Title: Maximising cycling safety to improve public health: a Cochrane review to assess the effectiveness of cycling infrastructure at reducing the risk of cycling injuries in cyclists
Funder: Department of Health (England)

Abstract: Methods: We will include RCTs cluster-RCTs controlled before-and-after studies and non randomised controlled trials. Target population and setting: Adult and child cyclists in the urban and rural environment in developed countries. Intervention being evaluated: 1. Cycling infrastructure that aims to manage the shared use of the road space for motorized vehicles and cyclists. 2. Infrastructure to separate cycle traffic from motorized traffic. 3. The management of infrastructure which aims to separate different types of traffic using direction signage which differentiates by vehicle type or speed management by the use of physical measures such as narrowed roads or speed bumps. (See section C2 for more details). In some situations there will be more than one infrastructure feature in place and the effect of individual features will be determined where possible. Studies for inclusion must include some measure of cycling injuries either self-reported non medically attended or medically attended. We will not include injuries sustained while racing mountain biking or playing but we will include those sustained as a result of maintenance issues of infrastructure such as poor surfaces. Search strategy:Search strategies will be developed iteratively: results will be assessed to determine whether the strategy is identifying relevant papers and adjusted as required. The proposed review will include a search of the following databases Medline PubMed Embase Geobase SIGLE Index to Theses SafetyLit Google Scholar TRANweb TRID the Cochrane Library and also the database at the Transport Research Laboratory. We will systematically search the internet. We will search relevant websites such as the National Bicycle Safety Network and the Cycling Embassy of Great Britain and road safety organisations such as AAA Foundation for Traffic Safety Australian Road Research Board Transport Canada and Transportation Research Board (US). We will handsearch abstracts of relevant conferences that is the World Conference on Injury Prevention and Safety Promotion Australian Cycling Conference NZ Cycling Conference and the European Transport Conference. We will search reference lists of included studies. Where we are unable to find the full paper or if we require further data we will contact authors. Review Process: A two stage screening process will be undertaken. Two reviewers will independently scan titles and abstracts of articles for relevance according to pre-determined criteria for study inclusion. For those articles retained at this stage the full article will be retrieved and will be reviewed independently once again by two reviewers for relevance. Disagreement at either stage will be dealt with by deferment to a third reviewer. Papers retained at this stage will be included in the review. An initial scoping exercise suggests that approximately 30 articles will be included in the final review. Two authors will independently extract data using an extraction form designed specifically for this review and pre-tested. Reviewers will extract data on study design country characteristics of the intervention and control areas nature of the intervention length of follow up and relevant outcome data. Two authors will undertake critical appraisal of the included studies for potential sources of bias; these will be selection performance detection reporting and attrition bias rated as high low or unclear. It is anticipated that due to the nature of the intervention the majority of the studies will be non RCT and for these studies quality assessment will consider selection bias based on the degree of similarity between the control and intervention areas performance and detection bias will be based on an assessment of whether data collection and analyses were performed by a researcher blind to location/time of data collection and attrition bias will consider length of time of data collection before and after installation of intervention. For both data extraction and critical appraisal the findings of the two reviewers will be examined for discrepancies. Expected output of research: Where sufficient data is available a meta-analysis will be undertaken. For binary outcome measures pooled relative risk will be estimated using random-effects meta-analysis and summary data. For outcomes measured as rates pooled incidence rate ratios (IRR) will be estimated using summary data and a random-effects model. A fixed-effects model will be used if there are fewer than five studies. If there are insufficient clinically homogenous studies to combine in a meta-analysis the results from individual studies will be combined in a narrative review. We will undertake statistical tests of homogeneity using chi squared tests (with significance defined as a P-value of <0.1) and the I2 statistic will be presented. Heterogeneity will be explored using subgroup analyses (these will include separate analyses of randomised and non randomised studies). If there are sufficient studies and there has been uncertainty or disagreement regarding the inclusion of studies missing data or in the event of one or more studies dominating the results a sensitivity analysis will be undertaken to determine whether the findings are robust to the decisions made relating to choice of study inclusion. If appropriate the possibility of publication bias will be assessed using funnel plots. Findings from the review will be presented in a report which will include strengths and weaknesses of the review and implications for practice and research. We will disseminate the findings through presentations at conferences and through peer reviewed publications. Timetable. Months 1-4 Devising and running search strategies handsearching - time required to identify studies in grey literature.Months 5-6 Initial review of titles and abstracts.Months 7-9 Obtaining copies of full papers review of full papers data extraction.Months 10-12 Data analyses and summarising.Months 13-15 Write up and dissemination.


Research activity codes: 3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS
Health categories: INJURIES AND ACCIDENTS