Post-licence driver education for the prevention of road traffic crashes: a systematic review of randomised controlled trials

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Abstract

The effectiveness of post-licence driver education for preventing road traffic crashes was quantified using a systematic review and meta-analyses of randomised controlled trials. Searches of appropriate electronic databases, the Internet and reference lists of relevant papers were conducted. The searches were not restricted by language or publication status. Data were pooled from 21 randomised controlled trials, including over 300,000 full licence-holding drivers of all ages. Nineteen trials reported subsequent traffic offences, with a pooled relative risk of 0.96 (95% confidence interval 0.94, 0.98). Fifteen trials reported traffic crashes with a pooled relative risk of 0.98 (0.96, 1.01). Four trials reported injury crashes with a pooled relative risk of 1.12 (0.88, 1.41). The results provide no evidence that post-licence driver education is effective in preventing road injuries or crashes. Although the results are compatible with a small reduction in the occurrence of traffic crashes, this may be due to selection biases or bias in the included trials.

Introduction

Each year over a million people are killed and some 10 million people are permanently disabled in road traffic crashes, worldwide (Murray and Lopez, 1996). For people under 44 years, road traffic crashes are second only to HIV and AIDS as a cause of death. Furthermore, the evidence suggests that the global epidemic of road traffic injuries is only beginning.

Because driver error is considered to be an important factor in the causation of road traffic crashes, great emphasis has been placed in road safety strategies on efforts to reduce driver error through driver education programmes. Promoting post-licence driver education, enhancing the status of advanced driving qualifications and encouraging extra training for professional drivers are key components of the UK government's road safety strategy (DETR, 2000). Many people drive as part of their job, and traffic crashes are now a leading cause of occupational injury with an estimated 92,000 work-related road traffic deaths each year worldwide (Takala, 1999). In response, some companies invest, at significant cost in driver education programmes for their employees. Driver education programmes have also been offered to drivers who have committed traffic offences. In some cases, drivers attending such programmes are offered lower insurance premiums or can have citations removed from their driving records, on the assumption that they would be ‘safer’ drivers after the programme.

In the past few years, however, a different perspective on road safety has emerged that emphasises a systems approach to improving road safety and that questions an over-reliance on education. It is well established in industrial safety that the operator is only part of a dynamic system with many components and has inherent limitations and predictable error rates. The systems approach accepts driver limitations and aims to reduce traffic crashes by designing the traffic environment with these limitations in mind. From a systems perspective, it is those that build and operate the road system that have the greatest impact on road safety and attempting to eliminate driver error is considered unlikely to have any significant impact in reducing traffic crashes (Mackay and Tiwari, 2001).

The debate about the value of driver education programmes can best be resolved by a consideration of the empirical evidence for their effectiveness. Indeed, the preparation of systematic reviews of the evidence for the effectiveness of road safety interventions has been given a high priority by the World Health Organization in its strategy to reduce traffic injuries. This systematic review was commissioned by the Head of Occupational Safety of AstraZeneca, a large pharmaceutical company, in response to a BMJ editorial (Roberts et al., 2002) calling for road safety policy to be based on evidence. In 2002, the 26,000 AstraZeneca sales representatives drove approximately 514 million km in total and there were 111 traffic crashes, of which 11 were serious. Road traffic injuries account for 59% of all lost time injuries and are the most common cause of injury within the company. The company had responded by providing driver education programmes. This review was conducted in order to establish whether this approach was effective.

Section snippets

Searching

We searched the following electronic databases: Cochrane Injuries Group's specialised register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, TRANSPORT (NTIS, TRIS, TRANSDOC, IRRD), Road Res. (ARRB), ATRI, National Research Register, PsycInfo, ERIC, SPECTR, Zetoc, SIGLE and Science (and Social Science) Citation Index. We searched the internet, checked reference lists of relevant papers and contacted appropriate organisations. The search was not restricted by language or

Quantitative data synthesis

The combined search strategy identified approximately 1300 published and unpublished studies, of which 87 were deemed to be potentially relevant based on the title or abstract. After a full text review 24 trials were judged to meet the inclusion criteria (Table 1) including more than 300,000 randomised participants.

The methodological quality of included trials was generally poor. Using predefined criteria (Schulz et al., 1995) the quality of allocation concealment was adequate in one, unclear

Discussion

This systematic review of randomised controlled trials provides no evidence that driver education programmes are effective in preventing road traffic injuries or crashes. Although the results are compatible with a small reduction in the occurrence of traffic offences, this may be due to publication or other selection biases, or else to bias in the included trials. Because of the large number of randomised participants included in the meta-analysis, close to 300,000 for some outcomes, we can

Acknowledgements

Many thanks to Johan Collander and Mirna Holle for help with translation, Paul Chinnock for proof reading and to the authors who provided us with further details of their studies. This systematic review is also published on the Cochrane Library where it will be regularly updated to take account of new data and comments. Ker K, Roberts I, Collier T, Beyer F, Bunn F, Frost C. Post-licence driver education for the prevention of road traffic crashes (Cochrane Review). In: The Cochrane Library,

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