (the Experienced Rider Course compo-

nent of the study)) and unspecified rider training on crash injury

and death rates (Kraus 1975 Hurt 1981 Haworth 1997 MAIDS

2004)

The studies provided conflicting evidence regarding motorcycle

rider training which is likely due to the poor design quality and

reporting of the studies Most of the studies included in the review

were likely to be adversely affected by significant selection biasalong with substantial detection bias(measurement and recall bias)

which limits our ability to make conclusive comments

Mandatory pre-licence rider training

There were two RCTs three cohort studies and one case-control

study that examined pre-licence ridertraining The two RCTs eval-

uated the Motorcycle Skills Operating Test (MOST) (Anderson

1980 Hall 1988) Anderson 1980 found a statistically significant

reduction in crashes in the intervention group at six months one

and twoyearsfollow up However when only participantswho ob-

tainedtheirlicence were included in theanalysis thereduction wasstatistically significant only at one year follow up The other RCT

(Hall 1988) found no statistically significant differences in crash

rates at any point of time neither in the total population group

nor in the licensed subgroup Neither of the two cohort stud-

ies assessing crash rates found a statistically significant difference

in crash rates between intervention and control groups ( Kloeden

1994 Billheimer1998) andthe case-control study (MAIDS 2004)

also did not find a statistically significant difference in the odds of

experiencing a crash between trained and untrained riders With

regards to offences neither of the RCTs found a statistically sig-

nificant difference in offence rate between the intervention and

control groups in the analysis of the total group of participants

entering the trial However Anderson 1980 found a statistically significant increase in offence rates in the intervention group but

only after two years of follow up andonly in the analysis of partici-

pants who obtained their licence The two cohort studies assessing

offence rates found no statistically significant difference between

the groups (Billheimer 1998 Perrino 2002)

None of the five studies (RCTs or cohort) found a reduction in

crashes or offences following mandatory pre-licence rider training

except for Anderson 1980 who observed a statistically significant

reduction in crashes in the intervention group at one year in both

analyses It is not clear why both RCTs that evaluated the same

MOST and training intervention observed different results Both

studies enrolled large samples and observed a similar uptake of

licensure following the intervention It is possible that differencesmay have arisen due to different study samples (California ver-

sus New York) or that the intervention delivery differed between

studies

In both trials of the Motorcycle Skills Operating Test including

rider training only a third of motorcycle licence applicants ob-

tained their motorcycle licence It is possible that a licensing pro-

cess including a skills test may reduce crashes through decreased

exposure

Non-mandatory pre-licence training





Three studies assessed the effect of non-mandatory pre-licence

training The Cooper 1988 cohort study found no difference incrash or offence rates between the trained and untrained groups

We cannot however be confident about this result as the study

sufferedfrom selectionbiaswhichcouldhave biasedthe measure of

effect toward the null The RCT conducted by Swaddiwudhipong

1998 examined injury and death rates and found a statistically

significant lower injury rate in the intervention villages after one

year of follow up but no longer at two year follow up There

was no statistically significant difference in death rates between

intervention and control villages Our confidence in the results of

this study are hindered by the inadequacy of the randomisation

process that led to significant differences between the intervention

and control districts on two important variables The intervention

districts were more likely than the control districts to have a validlicence andto wear a helmetSincethese differences were nottaken

into account in later analyses they could explain the differences

observed in injury rates between districts Furthermore with only

six districts randomised the sample size was probably too small

to detect a difference between intervention and control groups

had there been one The McDavid 1989 cohort study found a

lower percentage of injuries in the intervention group although

a statistical test was not conducted McDavid 1989 drew their

intervention and control groups from different populations but

did adjust for confounders although they only analysed 40 of

the initial sample (139 trained and 139 untrained) Because of

these substantial weaknesses we are unable to draw conclusions

from this studyAn overall effect of pre-licence training on the reductionof crashes

injuries deaths and offences was not found although one should

be aware that the research of this issue to date has had significant

flaws However a mandatory skill test (such as the MOST) in

combination with and even without pre-licence training as part

of a licensing process seems to reduce the number of individuals

completing the licensing procedure and therefore indirectly re-

duces crash rates through a reduction in exposure to motorcycle

riding Making licensure a more difficult process may therefore be

seen as advantageous if it delays licensure and therefore reduces

exposure It is possible that the group who chose not to continue

riding a motorcycle would not have been the group to experience a

crash or commit an offence if they had continued to ride anyhowfor example because they are more safety conscious and this was

the reason for their giving up riding in the first place If this is the

case deterring individuals from completing their licence and rid-

ing may not necessarily decrease overall crashes deaths or offence

rates In addition other potentially adverse effects of complicat-

ing a licensing procedure need to be considered such as increases

in unlicensed riding In Thailand non-mandatory rider training

offered as a community intervention may have decreased injury

rates but this needs to be confirmed through further research

Non-mandatory training

The majority of the studies assessed non-mandatory training

(training independent of any licensing procedure) and the results

were varied The two non-randomised trials assessing crash rates found no statistically significant difference in crash rates between

the intervention and control groups (Adams 1985 Leung 1987)

Of the nine cohort studies Satten 1980 found a lower percentage

of crashesin the intervention group although it is unclear whether

this was a statistically significant result Davis 1997 also found a

lower percentage of crashesin theinterventiongroup although it is

unclear with which control group the intervention group wascom-

pared Raymond 1979 Osga 1980 Waller 1992 and Savolainen

2007 found a statistically significant higher crash rate in the in-

tervention group and the remaining cohort studies (Jonah 1982

Mortimer 1984 Mortimer 1988 Billheimer 1998) found no sta-

tistically significant difference in crash rates between intervention

and control groups No conclusions can be drawn from these stud-

ies with confidence The Satten 1980 and Davis 1997 studies did

not adjust for any confounding factors even though important

differences existed between the intervention and control groups

Although Raymond 1979 and Waller 1992 adjusted for a num-

ber of confounders at baseline (Waller 1992) and in the analy-

sis (Raymond 1979 Waller 1992) the intervention and control

groups were drawn from such different populations that it is pos-

sible that unmeasured confounders were responsible for the sta-

tistically significant increased risk of crashes observed in the inter-

vention group The observed difference could also be attributed totheobserved differential loss to followup (Raymond 1979) which

could bias the measure of effect towards or away from the null

The Osga 1980 study found a protective effect of rider training

in the univariate analysis but statistically significant higher crash

rates in the intervention group when accounting for riding expo-

sure Sex (a significantly higher proportion of females in the in-

tervention group) and other potentially confounding factors that

could explain thedifferencebetween the groups were howeverun-

accounted for Finally Savolainen 2007 did control for potential

confounding variables yet it is not clear whether variables were

controlled for simultaneously or one at a time One case-control

study (MAIDS 2004) found no statistically significant reduction

in the odds of experiencing a crash between trained and untrainedriders but the quality of this study was poor mainly because the

analysis did not account for any confounding factors

One cohort study (Satten 1980) assessed the effect of non-manda-

tory rider training on injurious crashes and found a lower percent-

age of injuries in the intervention group although a statistical test

was not conducted As mentioned above the Satten 1980 studyrsquos

validity is reduced due to its lack of adjustment for confounding

factors

The only non-randomised trial that assessed offence rates (Leung

1987) found a statistically significant lower offence rate in the in-

tervention group and of the five cohort studies that assessed of-

fence rates (Satten 1980 Jonah 1982 Mortimer 1984 Mortimer





1988) one study (Jonah 1982) also found a statistically significant

lower offence rate in the intervention group However we have lit-tle confidence in the results from Leung 1987 since potential con-

founding factors were not appropriately addressed Jonah 1982

did conduct a multivariate analysis but was hindered by an initial

low response rate The other four cohort studies did control for

several potential confounders and found no difference in offence

rates following non-mandatory post-licence rider training

The non-randomised trials and cohort studies evaluating non-

mandatory rider training were at high risk of substantial selection

bias due to the non-random allocation of participants as well

as low participation rates and attrition bias and could therefore

not provide conclusive evidence with regard to the effect of the

training It should be noted that despite the biases and other issues

with this group of studies most didnot detectmajor effects relatedto rider training in either direction This may suggest that any

potential impact of rider training will be modest

Studies examining unspecified modes of ridertraining

Three case-control studies assessed whether injured or deceased

motorcyclists were more or less likely to have had rider training

compared to control motorcyclists All had conflicting results

Hurt1981 foundthe odds of havingan injuriouscrash waslower in

those who had received rider training whereas Kraus 1975 found

that the odds of having an injurious crash were higher in youngerand older trained riders Haworth 1997 who compared advanced

versus beginner training found no effect on motorcycle injuries

or deaths although they did find that those who had completed

advanced training had reduced chances of crashing compared to

those who had done a beginnersrsquo training course Similar issues

with uncontrolled confounding and biases of selection as described

above arose with the three case-control studies Hurt 1981 suffers

from inadequate control of confounding via poor matching and

both the Kraus 1975 and the Haworth 1997 findings were only

controlled for limited factors by means of stratified analysis It is

likely that these limitations are the reason for the contradictory

directions of effect observed for the three case-control studies

Methodological weaknesses of the studies

In summary most studies investigating the effectiveness of mo-

torcycle rider training on reducing crashes injuries and death suf-

fered from serious methodological weaknesses

The majority of studies were non-randomised and were there-

fore limited mainly by selection bias Although the approaches of

matching stratification or regression analyses can minimise bias

(Fleiss 2004) they were poorly employed in the reviewed studies

The inadequate adjustment for confounders in particular adds

to our lack of confidence in the studiesrsquo results since it has been

demonstrated that individuals who choose to take motorcycle rider

training differ from those not taking rider training For instance

trained riders often differ from controls in age sex and experi-ence usually ride less and may have a more positive attitude to

safety as indicated by the reported more frequent wearing of seat

belts (Mortimer 1982)

The two large randomised trials reported that a large proportion

of their study group were never exposed to the risk of offences or

crashes because they never attained licensure This made it impos-

sible to assess whether a reduction in crashes in the intervention

group was a result of training or due to delayed or never attained

licensure

In some studies the sample sizes were too small to detect any sta-

tistically significant differences Follow-up time after training dif-

fered between studies and was an impediment to observing any

real effects of training if they existed As riding experience ac-cumulates over time any differences in outcomes between those

trained and untrained would diminish in studies with lengthy fol-

low-up times This dilution of any possible effect of rider training

may have also occurred in studies that mixed both novice and ex-

perienced riders in the study groups since it is hypothesised that

novice riders serve to benefit most from rider training This would

increase the difficulty in finding any effect of rider training par-

ticularly when sample sizes are small

Detection bias may also account for some of the differences ob-

served between trained and untrained riders Detection bias would

have occurred if the self-report hospital driver or police records

used to record the outcomes of crash injury death or offences

differed between the trained and untrained riders Research hasdemonstrated that not all crashes are reported to police for ex-

ample small crashes or off-road crashes (Kraus 1975) even serious

injury crashes have been found to be underreported (Anderson

1980) However this would only introduce detection bias if the

reporting of outcome differs for trained and untrained riders This

does appear possible in that responsible riders may be more likely

to enroll in a rider training course and also may be more likely

to report crashes to police than irresponsible riders meaning that

the number of crashes from riskier riders could be underrepre-

sented on records An analysis to investigate the effectiveness of

rider training may then show that rider training is not effective in

reducing crashes

Rather than using reported outcomes some studies used self-re-ported survey data although this technique suffers from non-

response biases In fact two studies reported differences in de-

mographic characteristics in response rates to questionnaires

(Anderson 1980 Hall 1988) Self-reported data also introduce

the risk of recall bias survival bias and social desirability response

bias Recall bias may have been equally distributed among trained

and untrained riders howeverit is hypothesised that trained riders

may have felt it was lsquoexpectedrsquo to report good driving histories

hence leading the rider training to appear effective





Limitations of this review

Limitations of this review were that we found very few recentstudies (the two most recent ones published in 2002 and 2007)

and that we found very few studies conducted in low-and middle

income countries even though our search strategy was set up to

identify such studies Anotherlimitation wasthat forthe reviewed

studies we could not assess all outcomes of rider training that are

potentially useful Some of the included studies assessed outcomes

such as use of safety clothing including helmets Such outcomes

are valuable since the use of motorcycle helmets has been demon-

strated to be effective in preventing head injuries (Liu 2004) De-

spite this the use of safety clothing was not included as an out-

come in this review because the studies measuring this outcome

were limited by poor data quality due to very low response rates

Another outcome of interest in assessing the effectiveness of rider

training is lsquotype of injuryrsquo As Haworth 2005 state in their review

of motorcycle licensing and training rider training could be con-

sidered effective if injuries become less severe because motorcycle

riders have learned how to avoid more serious injuries through

rider training The studies included in this review did not specify

type of injury and so this outcome could not be assessed Last

changes in knowledge and attitudes following rider training are

other potentially useful outcomes We have excluded such studies

(Osga 1979 Clayton 1990 Goldenbeld 2004) as these outcomes

are proxies rather than direct measures of the effectiveness of mo-

torcycle rider training We opted to report on the outcomes of

crashes injury death and offences alone since there is little ev-

idence about how changes in knowledge and attitudes relate to

these outcomes

A U T H O R S rsquo C O N C L U S I O N S

Implications for practice

Due to the poor quality of studies included in this review we were

unable to draw any conclusions about the effectiveness of rider

training on crash rates injurious or fatal or offence rates The

findings do suggest that mandatory pre-licence training may be

an impediment to completing a motorcycle licensing process thuspossibly indirectly reducing crash injury death and offence rates

through a reduction in exposure to riding a motorcycle On the

basis of the existing evidence it is not clear if and what type of

training reduces the risk of crashes injuries deaths or offences in

motorcyclists and the selection of the best rider training practice

can therefore not be recommended The suggestion that manda-

tory pre-licence training indirectly reduces exposure to riding the

motorcycle because trainees are impeded from completing the li-

censing process does not help those motorcyclists who persist in

obtaining their licence and riding the motorcycle Some type of

rider training is likely necessary to teach motorcyclists to ride a

motorcycle safely Good policy is based on sound evidence and

evaluation but such evidence for motorcycle rider training is seri-

ously lacking Policy makers are therefore encouraged to include arigorous evaluation component to any new or existing rider train-

ing programme Such an evaluation should ideally be randomized

and assess whether the training programme is effective and if so

which component(s) of the programme work best

Implications for research

Given theresults of this review which found littlereliable evidence

about the effectiveness of motorcycle rider training it is necessary

to build up an evidence base of the effectiveness of motorcycle

rider training in the reduction of crash injury death and offence

rates To this end well designed randomised controlled trials need

to be conducted that examine the impact of rider training oncrashes and offences A randomised controlled trial is the preferred

method as it would significantly reduce most biases described in

this review To minimise the impact of participants delaying or

never attaining their licence and therefore exposure as found in

the randomised trials in this review such a trial should include

riders who are already licensed and reliable measures of riding

exposure in a reasonably lengthy follow up period It is expected

that a randomised controlled trial of sufficient sample size would

observe equal balance on possible confounders by study arm how-

ever an assessment of potentially important confounders (such as

helmet wearing) by study group would enable control for these

variables in the analyses if necessary It is imperative that the effec-

tiveness of each component of the rider training (such as theorypractice knowledge skills and modification of behaviour) and the

synergy of such components are evaluated Outcomes should be

objective ideally those that are routinely collected rather than self-

reported outcomes Even though riding the motorcycle poses dif-

ferent challenges and incurs different risks lessons may be learned

from research into the effects of car driver training

Motorcycles are a common means of transport in low- and middle

income countries and usage is increasing As the burden of mo-

torcycle crash victims is mostly borne in such countries research

should be focused on the effectiveness of types of rider training on

the reduction of crashes injuries and fatalities in such countries

and be supported by higher income countries This review found

only one study conducted in a middle income country that sug-gested decreasing injury rates It would be beneficial to conduct

additional research to confirm this suggestion and to enhance our

knowledge of the role of rider training in low- and middle-income

settings

March 2006 saw the launch of the University of North Carolina

Highway Safety Research Centre partnership with the Motorcycle

Safety Foundation (MSF) and plans were revealed to conduct a

study of the potential benefits of motorcycle rider training The

study is funded by the MSF and the National Highway Traffic Sa-

fety Administration (NHTSA) Called rsquoThe Discovery Projectrsquo it

will compare data on crash rates from riders participating in a basic





motorcycle safety class with riders participating in a basic motor-

cycle safety class as well as a variety of continuing education classesThe collection of pilot data was due to start in March 2007 and

the data collection portion of the study is expected to take three

years (Highway Safety Research Center) It is vital that researchers

and policy makers collaborate to develop furtherhigh quality eval-

uations of motorcycle rider training programmes to help inform

development of new and effective training programmes

A C K N O W L E D G E M E N T S

Staff from The University of Sydney library for helping us locate

and retrieve full reports of many papers

R E F E R E N C E S

References to studies included in this review

Adams 1985 published data only

Adams A Collingwood V Job RFS Evaluation of the 1982 Australia

Post motorcycle rider training scheme NSW Australia Traffic

Accident Research Unit Traffic Authority NSW 1985 [ RN 85]

Anderson 1980 published data only

Anderson J Ford JL Peck RC Improved motorcyclist licensing and testing project Washington DC National Highway Traffic Safety

Administration (NHTSA) USA 19801ndash217 [

DOTndashHSndash805ndash598]

Billheimer 1998 published data only

Billheimer JW Evaluation of the California Motorcyclist Safety

Program Transportation Research Record 19981640100ndash9 [

TRB Report Number 980652]

Cooper 1988 published data only

Cooper PJ Rothe JP Motorcyclists who they are and why they do

what they do Transportation Research Record 1988116878ndash85

Davis 1997 published data only

David CF Evaluation of community traffic safety programs and

motorcycle operator training programs Connecticut Department of Transportation 199763

Hall 1988 published data only

Hall CJ Buchanan L Engle R Motorcycle rider education evaluationproject Washington DC USA National Highway Traffic Safety

Administration (NHTSA) US Department of Transportation

1988 [ DTNH 22ndash80ndashCndash05123]

Haworth 1997 published data only

Haworth N Smith R Brumen I Pronk N In Monash University

Accident Research Centre editor(s) Case-control study of motorcycle

crashes Victoria Australia Department of Transport and Regional

Development The Federal Office of Road Safety 19971ndash149 [

ISBN 0 642 25501 6 ]

Hurt 1981 published data only

Hurt H Ouellet J Thom D Motorcycle accident cause factors and

identification of countermeasures USA Department of

Transportation 1981 [ Technical Report DOT HS 806ndash862]

Jonah 1982 published data onlylowast Jonah BA Dawson N Bragg B Are formally trained motorcyclists

safer Accident Analysis amp Prevention 198214(4)247ndash55

Jonah BA Dawson NE Bragg BW Evaluation of the Canada

Safety Councilrsquos Motorcycle Training Program Proceedings of theInternational Motorcycle Safety Conference Washington DC

USA 198059ndash93

Kloeden 1994 published data only

Kloeden CN Moore VM McLean AJ Evaluation of the pre-license

training program for motorcyclists in South Australia Walkerville

South Australia Australia NHMRC Road Accident Research Unit

The University of Adelaide 19941ndash37 [ ISBN 0 7308 0607 3]

Kraus 1975 published data only

Kraus JF Riggins RS Franti CE Some epidemiological features of

motorcycle collision injuries American Journal of Epidemiology 1975102(1)74ndash98

Leung 1987 published data only

Leung KS Reding VA Evaluation of the Wisconsin motorcycle rider course Wisconsin Bureau of Policy Planning and Analysis

Wisconsin Department of Transportation 1987

MAIDS 2004 published and unpublished data

MAIDS In-depth investigations of accidents involving powered

two wheelers ACEM (Acemacemeu) 2004 Vol Final report

20179

McDavid 1989 published data only

McDavid JC Lohrmann BA Lohrmann G Does motorcycle

training reduce accidents Evidence from a longitudinal quasi-

experimental study Journal of Safety Research 198920(2)61ndash72

Mortimer 1984 published data only

Mortimer R Evaluation of the motorcycle rider course Accident

Analysis amp Prevention 198416(1)63ndash71






Mortimer RG A further evaluation of the motorcycle rider courseJournal of Safety Research 198819(4)187ndash96

Osga 1980 published data only

Osga GA An investigation of the riding experiences of MSF rider

course participants Dissertation South Dakota USA The

University of South Dakota 19801ndash224

Perrino 2002 published data only

Perrino CS Ahmed A Callender A Rozier E Cantwell A Stewart

O The role of Marylandrsquos motorcycle rider course in promoting saver

behaviors and attitudes Baltimore USA National Transportation

Center Morgan State University 20021ndash52

Raymond 1979 published data only

Raymond S Tatum S An evaluation of the effectiveness of the RAC

ACU motorcycle training scheme - final report Road Safety ResearchUnit Dept of Civil Engineering University of Salford London

19791ndash131

Satten 1980 published data only

Satten RS Analysis and evaluation of the motorcycle rider courses

in thirteen Illinois counties International Motorcycle Safety

Conference Washington DC 1980145ndash93

Savolainen 2007 published and unpublished data

Savolainen Peter Mannering Fred Additional evidence on the

effectiveness of motorcycle training and motorcyclistsrsquo risk-taking

behaviour Transportation Research Board 2007 Vol March 20

19

Swaddiwudhipong 1998 published data only

Swaddiwudhipong W Boonmak C Nguntra P Mahasakpan P

Effect of motorcycle rider education on changes in risk behavioursand motorcycle-related injuries in rural Thailand Tropical Medicine

and International Health 19983(10)767ndash70

Waller 1992 published data only

Waller FL An analysis of the impact of the Texas Department of

Public Safety Motorcycle Operator Training Program upon

motocycle related traffic accidents Texas State University Public

Administration Program Applied Research Projects 199277

References to studies excluded from this review

Anderson 1980a published data only

Anderson LC Better biking a motorcycle rider improvement

program International Motorcycle Safety Conference Washington

DC USA Motorcycle Safety Foundation 1980231ndash53Aupetit 2008 published and unpublished data

Aupetit S Riff J Buttelli O Espie S Ergonomics research program

on motorcycle learning Contributions to the development of a

motorcycle simulator for training Transport Research Arena

Ljubljana 20089

Awane 1999 published data only

Awane T Integrating simulators in motorcycle safety education

Journal of International Association of Traffic and Safety Sciences 199923(1)26ndash35

Baldi 2005 published data only

Baldi S Baer JD Cook AL Identifying best practices states in

motorcycle rider education and licensing Journal of Safety Research200536(1)19ndash32

Batchler 1988 published data only

Batchler MW Evaluation of the pre-license motorcycle training course at the New South Wales traffic education centre Federal Office of

Road Safety (FORS) 19881ndash122 [ Report No CR 77 ]

Blanchard 2006 published data only

Blanchard HT Tabloski PA Motorcycle safety educating riders at

the teachable moment Mosby (CV) Company 200632330ndash2

Bonnett 2005 published data only

Bonnett J Mature age skills training for experienced motorcycle

riders Motorcycle ridersrsquo association of the Australian Capital

Territory 2005

Braver 2007 published data only

Braver ER et alPersuasion and licensure a randomized controlled

intervention trial to increase licensure rates among Maryland

motorcycle owners Traffic Injury Prevention 20078(1)39ndash46Clayton 1980 published data only

Clayton AB Sudlow DE An evaluation of the effectiveness of a one day training programme for learner motorcyclists Berkshire UK

Transport and Road Research Laboratory 19801ndash23 [ ISSN

0266ndash7045]lowast Clayton AB Sudlow DE An evaluation of the effectiveness of a one-day training programme for learner motorcyclists Berkshire UK

Road Safety Division Berkshire 19801ndash23 [ISSN 0266ndash7045]

Council 1978 published data only

Council FM Desper LP Dutt AK Driver education for motorcycle operation University of North Carolina Highway Safety Research

Center 19781ndash40

Crowther 2005 published data onlylowast Crowther G Engaging with motorcyclists UK police and theBikeSafe Road Safety Programme Published proceedings of the

Australasian Road Safety Research Policing Education Conference

Wellington New Zealand 2005 issue ISBN 0ndash473ndash10636ndash11ndash11

Daniello 2009 published data only

Daniello A Gabler HC Mehta YA Effectiveness of motorcycle

training and licensing Transportation Research Board 88th Annual

Meeting 200913

Dewanti 2007 published data only

Dewanti M Challenging efforts in promoting young motorcyclist

safety in Indonesia Road Safety on Four Continents 14th

International Conference Swedish National Road and Transport

Research Institute 2007

Du Plooy 1990 published data onlyDu Plooy DW Motorcycle training in South Africa The Human

Element International Motorcycle Safety Conference Orlando

Florida USA Motorcycle Safety Foundation 19904-1 to 4-9

Engel 1989 published data only

Engel U Krogsgaringrd Thomsen L [Faeligrdselsundervisning og

propaganda ndash en faeligrdselssikkerhedsfremmende foranstaltning]

Dansk Vejtidsskrift 198912295ndash7

Goldenbeld 2002 published data only

Goldenbeld C Houwing S de Craen S The development of

driving skills of young moped riders [De ontwikkeling van de

rijvaardigheid van jonge bromfietsers] SWOV Institute for Road

Safety Research (Stichting Wetenschappelijk Onderzoek

Verkeersveiligheid) Leidschendam the Netherlands 200263






Goldenbeld C Twisk D de Craen S Short and long term effects of moped training a field experiment Transportation Research Part F 20047(1)1ndash16


Haworth N Smith R Kowadlo N Motorcycle training in Victoria

evaluation of rider training curriculum in Victoria Monash

University Accident Research Centre Reports 2000 Vol 165 issue

3131


Haworth N Mulvihill C Review of motorcycle licensing and

training Monash University Accident Research Centre 2005 [

Report no240]


Haworth N Mulvihill C Rowdon P Teaching old dogs new tricksTraining and older motorcyclists Journal of the Australasian College of Road Safety 200718(4)20ndash5lowast Haworth NL Mulvihill C Rowden PJ Teaching old dogs new

tricks Training and older motorcyclists Australasian Road Safety

Research Policing and Education Conference Gold Coast

Queensland 2006

Hill 1983 published data only

Hill D Motorcycle rider training testing and licensing Motor

Cycle Council of New South Wales Sydney 1983

Imatake 1980 published data only

Imatake Y On the activities in Japan of motorcycle safe riding

promotion committee (MSRPC) - especially the education of

unskilled riders of class 1 motorbikes International Motorcycle

Safety Conference Washington DC USA Motorcycle Safety

Foundation 1980255ndash68

Ingebritsen 1990 published and unpublished data

Ingebrigtsen S [Risikofaktorer ved ferdsel med moped og

motorsykkel] TOslashI-rapport 66 Oslo Transportoslashkonomisk

institutt 1990

Jain 2009 published and unpublished data

Jain A et alTwo wheeler accidents on Indian roads a study from

Mangalore India Elsevier 200916130ndash3

Jonah 1979 published data only

Jonah BA Dawson NE Validation of the motorcycle operator skill

test Accident Analysis amp Prevention 197911(3)163ndash71

Jonah 1981 published data onlyJonah BA Dawson NE Bragg WE Predicting accident

involvement with the Motorcycle Operator Skill Test Accident Analysis amp Prevention 198113(4)307ndash418

Kadar 1990 published data only

Kadar KJ Countermeasures motorcycle rider education delivery

system The Human Element International Motorcycle Safety

Conference Motorcycle Safety Foundation 19906-27 to 6-41

Kelsey 1986 published data only

Kelsey SL Liddicoat C Ratz M Licensing novice motorcyclists a

comparison of Californiarsquos standard test and the MOST II (Motorcycle

Operator Skill Test) administered at centralized testing offices Sacramento California USA California Department of Motor

Vehicles Research and Development Office 19861ndash74

Koch 1980 published data only

Koch H Advanced course for motorcycle riders InternationalMotorcycle Safety Conference Washington DC USA Motorcycle

Safety Foundation 1980269ndash81


Koch H Brendicke R How to influence risk taking behaviour

within motorcycle rider training programs The Human Element

International Motorcycle Safety Conference Orlando Florida

USA Motorcycle Safety Foundation 1990Motorcycle Safety

Foundation 1990 p 9-1 to 9-25A

Labbett 2005 published data only

Labbett S Langham M Training can make the problem worse

Road Safety Congress 20051ndash12

Law 2005 published and unpublished data

Law TH Radin Umar RS Zulkaurnain S Kulanthayan S Impactof the effect of economic crisis and the targeted motorcycle safety

programme on motorcycle-related accidents injuries and fatalities

in Malaysia International Journal of Injury Control and Safety

Promotion 200512(1)9ndash21

Lowes 1990 published data only

Lowes BF In-traffic rider training The Human Element


USA Motorcycle Safety Foundation 19907-46 to 7-57

Mahon 1976 published data only

Mahon J Teaching accident avoidance on the motorcycle Journal of Traffic Safety Education 1976231ndash29

Maxwell 1985 published data only

Maxwell GS Evaluation of a Program for Training MotorcycleRiders Evaluation and Program Planning 19858(4)339ndash47

Mayhew 1996 published data only

Mayhew DR Simpson SH Effectiveness and role of driver educationand training in a graduated licensing system Ottowa Canada The

Traffic Injury Research Foundation 19961ndash89 [ ISBN

0ndash920071ndash12ndash0]

McKnight 1987 published data only

McKnight AJ Milburn BG An evaluation of the modified

motorcycle operator skill test exercises NHTSA Report 1987 [

Report No DOT HS 807 212 ]

McPherson 1976 published data only

McPherson K McKnight AJ The development and evaluation of a

motorcycle skill test manual and knowledge test Washington DCUSA National Highway Safety Administration 1976

Mohan 2004 published data only

Mohan D Evidence-based interventions for road traffic injuries in

South Asia Journal of the College of Physicians and SurgeonsPakistan 200414(12)746ndash7

Morgan 1980 published data only

Morgan JK Advanced motorcycle training course content and

study evaluation International Motorcycle Safety Conference

Washington DC USA Motorcycle Safety Foundation 1980

283ndash312

Motoki 1990 published data only

Motoki M Yamazaki S A study on effective motorcycle rider

education The Human Element International Motorcycle Safety





Conference Orlando Florida USA Motorcycle Safety

Foundation 19909-26 to 9-57A

Nairn 1992 published data onlylowast Nairn RJ Motorcycle safety research literature review 1987 to

1991 Federal Office of Road Safety Australia 1993 Vol Report

CR 117

Newland 1980 published data only

Newland R Darby J Automotive practicespre motorcycle rider


DC USA Motorcycle Safety Foundation 1980127ndash9


Newland R Motorcycle rider training and licensing requirements

Driver training steering a course for the future Melbourne

Victoria Transport Regulation Board 1982


Newland R Motorcycle training and licensing in Victoria 1980-

1990 The Human Element International Motorcycle Safety


Foundation 1990

Ormston 2003 published data only

Ormston R Dudleston A Pearson S Stradling Evaluation of

Bikesafe Scotland Scottish Executive Social Research Edinburgh

2003


Osga GS Ellingstad VS An evaluation of the effectiveness of the 1978

South Dakota motorcycle rider course program South Dakota USA


Panou 2007 published data only

Panou M Bekiaris E A new concept on the integration of driving

simulators in driving training the train-all approach Road Safety

on Four Continents 14th International Conference Swedish

National Road and Transport Research Institute 2007

Peterson 1990 published data only

Peterson A Kadar K Status report 1980-1989 Minnesota rider

education statistics The Human Element International

Motorcycle Safety Conference Orlando Florida USA 199013-

113 to 13-129

Prem 1984 published data only

Prem H Good MC Motorcycle rider skills assessment ACT

Australia Office of Road Safety Department of Transport 1984

1ndash377 [ Report No CR 34 ]

Radin Umar 2006 published data only

Radin Umar RS Motorcycle safety programmes in Malaysia how

effective are they International Journal of Injury Control and Safety Promotion 200613(2)71ndash9

Rockwell 1990 published data only

Rockwell TH Kiger S Carnot M An evaluation of the Ohio

motorcyclist enrichment program Ohio Department of Highway

Safety 1990

Rothe 1987 published data only

Rothe JP A motorcycle riding course Motorcyclists Image and reality Canada Insurance Corporation of British Columbia 1987

59ndash83

Rowden 2007 published data only

Rowden P Watson B Haworth N What can riders tell us aboutmotorcycle training A view from the other side of the fence

Australasian Road Safety Research Policing and Education

Conference Melbourne Australia Melbourne 2007

RSC Victoria 1993 published data only

Road Safety Committee Inquiry into Motorcycle Safety in Victoria

Parliament of Victoria 1993

Russam 1979 published data only

Russam K Motorcycle training and licensing in Japan UK Transport

and Road Research Laboratory (TRRL) 1979 [ Report 916 ]

Saffron 1981 published data only

Saffron DG Driver and rider education training and licensing a

brief review Traffic Accident Research Unit Traffic Authority of

New South Wales NSW Australia Traffic Accident Research UnitTraffic Authority of New South Wales 1981

Schulz 1990 published data only

Schulz U Motorcycle accidents among learner riders Motorcycle

licensing Evaluation of the effectiveness of a Graduated Licensing Scheme Forshungshefte des Institut fur Zweiradsicherheit 1990

Sexton 2004 published data only (unpublished sought but not used)

Sexton B Baughan C Elliott M Maycock G The accident risk of

motorcyclists 2004TRL Report TRL 607(ISSN 09684107)58

Shephard 1986 published data only

Shepherd R Do Motorcycle Safety Foundation programs work

Driver 198619(9)16ndash8

Simpson 1990 published data onlySimpson HM Mayhew DR The promotion of motorcycle safety

training education and awareness Health Education Research

Theory and Practice 19905(2)257ndash64

Sokolov 1990 published data only

Sokolov O Safe motorcycle riding some aspects of motorcycle

riding in the USSR The Human Element International

Motorcycle Safety Conference Motorcycle Safety Foundation

19904ndash37 - 4-48

Steffens 1988 published data only

Steffens U Gawatz R Willmes G Effectiveness of mofa courses

[Wirksamkeit von Mofakursen] Unfall- und sicherheitsforschung

strasenverkehr 198867168

Sudlow 2003 published data only

Sudlow D Scoping study on motorcycle training Road Safety

Research Report London UK The British Institute of Traffic

Education Research Department for Transport 2003 Vol June

[ Report No 36]

Tasmania 1995 published data only

Mannering FL Grodsky LL Motorcycle rider training scheme

Traffic Education Research Centre Armidale Australia Driver

Training Australia Limited 1995 Vol April1ndash56

Tetard 1985 published data only

Tetard C Motorcycle ridersrsquo training to detect indices in an

intersection situation [Lrsquoentrainement a la prise drsquoinformation dans

lrsquoapprentissage de la conduite motocycliste] Le Travail Humain198548(2)147ndash59





Thackray 1980 published data only

Thackray RM Prescott JC Field test of the motorcycle ridercourse International Motorcycle Safety Conference Washington


Thompson 1994 published data only

Thompson M Evaluation of compulsory basic training for

motorcyclists Transport Research Laboratory Crowthorne

Berkshire UK 1994 [ Report 63]

Tobler 1990 published data only

Tobler U Individual driving instruction for motorcycle driving

learners the Swiss experiment of motorcycle driving school The

Human Element International Motorcycle Safety Conference

Orlando Florida USA Motorcycle Safety Foundation 1990

Transport 1989 published data only

Transport Communications Road Crash Statistics Australia Bureauof Transport and Communications Economics 198914ndash20

Tuan 2007 published data only

Tuan VA Shimizu T Towards development and evaluation of the

motorcycle drivers re-education program in Vietnam modeling of

motorcycle driverrsquos undesired behaviors 11th World Conference

on Transport Research 200725

Victor 1980 published data only

Victor DJ Traffic safety education for motorcyclists International

Motorcycle Safety Conference Washington DC USA Motorcycle


Waterer 1990 published data only

Waterer TH Compulsory training for motorcyclists from liberty

to compulsion The Human Element International Motorcycle

Safety Conference Orlando Florida USA Motorcycle Safety

Foundation 19904-49 to 4-57

Weller 1989 published data only

Weller RB Chandler EW Motorcycle safety and motorcycle

education past research and survey results Journal of Public Policy

amp Marketing 1989893ndash108

Wells 1981 published data only

Wells P Observations of some RACACU motorcycle training

schemes Transport and Road Research Laboratory Crowthorne

Berkshire UK 1981

Winn 1986 published data only

Winn G Two important trends in motorcycle safety regulations

rider education and conspicuity improvement American

Motorcyclist Association 1986147ndash52

Wisher 1988 published data only

Wisher G Reid J Motorcycle accidents in Norfolk a three-year study of motorcycle training and the Part 1 test Norfolk UK Road Safety

Division Highways Department Norfolk County Council 1988

Wood 1987 published data only

Wood HT Bowen R Evaluation of the revised learner permit scheme

July 1983 to December 1985 Victoria Australia Road Traffic

Authority 19871ndash27 [ ISBN 0 7306 0247 8]

Yamazaki 1990 published data only

Yamazaki S Nakanishi M Survey on effect of Honda rider


Conference Orlando Florida USA 199012-167 to 12-187

References to ongoing studies

Burgess 2010 unpublished data only

Burgess C Broughton P Fylan F Stradling Interim evaluation of

the UKs National Ride program In L Dorn editor(s) Driver

behaviour and Training Vol IV Aldershot Ashgate Publishing

Limited 2010

Additional references

Anderson 1980

Anderson J Ford JL Peck RC Improved motorcyclist licensing and

testing project Volume I and II National Highway Traffic Safety

Administration US department of Transportation Washington

DC 1980

Bjornstig 1985

Bjornstig U Bylund P Lekander T Brorsson B Motorcycle fatalitiesin Sweden Acta Chirurgica Scandinavica 1985151(7)577ndash81

Clayton 1990

Clayton A Sudlow DE An evaluation of the effectiveness of a one-

day training program for learner motorcyclists The Human


Florida USA 199013-105 to 13-111

Cochrane Collaboration 2008

Higgins JP Green S Cochrane Handbook for Systematic Reviews of

Interventions 500 The Cochrane Collaboration 2008

Elliot 2003

Elliott MA Baughan CJT Broughton J Grayson G Knowles J et

alMotorcycle Safety a Scoping Study TRL [ Report No

0968ndash4107]Fleiss 2004

Fleiss JL Levin B Paik MC Statistical methods for rates and proportions 3rd Edition John Wiley amp Sons Inc 2004 [ ISBN

978ndash0ndash471ndash52629ndash2 ]

FORS 1999

FORS Federal Office of Road Safety Road risk for sober licensed

motorcyclists Vol Monograph 27 Federal Office of Road Safety

19991ndash2

Haworth 2005

Haworth N Mulvihill C Review of motorcycle licensing and training

Victoria Australia Monash University Accident Research Centre

20051ndash83 [ Report No 240]

Huwiler-Muumlntener 2002Huwiler-Muumlntener K Juumlni P Junker C Egger M Quality of

Reporting of Randomized Trials as a Measure of Methodologic

Quality JAMA 20022872801ndash4

Johnston 2008

Johnston P Brooks C Savage H Fatal and serious road crashes

involving motorcyclists Road Safety Research and Analysis Report

ATSB Monograph 20 Canberra Department of Infrastructure

Transport Regional Development and Local Government 0205

081ndash26

Juumlni 2001

Juumlni P Altman DG Egger M Systematic reviews in health care

Assessing the quality of controlled clinical trials BMJ 2001323

42ndash6





Kopits 2003

Kopits E Cropper M Traffic fatalities and economic growth TheWorld Bank Development Research Group Infrastructure and

Environment Policy research working paper 3035 2003

Leung 1983

Leung P Chau BTW Motorcycle accidents in Hong Kong pattern

of injury treatment causative factors and socio-economic

implications Injury 198315(1)23ndash9

Liu 2004

Liu B Ivers R Norton R Blows S Lo SK Helmets for preventing

injury in motorcycle riders Cochrane Database of Systematic Reviews 2004 Issue 2 [DOI 10100214651858CD004333pub3]

Mohan 2002

Mohan D Road safety in less-motorized environments future

concerns International Journal of Epidemiology 200231(3)527ndash32Mortimer 1982

Mortimer RG An evaluation of the motorcycle rider course

Proceedings of the 20th conference of the American Association for

Automotive Medicine Arlington Heights IL USA American

Association for Automotive Medicine 198277ndash96

Mullin 1997

Mullin BT Risk factors for motorcycle injury the role of age

gender experience training and alcohol PhD thesis Auckland

New Zealand University of Auckland 1997

Noordzij 2001

Noordzij PC Forke E Brendicke R Chinn BP Integration of needs

of moped and motorcycle riders into safety measures review and

statistical analysis in the framework of the European research

project PROMISING SWOV Institute for Road Safety Research

Leidschendam The Netherlands 2001 [ Report No Dndash2001ndash5]

Osga 1979

Osga G Ellingstad VS An evaluation of the effectiveness of the 1978 South Dakota Motorcycle Riders Course Program South Dakota

University of South Dakota Vermillion Human Factors Lab 1979

Oxford English Dictionary Online

httpoxforddictionariescom Oxford English Dictionary Online

Oxford University Press 2010

Peden 2004

Peden M Scurfield R Sleet D World Report on Road TrafficInjury Prevention Geneva World Health Organization Available

at httpwwwwhointviolence˙injury˙preventionpublications

road˙trafficworld˙reporten 2004Chapter 3

Radin Umar 1995

Radin Umar R Macakay G Hills B Preliminary analysis of

motorcycle accidents Short-term impacts of the running

headlights campaign and regulations in Malaysia J Traffic Med 199523(1)17ndash27

Tsai 1995

Tsai YJ Wang JD et alCase-control study of the effectiveness of

different types of helmets for the prevention of head injuries among

motorcycle riders in Taipei Taiwan American Journal of

Epidemiology 1995142(9)974ndash81

Vis 1995

Vis AA In-depth study of the hazards of motorcycling [De

onveiligheid van motorrijden nader bekeken] SWOV Institute for

Road Safety Research Leidschendam the Netherlands 1995 [

Report No Rndash95ndash69]

Weaver 1990

Weaver EA Motorcycle safety education in the United States

Motorcycle Safety Foundation Orlando Florida USA 1990

Winn 1987


rider education and conspicuity improvement No more

information available Detroit MI US Society of Automotive

Engineers 1987147ndash52

Yuan 2000

Yuan W The effectiveness of the rsquoride-brightrsquo legislation for

motorcycles in Singapore Accident Analysis amp Prevention 200032

(4)559ndash63

Zambon 2006

Zambon F Hasselberg M Factors affecting the severity of injuries

among young motorcyclists a Swedish nationwide cohort study

Traffic Injury Prevention 20067(2)143ndash9lowast Indicates the major publication for the study





C H A R A C T E R I S T I C S O F S T U D I E S

Characteristics of included studies [ordered by study ID]

Adams 1985

Methods Non-randomised trial

Participants Initial sample size

Total of 162 Australia Post telegram delivery riders

Not clear how many in intervention and control groups

Analysis sample size

Intervention group 63Control group 35

Total 98 (61)

Interventions No formal training vs voluntary rider training course of 12 hours over 2 consecutive days (theory 4 hours practice

8 hours)


No information given

Outcomes Australia Post recorded crashes


Notes Study conducted in NSW Australia

Anderson 1980

Methods Randomised trial


Total 41188 motorcycle licence applicants


Intervention group with skills training 13160

Intervention group without skills training 12634

Control group 15080

Total 40874 (99)

Interventions Standard licensing skill test vs the Motorcycle Operators Skill Test (MOST) with or without a training component

MOST is not to be confused with rider training because it is a licensing test The training component was for

participants who failed the skill test on the first attempt was of 3 hours duration and consisted of instructions about

the skills needed to pass the skill test The training consisted of 30 min theory and 2 frac12 hours practice on the

motorcycle


33 in MOST with skills training 31 in MOST without skills training and 43 in control group obtained their

motorcycle licence in the end

Outcomes Police recorded crashes and offences






Anderson 1980 (Continued)

Notes Study conducted in California USA

Billheimer 1998

Methods Cohort study


Intervention group Unclear numbers of CMSP graduates and ERC graduates

Control group Over 16000 untrained motorcyclists


1139 matched CMSP-pairs and 1182 ERC-pairs

Interventions No formal training vs the mandatory (for those younger than 18 years) pre-licence 16-hours basic California

Motorcyclist Safety Program (CMSP) and the 8-hour Experienced Rider Course (ERC)






Cooper 1988



Intervention group 418 graduates and 57 who failed

Control group 402


Intervention group unclear

Control group unclear

Total 863 (984)

Interventions No formaltrainingvs non-mandatory pre-licence rider trainingThe content of thetrainingwas notfurther explainedIntervention integrity

Participants had all completed the rider training



Notes Study conducted in British Columbia Canada





Davis 1997

Methods Retrospective cohort study


Intervention group 9320 graduates





Interventions No formal training vs the non-mandatory Connecticut Motorcycle Operator Training Program The content of

training was not further explained

Intervention integrity Participants had all completed the rider training

Outcomes Police recorded crashes severity of crashes


Notes Study conducted in Connecticut USA

Hall 1988


Participants Initial sample sizeIntervention group A 6248

Intervention group B 6616

Intervention group C 6996

Control group 6604



Intervention group A 6012 (96)

Intervention group B 6428 (97)

Intervention group C 6778 (97)

Control group 6502 (98)

Interventions Standard licensing skill test vs the Motorcycle Operator Skill Test (MOST II) without training (A) MOST II with

3 hours training (B) or MOST II with 20 hours training (C) The 3 hours training comprised instructions aboutthe skills needed to pass the skill test (30 min theory and 2 frac12 hours practice on the motorcycle) The 20 hours

training consisted of the Motorcycle Safety Foundationrsquos Motorcycle Rider Course (MRC) comprising of 8 hours

theory (lectures discussions films and multiple choice tests) a textbook and 12 hours off-road practice


25 and 26 obtained their motorcycle licence in the lsquoMOST 3-hour trainingrsquo and lsquoMOST 20-hour trainingrsquo

intervention arm respectively In the lsquoMOST testrsquo intervention arm 29 obtained their licence and in the control

group 35







Hall 1988 (Continued)

Notes Study conducted in New York USA

Haworth 1997

Methods Population based case-control study

Participants Cases Motorcycle riders or pillion riders involved in motorcycle crash (on road) Recruited from hospital and police

records Not clear whether all cases (especially fatalities) were included

Community controls Multiple matched sample of motorcycle rider or pillion who passed the crash site at the same

time of day and day of week that the crash occurred

Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)

Interventions Basic handling skills course beginner intermediate or advanced course measured through self-report not validated

Outcomes Injuries with an Injury Severity Score of 5 or greater or admission for at least four hours and fatalities from a

motorcycle crash (from hospital and police records)

Length of follow up two years or more prior to the interview

Notes Study conducted in Victoria Australia

Hurt 1981


Participants Cases Motorcycle riders who had a motorcycle crash that was reported to police (traffic accident reports) Not all

cases included

Community controls Multiple matched sample of motorcycle riders who passed the crash site at the same time of

day and day of week as the crash occurred but 2 years later

Initial sample size

Cases 4500 notifications of crashes to police (only 50 received in time research team able to respond to 1126 for

unreported reasons data collection completed for 900)

Controls Number approached unreported 2310 consented and interviewed


Cases 808 (808900 data on rider training) - 18 of initial sample

Controls 670 (6702310 data on rider training) - lt 29 of initial sample

Interventions Training experience self taught friends-family school-club formal-professional others measured through self-

report validated

Outcomes Injuries and fatalities from a motorcycle crash (from hospital records and coronerrsquos office)





Hurt 1981 (Continued)

Notes Study conducted in Los Angeles USA

Jonah 1982



Intervention group

2310 licensed MTP graduates who are active riders

Control group

2029 licensed motorcyclists who are active riders

Non-licensed and non-active riders excluded


Intervention group

811 interviews (35) 533 driver records (23)

Control group 1080 interviews (71) 905 driver records (45)

Interventions No training vs the non-mandatory Canada Safety Council Motorcycle Training Program (MTP) comprising of 4

hours theory and 16 hours practise (6 hrs on-road) over 2 weekends


Participants had all successfully completed the MTP

Outcomes Self-reported and police reported crashes and offencesLength of follow up 4 years

Notes Study conducted in Ontario Canada

Kloeden 1994



Intervention group 2533 licence applicants

Control group Unclear

Sample of riders obtaining probationary licenceIntervention group 1625 (64)

Control group 5015 (unclear)

Non-active riders excluded from control group (~66)


Intervention group 631 (39)


Interventions No formal training vs the mandatory pre-licence Ridersafe course consisting of two levelsthe first is a training course

in the basics of motorcycle riding where a pass entitles the rider to obtain a learnerrsquos permit The second is a skill

test where a pass entitles the rider to obtain a probationary motorcycle licence The training course consists of two 4

hour training sessions on separate days involving instruction videos and actual riding on motorcycles The skill test

consists of a 4 hour preparation course of 74 minutes of lecturediscussion 38 minutes of video and 75 minutes of





Kloeden 1994 (Continued)

on-course riding which is the testing phase


Unclear what percentage in the Ridersafe group and the control group obtained their probationary licence halfway

and their full motorcycle licence in the end

Outcomes Police reported crashes


Notes Study conducted in SA Australia

Kraus 1975


Participants Cases All motorcycle riders with a confirmed medically treated motorcycle injury (including fatalities) from all

hospitals in study base and peripheral area hospitals and all deaths due to motorcycle crashes in the study base All

serious injuries (leading to hospitalisation) and fatalities likely to be included

Community controls A random sample of registered motorcycle owners in the same temporary and geographical

study base as the cases arose from

Initial sample size Cases 1273

Controls 738

Analysis sample size Cases 741 (58)

Controls 434 (59)

Interventions Motorcycle rider training (not specified) measured through self-report

Outcomes Injuries leading to hospitalisation fatalities


Notes Study conducted in Sacramento county USA

Leung 1987


Participants Initial sample sizeIntervention group unknown number of MRC graduates

Control group unknown number of licensed motorcyclists


Intervention group 2941

Control group 43094

Interventions No formal training vs non-mandatory Wisconsin motorcycle rider course a 22 hours off-street programme that

teaches the basic rules of safe motorcycling


50 in the MRC group and 100 in the control group obtained their motorcycle licence in the end





Leung 1987 (Continued)



Notes Study conducted in Wisconsin USA

MAIDS 2004


Participants Cases Motorcycle riders who had a motorcycle crash Unclear whether all cases included

Community controls Motorcycle riders identified at petrol stations Unclear whether matched to cases

Initial sample size

Cases not reported

Controls not reported


Cases 921 (Italy 200 Netherlands 200 Spain 121 Germany 250 France 150)

Controls 923 (Italy 200 Netherlands 200 Spain123 Germany 250 France 150)

Interventions Pre-license rider training or additional training (non-compulsory)

Outcomes Crashes

Notes Study in five sampling areas located in five European countries (France Germany Netherlands Spain and Italy)

McDavid 1989


Participants Sample size after first match

Intervention group 346 male training graduates

Control group 346 male motorcycle riders licensed in same year

Sample size after second match






Interventions No formal training vs the non-mandatory pre-licence British Columbia Safety Councilrsquos 37-hour motorcycle safety

programme


Participants had all completed and passed the training

Outcomes Police reported crashes injurious crashes

Length of follow up 1-6 years





McDavid 1989 (Continued)


Mortimer 1984



Intervention group 608 MRC graduates

Control group 360 motorcycle riders

Response rates



Non-active riders excluded




Interventions No formal training vs the non-mandatory Motorcycle Safety Foundationrsquos Motorcycle Rider Course comprising of

8 hours theory (lectures discussions films and multiple choice tests) a textbook and 12 hours off-road practice


Participants had all completed and passed the MRC

Outcomes Self-reported crashes and offencesLength of follow up 1 year

Notes Study conducted in Illinois USA

Mortimer 1988




Control group 556 active licensed motorcycle riders

Response ratesIntervention group 1298 (56)














Mortimer 1988 (Continued)

Outcomes Self reported crashes and offences



Osga 1980


Participants Initial sample sizeIntervention group 1163 MSF MRC participants invited 818 (74) responded

Control group 329 motorcycle riders responded to recruitment strategies

Non-active riders excluded from analysis




Interventions No formal training vs the non-mandatory Motorcycle Safety Foundationrsquos Motorcycle Rider Course (MRC) com-

prising of 8 hours theory (lectures discussions films and multiple choice tests) a textbook and 12 hours off-road

practice


Participants had all successfully completed the MRC

Outcomes Self-reported crashes police recorded crash reports

Length of follow up 6 months - 3 12 years

Notes Study conducted in South Dakota USA

Perrino 2002



Intervention group 2144 (unclear) MRC graduates (motorcycle licence applicants)

Control group 2601 (unclear) regular licensing test graduates (motorcycle licence applicants)Analysis sample size

Intervention group 1070 (unclear)


Interventions No formal training vs the mandatory (for those younger than 18 years) pre-licence Maryland Motorcycle Rider

Course (MRC) consisting of 8 hours theory and 12 hours practice



Outcomes Self-reported and police recorded crashes and offences






Perrino 2002 (Continued)

Notes Study conducted in Maryland USA

Raymond 1979



Intervention group

258 volunteers mainly (but not all) novice riders

Control group

1104 provisional licence applicants




Interventions No formal training vs the non-mandatory RACACU (Royal Automobile ClubAuto-Cycle Union) training scheme

The training program consisted of either 24 one-hour sessions or 13 two-hour sessions Twelve hours of the training

focused on theory about basic operational procedures traffic laws and highway code The practical session focused

on basic operational skills riding on a training area and riding in traffic with an instructor A proficiency test was

administered at the end of the course



Outcomes Self-reported crashes (including minor non-injury non-damage and off-road crashes)


Notes Study conducted in the UK

Satten 1980



Intervention group interviewers kept interviewing until they had 100 riders selected from a population of 891

enrollees in the MSF MRC course (unknown how many were asked and how many refused to participate)Control group unknown number of registered motorcycle riders




Control group 100

Interventions No formal training vs the non-mandatory Motorcycle Safety Foundationrsquos (MSF) Motorcycle Rider Course (MRC)

comprising of 8 hours theory (lectures discussions films and multiple choice tests) a textbook and 12 hours off-

road practice







Satten 1980 (Continued)

Outcomes Self-reported crashes injuries and offences



Savolainen 2007



Intervention group 4000 riders that had conducted the MSF MRC course (passed or failed)

Control group 4000 motorcycle owners or permit or endorsement holders from the Indiana Bureau of Motor

Vehicles database




Interventions Intervention integrity


Outcomes Probability of crash involvement


Notes Study conducted in Indiana USA

Swaddiwudhipong 1998



Intervention group

all 16 villages of 3 sub-districts

(participants were practising motorcyclists licensed and unlicensed)

Control group

18 villages of 3 other sub-districtsAnalysis sample size

Intervention group 3 districts (100)

Control group 3 districts (100)

Interventions No rider education vs non-mandatory community based rider education consisting of theory on motorcycle injury

risk helmet use traffic laws vehicle regulations and traffic signs and a written and skill test leading to a licence



Outcomes Injuries fatalities






Swaddiwudhipong 1998 (Continued)

Notes Study conducted in Tak Province rural Thailand

Waller 1992



Intervention group 349 riders who succesfully completed the Department of Public Safety motorcycle operator

training in 1988

Control group 349 motorcyclists who never completed the DPS motorcycle operator training



Control group 349

Interventions No DPS motorcycle operator training vs non-mandatory DPS motorcycle operator training The DPS training is

the Motorcycle Safety Foundationrsquos Motorcycle Rider Course comprising eight hours of theory (lectures discussions

films and multiple choice tests) a textbook and 12 hours off-road practice


All 349 riders succesfully completed the rider training

Outcomes Police recorded crashes


Notes Study conducted in

Characteristics of excluded studies [ordered by study ID]

Study Reason for exclusion

Anderson 1980a Study type review and process evaluation of a rider course

Aupetit 2008 Outcome proposal of a rider training curriculum that combines traditional training and a motorcycle riding

simulator

Awane 1999 Study type review on use of simulators in rider and driver training

Baldi 2005 Intervention not rider training but intervention integrity of rider training availabilty of rider education

implementation of graduated licensing system etc on a state-wide level

Batchler 1988 Study type description of a training course

Blanchard 2006 Study type not a study assessing the association between rider training and outcomes

Bonnett 2005 Outcome qualitative data regarding satisfaction with the training programme





(Continued)

Braver 2007 Outcome licensure rates

Clayton 1980 Outcome knowledge skills attitude

Council 1978 Outcome crash reduction in ANY vehicle not motorcycles exclusively

Crowther 2005 Study type qualitative study

Daniello 2009 Study type review of the effectiveness of motorcycle training and licensing

Dewanti 2007 Intervention emotional characteristics behaviour (ie not motocycle rider training)

Du Plooy 1990 Study type review of types of rider training courses in South Africa

Engel 1989 Study type uncontrolled before-after study

Goldenbeld 2002 Outcome skills

Goldenbeld 2004 Outcome knowledge and skills

Haworth 2000 Intervention balance between attitudinal andvehicle control skills acrosscurriculla of motorcycle rider training

courses

Haworth 2005 Study type review

Haworth 2006 Study type cross-sectional survey

Hill 1983 Study type review and description of training system

Imatake 1980 Study type course descriptionreview

Ingebritsen 1990 Intervention risk factors for motorcycle crashes

Jain 2009 Study type cross-sectional descriptive study of motorcycle crashes over a 5 year period

Jonah 1979 Study type cross-sectional survey Outcome scores on motorcycle operator skill test

Jonah 1981 Intervention evaluation of a motorcycle rider skill test not motorcycle rider training

Kadar 1990 Study type review of components of rider training courses

Kelsey 1986 Intervention evaluation of a motorcycle rider skill test not motorcycle rider training

Koch 1980 Study type reviewcourse description

Koch 1990 Study type description of course content





(Continued)

Labbett 2005 Study type essay about possible explanations for motorcycle deaths

Law 2005 Intervention targeted motorcycle safety programme not specifically rider training

Lowes 1990 Study type review and descriptions of rider training

Mahon 1976 Study type review of motorcycle rider training methods

Maxwell 1985 Outcomesrecommendations forprogramme operatorsand otherson howthe motorcycle trainingprogramme

works and how it can be improved

Mayhew 1996 Study type review

McKnight 1987 Study type evaluation of methodological and administrative aspects of a motorcycle operator skill test

McPherson 1976 Outcome knowledge and skills

Mohan 2004 Study type review of evidence of interventions to reduce road traffic injuries

Morgan 1980 Study type reviewcourse description

Motoki 1990 Study type proposal and development of rider training curriculum

Nairn 1992 Study type literature review

Newland 1980 Study type description of development of motorcycle safety course

Newland 1982 Study type descriptionreview of a rider training course

Newland 1990 Study type uncontrolled BeforeAfter study

Ormston 2003 Outcome changes in attitude and self reported behaviour

Osga 1979 Outcome knowledge attitudes and skills

Panou 2007 Intervention new simulation tool to teach driverrider

Peterson 1990 Study factor demographic details of course participants completing the course vs those not completing the

course

Prem 1984 Study type experimental

Study factor examines association between skills and performance in tests

Radin Umar 2006 Intervention motorcycle safety programme not specifically rider training

Rockwell 1990 Study type methodologically flawed study type





(Continued)

Rothe 1987 Study type qualitative study of rider training in general

Rowden 2007 Study type qualitative study

RSC Victoria 1993 Study type review of motorcycle rider training and education in Victoria

Russam 1979 Study type review of training programmes in Japan

Saffron 1981 Study type literature review

Schulz 1990 Study factor predictors of motorcycle crashes

Sexton 2004 Study type cross-sectional analytic analysis

Shephard 1986 Study factor reviewdescription of programme

Simpson 1990 Study type review of motorcycle rider trainingeducation

Sokolov 1990 Study factor review of motorcycle riding courses in USSR

Steffens 1988 Outcome self-reported behaviour experiences and researcher observed riding behaviour

Sudlow 2003 Study type review of motorcycle training in the UK

Tasmania 1995 Study type cross-sectional descriptiveprocess evaluation

Tetard 1985 Study type experimental

Outcome detection of indices

Thackray 1980 Outcome instructional effectiveness user acceptance administrative feasibility

Thompson 1994 Study type cross-sectional survey

Outcome attitudes and knowledge

Tobler 1990 Study type review of course curricula

Transport 1989 Intervention syllabus for rider training

Tuan 2007 Study type cross-sectional study (survey) which does not assess the effects of an intervention but examines

motocyclistsrsquo behaviour

Victor 1980 Study type review

Waterer 1990 Study type review of UK rider training issues

Weller 1989 Study type review of studies evaluating motorcycle safety and education measures





(Continued)

Wells 1981 Study type description of different methods of training

Winn 1986 Study type review of rsquohistoryrsquo of rider training

Wisher 1988 Study type cross-sectional survey

Wood 1987 Study type Interrupted Time Series but did not meet the criteria for an ITS as published by the Cochrane

Effective Practice and Organisation of Care Group

Yamazaki 1990 Study type cross-sectional survey

Outcome riding skills skills retention and attitude

Characteristics of ongoing studies [ordered by study ID]

Burgess 2010

Trial name or title UKs National Ride program


Participants Motorcycle offenders

Interventions Police led diversion program

Outcomes Self reported attitudinal and behavioural measures

Starting date

Contact information

Notes Expected to be completed in early 2010





D A T A A N D A N A L Y S E S

This review has no analyses

A P P E N D I C E S

Appendix 1 Search strategy


bull Cochrane Injuries Group Specialised Register (searched 22 Sept 2008)

bull CENTRAL (The Cochrane Library 2008 Issue 3)

bull TRANSPORT 1988 to 200706 (latest date available)





bull WHOLIS (World Health Organization Library Information System) (to Sept 2008)


bull LILACS (BIREME) (Latin American and Caribbean Health Sciences) (1982 to Sept 2008)

bull ISI Web of Science Social Sciences Citation Index (SSCI) 1970 to Sept 2008

bull ERIC (searched 25 Sept 2008)

bull ZETOC (searched 25 Sept 2008)

bull SIGLE (searched 25 Sept 2008)

All of the databases were searched using the following text-word search strategy The strategy was adapted using either rsquorsquo or rsquo$rsquo as atruncation symbol

1 motor-cycl or motorcycl or motor-bik or motorbik or motor-scooter or motorscooter or scooter or moped or motocycl

or motocicl or moto

2 train or educat or instruct or program or course or qualif or learn or improv

3 1 and 2

H I S T O R Y

Protocol first published Issue 2 2005

Review first published Issue 10 2010





C O N T R I B U T I O N S O F A U T H O R S

Katina Kardamanidis was the first author of the protocol conducted the literature search extracted full studies assessed the studies

according to inclusion criteria assessed quality of the studies compared findings with the second author discussed disagreements with

the third author wrote the drafts and the final review

Rebecca Ivers was the second author of the protocol assessed the studies according to inclusion criteria assessed quality of the studies

compared findings with the first author edited the final draft and provided overall guidance for the process

Alexandra Martiniuk assessed quality of the studies compared findings with the first author discussed disagreements with the third

author and helped write the first draft and the final review

Mark Stevenson contributed to the protocol reviewed methods of studies and contributed to the final draft

Katrina Thistlethwaite conducted a second literature search extracted full studies and contributed to the final draft

D E C L A R A T I O N S O F I N T E R E S T

None known

S O U R C E S O F S U P P O R T

Internal sources

bull No sources of support supplied

External sources

bull National Health and Medical Research Council of Australia Australia

Salary support for Martiniuk Ivers and Stevenson

bull University of Sydney Sesqui Research Grant Australia

Direct research costs and salary support for Kardamanidis

D I F F E R E N C E S B E T W E E N P R O T O C O L A N D R E V I E W

There are no differences between the protocol and the review

I N D E X T E R M S

Medical Subject Headings (MeSH)

lowastMotorcycles Accident Prevention [lowastmethods] Accidents Traffic [lowastprevention amp control] Licensure Program Evaluation Wounds

and Injuries [mortality lowastprevention amp control]





MeSH check words

Humans



T A B L E O F C O N T E N T S

1HEADER 1ABSTRACT

2PLAIN LANGUAGE SUMMARY

2BACKGROUND

3OBJECTIVES

3METHODS

11RESULTS

20DISCUSSION

23AUTHORSrsquo CONCLUSIONS

24ACKNOWLEDGEMENTS

24REFERENCES

29CHARACTERISTICS OF STUDIES

46DATA AND ANALYSES

46APPENDICES

46HISTORY

46CONTRIBUTIONS OF AUTHORS

47DECLARATIONS OF INTEREST

47SOURCES OF SUPPORT

47DIFFERENCES BETWEEN PROTOCOL AND REVIEW

47INDEX TERMS

iMotorcycle rider training for the prevention of road traffic crashes (Review)














10100214651858CD005240pub2


A B S T R A C T

Background




Objectives



Search strategy





Selection criteria






third review author





Main results
























recommended




B A C K G R O U N D











(Peden 2004)














































(Weaver 1990)




death

O B J E C T I V E S




M E T H O D S


Types of studies

















status

Electronic searches



Sept 2008)












1970 to Sept 2008














training





use













where




usable










records



















use





course































occurred















status







training graduates













to cases





























validated


tionnaires













































accident reports












separately




group






groups separately



separately

















control group


R E S U L T S







studies)









1997 MAIDS 2004)











































studies







training














in 1976





























rider training











conducted








end of the course





a licence


















was not described















information
















Allocation bias





























Selection bias













Detection bias







Attrition bias
































at the same time





Analysis




















trials








Selection bias






















the analysis
















































Detection bias


































tained

Attrition bias










































groups

Survival bias






























Analysis




























































rider training

Selection bias







































available








Detection bias







































Analysis




















Randomised trials





Crashes















Offences







groups






Cohort studies

Crashes




Offences




groups


Crashes




076 to 110)


Randomised trial

Injuries and deaths







tween groups

Cohort studies

Crashes






Injuries and deaths








Offences






Crashes


Offences





Cohort studies

Crashes





































result

Injuries and deaths




was reported

Offences













OR 146 95 CI 064 to 337)







Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans













10100214651858CD005240pub2


A B S T R A C T

Background




Objectives



Search strategy





Selection criteria






third review author





Main results
























recommended




B A C K G R O U N D











(Peden 2004)














































(Weaver 1990)




death

O B J E C T I V E S




M E T H O D S


Types of studies

















status

Electronic searches



Sept 2008)












1970 to Sept 2008














training





use













where




usable










records



















use





course































occurred















status







training graduates













to cases





























validated


tionnaires













































accident reports












separately




group






groups separately



separately

















control group


R E S U L T S







studies)









1997 MAIDS 2004)











































studies







training














in 1976





























rider training











conducted








end of the course





a licence


















was not described















information
















Allocation bias





























Selection bias













Detection bias







Attrition bias
































at the same time





Analysis




















trials








Selection bias






















the analysis
















































Detection bias


































tained

Attrition bias










































groups

Survival bias






























Analysis




























































rider training

Selection bias







































available








Detection bias







































Analysis




















Randomised trials





Crashes















Offences







groups






Cohort studies

Crashes




Offences




groups


Crashes




076 to 110)


Randomised trial

Injuries and deaths







tween groups

Cohort studies

Crashes






Injuries and deaths








Offences






Crashes


Offences





Cohort studies

Crashes





































result

Injuries and deaths




was reported

Offences













OR 146 95 CI 064 to 337)







Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans



Main results
























recommended




B A C K G R O U N D











(Peden 2004)














































(Weaver 1990)




death

O B J E C T I V E S




M E T H O D S


Types of studies

















status

Electronic searches



Sept 2008)












1970 to Sept 2008














training





use













where




usable










records



















use





course































occurred















status







training graduates













to cases





























validated


tionnaires













































accident reports












separately




group






groups separately



separately

















control group


R E S U L T S







studies)









1997 MAIDS 2004)











































studies







training














in 1976





























rider training











conducted








end of the course





a licence


















was not described















information
















Allocation bias





























Selection bias













Detection bias







Attrition bias
































at the same time





Analysis




















trials








Selection bias






















the analysis
















































Detection bias


































tained

Attrition bias










































groups

Survival bias






























Analysis




























































rider training

Selection bias







































available








Detection bias







































Analysis




















Randomised trials





Crashes















Offences







groups






Cohort studies

Crashes




Offences




groups


Crashes




076 to 110)


Randomised trial

Injuries and deaths







tween groups

Cohort studies

Crashes






Injuries and deaths








Offences






Crashes


Offences





Cohort studies

Crashes





































result

Injuries and deaths




was reported

Offences













OR 146 95 CI 064 to 337)







Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans







































(Weaver 1990)




death

O B J E C T I V E S




M E T H O D S


Types of studies

















status

Electronic searches



Sept 2008)












1970 to Sept 2008














training





use













where




usable










records



















use





course































occurred















status







training graduates













to cases





























validated


tionnaires













































accident reports












separately




group






groups separately



separately

















control group


R E S U L T S







studies)









1997 MAIDS 2004)











































studies







training














in 1976





























rider training











conducted








end of the course





a licence


















was not described















information
















Allocation bias





























Selection bias













Detection bias







Attrition bias
































at the same time





Analysis




















trials








Selection bias






















the analysis
















































Detection bias


































tained

Attrition bias










































groups

Survival bias






























Analysis




























































rider training

Selection bias







































available








Detection bias







































Analysis




















Randomised trials





Crashes















Offences







groups






Cohort studies

Crashes




Offences




groups


Crashes




076 to 110)


Randomised trial

Injuries and deaths







tween groups

Cohort studies

Crashes






Injuries and deaths








Offences






Crashes


Offences





Cohort studies

Crashes





































result

Injuries and deaths




was reported

Offences













OR 146 95 CI 064 to 337)







Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans












training





use













where




usable










records



















use





course































occurred















status







training graduates













to cases





























validated


tionnaires













































accident reports












separately




group






groups separately



separately

















control group


R E S U L T S







studies)









1997 MAIDS 2004)











































studies







training














in 1976





























rider training











conducted








end of the course





a licence


















was not described















information
















Allocation bias





























Selection bias













Detection bias







Attrition bias
































at the same time





Analysis




















trials








Selection bias






















the analysis
















































Detection bias


































tained

Attrition bias










































groups

Survival bias






























Analysis




























































rider training

Selection bias







































available








Detection bias







































Analysis




















Randomised trials





Crashes















Offences







groups






Cohort studies

Crashes




Offences




groups


Crashes




076 to 110)


Randomised trial

Injuries and deaths







tween groups

Cohort studies

Crashes






Injuries and deaths








Offences






Crashes


Offences





Cohort studies

Crashes





































result

Injuries and deaths




was reported

Offences













OR 146 95 CI 064 to 337)







Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans

















use





course































occurred















status







training graduates













to cases





























validated


tionnaires













































accident reports












separately




group






groups separately



separately

















control group


R E S U L T S







studies)









1997 MAIDS 2004)











































studies







training














in 1976





























rider training











conducted








end of the course





a licence


















was not described















information
















Allocation bias





























Selection bias













Detection bias







Attrition bias
































at the same time





Analysis




















trials








Selection bias






















the analysis
















































Detection bias


































tained

Attrition bias










































groups

Survival bias






























Analysis




























































rider training

Selection bias







































available








Detection bias







































Analysis




















Randomised trials





Crashes















Offences







groups






Cohort studies

Crashes




Offences




groups


Crashes




076 to 110)


Randomised trial

Injuries and deaths







tween groups

Cohort studies

Crashes






Injuries and deaths








Offences






Crashes


Offences





Cohort studies

Crashes





































result

Injuries and deaths




was reported

Offences













OR 146 95 CI 064 to 337)







Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans





occurred















status







training graduates













to cases





























validated


tionnaires













































accident reports












separately




group






groups separately



separately

















control group


R E S U L T S







studies)









1997 MAIDS 2004)











































studies







training














in 1976





























rider training











conducted








end of the course





a licence


















was not described















information
















Allocation bias





























Selection bias













Detection bias







Attrition bias
































at the same time





Analysis




















trials








Selection bias






















the analysis
















































Detection bias


































tained

Attrition bias










































groups

Survival bias






























Analysis




























































rider training

Selection bias







































available








Detection bias







































Analysis




















Randomised trials





Crashes















Offences







groups






Cohort studies

Crashes




Offences




groups


Crashes




076 to 110)


Randomised trial

Injuries and deaths







tween groups

Cohort studies

Crashes






Injuries and deaths








Offences






Crashes


Offences





Cohort studies

Crashes





































result

Injuries and deaths




was reported

Offences













OR 146 95 CI 064 to 337)







Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans

























validated


tionnaires













































accident reports












separately




group






groups separately



separately

















control group


R E S U L T S







studies)









1997 MAIDS 2004)











































studies







training














in 1976





























rider training











conducted








end of the course





a licence


















was not described















information
















Allocation bias





























Selection bias













Detection bias







Attrition bias
































at the same time





Analysis




















trials








Selection bias






















the analysis
















































Detection bias


































tained

Attrition bias










































groups

Survival bias






























Analysis




























































rider training

Selection bias







































available








Detection bias







































Analysis




















Randomised trials





Crashes















Offences







groups






Cohort studies

Crashes




Offences




groups


Crashes




076 to 110)


Randomised trial

Injuries and deaths







tween groups

Cohort studies

Crashes






Injuries and deaths








Offences






Crashes


Offences





Cohort studies

Crashes





































result

Injuries and deaths




was reported

Offences













OR 146 95 CI 064 to 337)







Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans


































accident reports












separately




group






groups separately



separately

















control group


R E S U L T S







studies)









1997 MAIDS 2004)











































studies







training














in 1976





























rider training











conducted








end of the course





a licence


















was not described















information
















Allocation bias





























Selection bias













Detection bias







Attrition bias
































at the same time





Analysis




















trials








Selection bias






















the analysis
















































Detection bias


































tained

Attrition bias










































groups

Survival bias






























Analysis




























































rider training

Selection bias







































available








Detection bias







































Analysis




















Randomised trials





Crashes















Offences







groups






Cohort studies

Crashes




Offences




groups


Crashes




076 to 110)


Randomised trial

Injuries and deaths







tween groups

Cohort studies

Crashes






Injuries and deaths








Offences






Crashes


Offences





Cohort studies

Crashes





































result

Injuries and deaths




was reported

Offences













OR 146 95 CI 064 to 337)







Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans





separately




group






groups separately



separately

















control group


R E S U L T S







studies)









1997 MAIDS 2004)











































studies







training














in 1976





























rider training











conducted








end of the course





a licence


















was not described















information
















Allocation bias





























Selection bias













Detection bias







Attrition bias
































at the same time





Analysis




















trials








Selection bias






















the analysis
















































Detection bias


































tained

Attrition bias










































groups

Survival bias






























Analysis




























































rider training

Selection bias







































available








Detection bias







































Analysis




















Randomised trials





Crashes















Offences







groups






Cohort studies

Crashes




Offences




groups


Crashes




076 to 110)


Randomised trial

Injuries and deaths







tween groups

Cohort studies

Crashes






Injuries and deaths








Offences






Crashes


Offences





Cohort studies

Crashes





































result

Injuries and deaths




was reported

Offences













OR 146 95 CI 064 to 337)







Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans





control group


R E S U L T S







studies)









1997 MAIDS 2004)











































studies







training














in 1976





























rider training











conducted








end of the course





a licence


















was not described















information
















Allocation bias





























Selection bias













Detection bias







Attrition bias
































at the same time





Analysis




















trials








Selection bias






















the analysis
















































Detection bias


































tained

Attrition bias










































groups

Survival bias






























Analysis




























































rider training

Selection bias







































available








Detection bias







































Analysis




















Randomised trials





Crashes















Offences







groups






Cohort studies

Crashes




Offences




groups


Crashes




076 to 110)


Randomised trial

Injuries and deaths







tween groups

Cohort studies

Crashes






Injuries and deaths








Offences






Crashes


Offences





Cohort studies

Crashes





































result

Injuries and deaths




was reported

Offences













OR 146 95 CI 064 to 337)







Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans





in 1976





























rider training











conducted








end of the course





a licence


















was not described















information
















Allocation bias





























Selection bias













Detection bias







Attrition bias
































at the same time





Analysis




















trials








Selection bias






















the analysis
















































Detection bias


































tained

Attrition bias










































groups

Survival bias






























Analysis




























































rider training

Selection bias







































available








Detection bias







































Analysis




















Randomised trials





Crashes















Offences







groups






Cohort studies

Crashes




Offences




groups


Crashes




076 to 110)


Randomised trial

Injuries and deaths







tween groups

Cohort studies

Crashes






Injuries and deaths








Offences






Crashes


Offences





Cohort studies

Crashes





































result

Injuries and deaths




was reported

Offences













OR 146 95 CI 064 to 337)







Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans










Allocation bias





























Selection bias













Detection bias







Attrition bias
































at the same time





Analysis




















trials








Selection bias






















the analysis
















































Detection bias


































tained

Attrition bias










































groups

Survival bias






























Analysis




























































rider training

Selection bias







































available








Detection bias







































Analysis




















Randomised trials





Crashes















Offences







groups






Cohort studies

Crashes




Offences




groups


Crashes




076 to 110)


Randomised trial

Injuries and deaths







tween groups

Cohort studies

Crashes






Injuries and deaths








Offences






Crashes


Offences





Cohort studies

Crashes





































result

Injuries and deaths




was reported

Offences













OR 146 95 CI 064 to 337)







Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans



Analysis




















trials








Selection bias






















the analysis
















































Detection bias


































tained

Attrition bias










































groups

Survival bias






























Analysis




























































rider training

Selection bias







































available








Detection bias







































Analysis




















Randomised trials





Crashes















Offences







groups






Cohort studies

Crashes




Offences




groups


Crashes




076 to 110)


Randomised trial

Injuries and deaths







tween groups

Cohort studies

Crashes






Injuries and deaths








Offences






Crashes


Offences





Cohort studies

Crashes





































result

Injuries and deaths




was reported

Offences













OR 146 95 CI 064 to 337)







Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans




Detection bias


































tained

Attrition bias










































groups

Survival bias






























Analysis




























































rider training

Selection bias







































available








Detection bias







































Analysis




















Randomised trials





Crashes















Offences







groups






Cohort studies

Crashes




Offences




groups


Crashes




076 to 110)


Randomised trial

Injuries and deaths







tween groups

Cohort studies

Crashes






Injuries and deaths








Offences






Crashes


Offences





Cohort studies

Crashes





































result

Injuries and deaths




was reported

Offences













OR 146 95 CI 064 to 337)







Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans
















Analysis




























































rider training

Selection bias







































available








Detection bias







































Analysis




















Randomised trials





Crashes















Offences







groups






Cohort studies

Crashes




Offences




groups


Crashes




076 to 110)


Randomised trial

Injuries and deaths







tween groups

Cohort studies

Crashes






Injuries and deaths








Offences






Crashes


Offences





Cohort studies

Crashes





































result

Injuries and deaths




was reported

Offences













OR 146 95 CI 064 to 337)







Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans




















available








Detection bias







































Analysis




















Randomised trials





Crashes















Offences







groups






Cohort studies

Crashes




Offences




groups


Crashes




076 to 110)


Randomised trial

Injuries and deaths







tween groups

Cohort studies

Crashes






Injuries and deaths








Offences






Crashes


Offences





Cohort studies

Crashes





































result

Injuries and deaths




was reported

Offences













OR 146 95 CI 064 to 337)







Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans



Crashes















Offences







groups






Cohort studies

Crashes




Offences




groups


Crashes




076 to 110)


Randomised trial

Injuries and deaths







tween groups

Cohort studies

Crashes






Injuries and deaths








Offences






Crashes


Offences





Cohort studies

Crashes





































result

Injuries and deaths




was reported

Offences













OR 146 95 CI 064 to 337)







Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans



Offences






Crashes


Offences





Cohort studies

Crashes





































result

Injuries and deaths




was reported

Offences













OR 146 95 CI 064 to 337)







Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans



Injuries and deaths


















death (OR 02 95 CI 01 to 08)

D I S C U S S I O N





control studies


















2004)







































studies





exposure
































































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans





























































































factors






























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans
























































licensure



























reducing crashes









































these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans






























these outcomes

























































settings






















R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans













R E F E R E N C E S





























ISBN 0 642 25501 6 ]









USA 198059ndash93















20179


























19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans

















19791ndash131









19


















Ljubljana 20089
















Territory 2005











Center 19781ndash40







Meeting 200913





























3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans









3131




Report no240]





Queensland 2006













institutt 1990





























































283ndash312












CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans







CR 117













Foundation 1990




2003














113 to 13-129











Safety 1990



59ndash83































19904ndash37 - 4-48









[ Report No 36]
















































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans






































Berkshire UK 1981





















Limited 2010


Anderson 1980




DC 1980

Bjornstig 1985


Clayton 1990




Florida USA 199013-105 to 13-111




Elliot 2003






FORS 1999



19991ndash2

Haworth 2005







Johnston 2008





081ndash26

Juumlni 2001



42ndash6





Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans



Kopits 2003



Leung 1983




Liu 2004



Mohan 2002







Mullin 1997




Noordzij 2001






Osga 1979






Peden 2004




Radin Umar 1995




Tsai 1995





Vis 1995





Weaver 1990



Winn 1987





Yuan 2000



(4)559ndash63

Zambon 2006










Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans





Adams 1985







Total 98 (61)


8 hours)






Anderson 1980







Control group 15080

Total 40874 (99)





motorcycle












Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans





Billheimer 1998














Cooper 1988




Control group 402




Total 863 (984)










Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans



Davis 1997














Hall 1988





Control group 6604














group 35









Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans





Haworth 1997






Initial sample size

Cases 336

Controls 1195


Cases 234 (70)

Controls 561 (47)






Hurt 1981



cases included



Initial sample size








report validated








Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans





Jonah 1982



Intervention group


Control group




Intervention group









Kloeden 1994




























Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans











Kraus 1975








Controls 738


Controls 434 (59)





Leung 1987






Control group 43094













MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans







MAIDS 2004




Initial sample size

Cases not reported






Outcomes Crashes


McDavid 1989












programme











Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans





Mortimer 1984





Response rates













Mortimer 1988























Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans







Osga 1980










practice






Perrino 2002



















Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans





Raymond 1979



Intervention group


Control group















Satten 1980








Control group 100



road practice











Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans







Savolainen 2007





Vehicles database












Intervention group



Control group
















Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans





Waller 1992




training in 1988




Control group 349













simulator











(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans



(Continued)












courses

















(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans



(Continued)





















course









(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans



(Continued)






























(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans



(Continued)









Burgess 2010






Starting date

Contact information








A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans





A P P E N D I C E S



















or motocicl or moto


3 1 and 2

H I S T O R Y


















None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans














None known


Internal sources


External sources







I N D E X T E R M S








MeSH check words

Humans



MeSH check words

Humans

kardamanidis et al (2010) - motorcycle rider training for the prevention of road traffic crashes

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