Does an on-road motorcycle coaching program reduce crashes in novice riders? A randomised control trial

ContentslistsavailableatScienceDirect

Accident

Analysis

and

Prevention

j o ur na l h o me pa g e :w w w . e l s e v i e r . c o m / l o c a t e / a a p

Does

an

on-road

motorcycle

coaching

program

reduce

crashes

in

novice

riders?

A

randomised

control

trial

Rebecca

Q.

Ivers

,

Chika

Sakashita

_,

_Teresa

_Senserrick

_,

_Jane

_Elkington

_,

_Serigne

_Lo

_,

Soufiane

Boufous

_,

_Liz

_de

_Rome

a_{TheGeorgeInstituteforGlobalHealth,UniversityofSydney,Sydney,Australia} b_{TransportandRoadSafetyResearch,TheUniversityofNSW,Sydney,Australia} c_{NewYorkUniversity,Sydney,Sydney,Australia}

d_{NeuroscienceResearchAustralia,Sydney,Australia}

a

r

t

i

c

l

e

i

n

f

o

Articlehistory:

Received24June2015

Receivedinrevisedform13October2015 Accepted15October2015

Availableonline26October2015

Keywords: Injuryprevention Roadsafety Epidemiology Motorcycle

a

b

s

t

r

a

c

t

Objectives:Motorcycleridingisincreasinggloballyandconfersahighriskofcrash-relatedinjuryand death.Thereiscommunitydemandforinvestmentinridertrainingprogramsbutnohigh-quality evi-denceaboutitseffectivenessinpreventingcrashes.Thisrandomisedtrialofanon-roadridercoaching programaimedtodetermineitseffectivenessinreducingcrashesinnovicemotorcycleriders. Methods:BetweenMay2010andOctober2012,2399newly-licensedprovisionalriderswererecruitedin Victoria,Australiaandcompletedatelephoneinterviewbeforerandomisationtointerventionorcontrol groups.Ridersintheinterventiongroupwereofferedanon-roadmotorcycleridercoachingprogram whichinvolvedpre-programactivities,4hridingandfacilitateddiscussioninsmallgroupswithariding coach.Outcomemeasureswerecollectedforallparticipantsviatelephoneinterviewsat3and12months afterprogramdelivery(orequivalentforcontrols),andvialinkagetopolice-recordedcrashandoffence data.Theprimaryoutcomewasacompositemeasureofpolice-recordedandself-reportedcrashes; sec-ondaryoutcomesincludedtrafficoffences,nearcrashes,ridingexposure,andridingbehavioursand motivations.

Results:Follow-upwas89%at3monthsand88%at12months;60%oftheinterventiongroupcompleted theprogram.Intention-to-treatanalysesconductedin2014indicatednoeffectoncrashriskat3months (adjustedOR0.90,95%CI:0.65–1.27)or12months(adjustedOR1.00,95%CI:0.78–1.29).Ridersinthe interventiongroupreportedincreasedridingexposure,speedingbehavioursandriderconfidence. Conclusions:Therewasnoevidencethatthison-roadmotorcycleridercoachingprogramreducedthe riskofcrash,andwefoundanincreaseincrash-relatedriskfactors.

©2015TheAuthors.PublishedbyElsevierLtd.ThisisanopenaccessarticleundertheCCBY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/4.0/).

1. Introduction

Motorcyclesarewidelyusedglobally,with314million pow-eredtwo-andthree-wheelers(PTW)registeredin154countries in2010,representinga quarterof allregisteredvehicles.PTWs accountedfornearlyonehalfoftotalregisteredvehiclesin low-andmiddle-incomecountries(49.6%and45.8%)and6.8%in high-incomecountriesin2010(WorldHealthOrganisation,2013).

Motorcycleridershaveahighriskofcrashrelatedinjury com-paredtocaroccupants:inhighincomecountrysettingstherate ofdeathandseriousinjuryformotorcyclistsis30–40timesthatof

∗Correspondingauthorat:TheGeorgeInstituteforGlobalHealth,Universityof Sydney,POBoxM201,MissendenRoad,2050NSW,Australia.

E-mailaddress:[email protected](R.Q.Ivers).

caroccupants(Johnstonetal.,2008).Inlowincomesettingsroad injuryisasignificantcontributortocatastrophichouseholdcosts (Nguyenetal.,2013)andmotorcyclerelatedtraumaisarapidly growingpublichealthissue.

Noviceridershaveagreaterriskofcrashingthanexperienced riders(Mullinetal.,2000;Haworthetal.,2000).Althoughskill developmentfornoviceridersisimportantforsaferiding,there is little evidence on whether rider training programs decrease riskofcrashinnoviceriders.Multiplestudieshaveexaminedthe effectivenessofvariousridertrainingprograms,buta Cochrane reviewfoundresearchoneffectivenessofridertrainingprograms tobeinconclusive(Kardamanidis et al.,2010).The reviewalso recommendedthatdue tosignificantattritioninprevious stud-iesoflearnerriders,anyfuturetrialsshouldfocusonrecruiting committedriders whohad passedtheirprovisional licencetest (Kardamanidisetal.,2010).

http://dx.doi.org/10.1016/j.aap.2015.10.015

Assessed for eligibility (n=9,885)

Excluded (n= 7486)

♦ Not meeting inclusion criteria & other reasons (n=6925)

♦ Declined to participate (n= 561)

Analysed at 3-months (n= 1061) Analysed at 12-months (n= 1066)

Lost to follow-up at 3-months (n = 171) Lost to follow-up at 12-months (n = 166) Allocated to intervention (n= 1232) ♦Received allocated intervention (n= 720) ♦Did not receive allocated intervention (n=

512) (top 3 reasons: work (23.1%);no bike (18.8%);lack of time (17%))

Lost to follow-up at 3-months (n = 100) Lost to follow-up at 12-months (n = 131) Allocated to control group (n= 1167)

Analysed at 3-months (n= 1067) Analysed at 12-months (n= 1036)

Allocaon

Analysis

Follow-Up

Randomized (n=2399)

Enrollment

Fig.1. Trialdesignandprocedure.

In 2010, VicRoads, the road authority for the State of Vic-toria, Australia, commissioned the development of an on-road coachingprogramfornoviceridersinVictoria.Theaimofthe pro-gramwastoassistrecentlylicensedriderswhotobecomesafer ridersand toreducetheirinvolvement inrisk-takingbehaviour andcrashes.Learner-centredapproachesandprinciplesofinsight training(Gregersen,1996)werecentraltothephilosophyofthe programdesign.Thisstudyaimedtodeterminetheeffectiveness oftheresultingprogram“VicRide”inreducingcrashinvolvement fornovicemotorcycleridersinVictoria.

2. Methods

2.1. Studydesignandparticipants

This was a randomised control trial with blinded outcome assessmentconductedinthestateofVictoria,Australia.The tar-getpopulationwerenovicemotorcycleriderswhohadpassedthe motorcycleoperators’test(MOST)withintheprevious12months andheldaprobationaryorrestrictedlicence.InVictoriathereisno mandatorypre-licencetraining.Participantswererequiredtobe theregisteredownerofamotorcycle(notascooter)thatcomplied withtheVicRoadsLearnerApprovedMotorcycleScheme (power-to-weightratioofthemotorcyclelessthan150kWpertonneand enginecapacitynogreaterthan660cc),andtohaveriddenatleast 500kmoveratleast12tripsonpublicroadssinceobtainingtheir learnerpermittoensure aminimum levelof experienceriding on-road.

Thetrialwasregisteredon10thMay2010withtheAustralian andNewZealandClinicalTrialRegistry:ACTRN12610000372088 andethicsapprovalwasobtainedfromtheMonashUniversityand theUniversityofSydneyHumanEthicscommittees.

Thestudydesignandproceduresaresummarisedinaflow dia-graminFig.1.

2.2. Recruitmentandrandomisation

Baselineinterviewswereconductedbetween19May2010and 30October2012andthefinalfollow-upinterviewwasonJanuary 82014.Datawereanalysedin2014.Recruitmentwasinitiallyby mailedinvitationthroughtheStatelicencedatabasebutproved slowsoasecondrecruitmentapproachwasintroducedfrom25th October2010,wherebyparticipantswereapproacheddirectlyby trainedtelephoneinterviewersafterreceivingtheinitialmailed invitation.Consentingparticipantscompletedabaselinetelephone interview,andwererandomisedtointerventionorcontrolgroups usinganautomaticsimple randomisationprocessbuiltintothe CATIsoftware.Initiallya50:50allocationwasusedbutwaschanged toa60:40allocationinApril2012duetolowintervention comple-tionrates.

On completion of the baseline interview, participants were advisedoftheirinterventiongroupstatus.Theinterventiongroup wereaskedtocompletetheprogramwithinsixweeks;thecontrol groupwereadvisedtheirprogramparticipationwouldbedelayed for12months.Allparticipantsconsentedtodatalinkagetotheir police-recordedcrashandoffencedataandtotelephoneinterviews atbaseline,andatthreeand12monthsfollowingprogramdelivery. Participantsreceived$90andahighvisibilityvestoncompletionof theprogram.Thosewhoundertooktheprogramwithinsixweeks receivedanadditional$50.

2.3. Procedures

Priortothecoachedride,participantsweresentabookletin preparationfortheride.Thisincludedbecomingfamiliarwiththe

Table1

Reliabilityoftheself-reportedattitude,behaviour,andmotivationscales.

Baseline Interview-2 Interview-3

Confidenceforridingskills .78 .80 .81

Crashattributionscale–Driverattribution .56 .57 .56

Crashattributionscale–Riderattribution .35 .37 .43

Safetybeliefsscale–deviantbeliefs .73 .77 .76

Safetybeliefsscale–safetybeliefs .59 .60 .61

MRBQ–errors .79 .81 .82

MRBQ–speedingbehaviours .80 .81 .82

MRBQ–stunts .64 .65 .68

MRBQ–protectivegearuse .48 .51 .50

MRMQ–pleasure .75 .76 .77

MRMQ–speedingmotivations .75 .78 .79

MRMQ–convenience .68 .70 .69

handsignalstobeusedbytheircoach,andcompletingashort sur-veydesignedtostimulatereflectionontheirridingexperiencesto dateandtoprovideanindicatoroftheircrashriskprofile.Before departingontheride,participantswererequiredtodemonstrate tothecoachtheyhadbasiccompetenceinbraking,corneringand obstacleavoidance.

Theprogramconsistedofonefour-hoursessioncomprisinga seriesofshortrides(15–20min)onaplannedrouteandpre-and post-ridediscussionsinagroupofuptothreenoviceriders accom-paniedbyatrainedcoach.Therouteincludedbothruralandurban ridingenvironmentsselectedtoexposeriderstoeveryday situ-ationsidentifiedaspotentially hazardousfor motorcyclists.The focusoftheprogramwasonhigherorderridingskillsincluding cognitivestrategiesforsaferiding,especiallyinrelationtoroad craft,hazardperception,motivationsandexperience.

Coacheswereexperiencedridinginstructorswhoweretrained incoachingmethods.Theirtrainingemphasisedtheirroleto facili-tatediscussionsandsaferiding,interveningonlyasnecessary,and tousequestionstothegrouptore-focusdiscussionratherthan providinganswers.

2.4. Outcomes

The primary outcome was a composite measure of police-recordedandself-reportedcrashesatthreeand12monthsafter program delivery. Secondary outcomes included time to first police-recordedcrash,self-reportednearcrashes,safetyattitudes, riding behaviours, riding motivations and riding exposure, and police-recordedtrafficoffencesat12months.

Police-recorded outcomes were collected via deterministic (basedonlicencenumber)andprobabilistic(basedonfirstandlast names,dateofbirth,andgender)datalinkage.

Self-reportedoutcomeswerecollectedatbaseline,three and 12monthsviacomputer-assistedtelephoneinterviewsbytrained interviewers blindedtoparticipants’intervention status. Estab-lishedinstrumentsadministered:theMotorcycleRiderBehaviour Questionnaire(MRBQ)(Elliottetal.,2007);theMotorcycleRider MotivationQuestionnaire(MRMQ)(Sextonetal.,2004);theCrash AttributionScale(HaworthandMulvihill, 2005); optimismbias (theperceptionthattheriderisatlessriskofcrashing)andrider confidence(Sextonetal.,2004),theSafetyBeliefScales(Burgess etal.,2010);numberofnearcrashesandridingexposure(Haworth andMulvihill,2005;deRomeetal.,2010).

The MRBQ consists of 33 items with four behaviour scales of errors, speeding violations, stunts, and protective gear use (Sakashitaetal.,2014a),withhigherscoresindicatingmore fre-quent engagement in the behaviours. The MRMQ consists of 20 items with three motivation scales of speed, pleasure and convenience(Sakashita,2013);higherscoresindicatingstronger motivation.Riders’assessmentoftheirownlevelofridingskills comparedtootherridersoftheirage,gender,andridingexperience

wasmeasuredbyafour-itemscaleofconfidenceinridingskills. Riders’assessment oftheirown likelihood ofbeinginvolved in acrashcomparedtootherridersoftheirage,gender,andriding experiencewasmeasuredbyaone-itemscaleofoptimismbias forcrashes.Lowerscoresindicatemoreconfidenceinridingskills, andoptimismbiasforcrashes(perceivedreducedriskofcrashing). Ridingexposurewasmeasuredviaasingleitemreportinghoursof ridinginanaverageweek(Sakashitaetal.,2014b).

Cronbach’salphasforthemultipleitemscalesinthepresent samplearesummarisedinTable1.Mostoftheself-reportedscales werereliablewithalphascoresgreaterthan0.7,exceptforthecrash attributions,safetybelief,MRBQstuntsandprotectivegearuse,and MRMQconveniencescales(Sakashita,2013).

2.5. Statisticalanalysis

Samplesizecalculationsassumedacompositecrashoutcome (atleastonepolice-recordedcrashorself-reportedcrash)of22% after12months,basedonpreviousstudiesreportingcrashratesin novicemotorcyclistsordrivers(Haworthetal.,1997;Boufousetal., 2010).Assuminga15%drop-outrate,2400riderswererequiredfor statisticalpowerof88%(˛=0.05)todetectanabsolutereduction incrashoutcomeof5.5%(arelativereductionof25%).

Primaryanalyses were conductedby intention-to-treat. Dif-ferencesinprimaryoutcomeswerecompared betweenthetwo groupsbyusingstandard logisticregression.Countoutcomesof police-recordedoffencesweremodelledwithazero-inflated Pois-sonregression.Countoutcomesofself-reportednearcrasheswere modelledwithageneralisedPoissonregression.Allother contin-uousvariables weremodelledwithsimplelinearregression. All modelswereadjustedforage,gender,andridingexposurereported atbaseline.Timetofollow-upwasincludedasanoffsetvariablein allregressionmodels.

Timetofirstpolice-recordedcrashwasmeasuredfromprogram completionfortheinterventiongroupandforcontrolsfrom base-lineinterviewdateplustheaveragedaystoprogramcompletion (47days).ThisoutcomewastreatedbymeansoftheKaplan–Meier survivalcurvesandtestedusingthelog-ranktestortheCoxmodel (whenadjusted).AnalyseswereledbyS.Lo.

2.6. Sensitivityanalysis

Asupplementarysensitivityanalysisbasedona1:1propensity scorematchingwasconductedtoestimatetheeffectoftheVicRide programforonlythoseinterventiongroupriderswhoactually com-pletedtheprogram.Sixtypercent(720/1232)oftheparticipants randomisedtotheinterventiongroupcompletedtheprogram.A logisticregressionusingautomaticforward-selectionforall par-ticipantsrandomisedtotheinterventionwasconductedtopredict programcompletion.Duetomissingvalues,1136(92%)of1232 rid-ersintheinterventiongroupcontributedtothefinalmodel,with

Table2

Participantcharacteristicsatbaselineinterview.

Characteristics Control(N=1167) TrainingGroup(N=1232) Total(N=2399)

Male 937(80.3%) 1000(81.2%) 1937(80.7%)

Meanage(SD) 35.4(11.09) 35.3(11.27) 35.3(11.18)

Totalmonthsonlearnerpermit

Mean(SD) 7.5(4.29) 7.5(4.47) 7.5(4.38)

Motorcycletype

Sports(includingSupersports/supermotard) 449(38.7%) 478(39.0%) 927(38.8%)

Cruiser 235(20.2%) 272(22.2%) 507(21.2%)

Standard(includingNaked) 301(25.9%) 298(24.3%) 599(25.1%)

Touring(includingSportstourer) 95(8.2%) 97(7.9%) 192(8.0%)

Adventure/adventuretourer/dualsport 34(2.9%) 25(2.0%) 59(2.5%)

Offroad–Trail/enduro/mx 38(3.3%) 47(3.8%) 85(3.6%)

Scooter 0(0.0%) 0(0.0%) 0(0.0%)

Averageweeklyhoursofon-roadriding

Mean(SD) 4.1(3.95) 4.0(3.41) 4.1(3.68)

On-roadridingexperiencebeforelearnerpermit

No 930(79.7%) 999(81.1%) 1929(80.4%)

Yes 237(20.3%) 233(18.9%) 470(19.6%)

Numberoftimesridingon-roadbeforelearnerpermit

1–3times 36(15.2%) 39(16.7%) 75(16.0%)

4–10times 26(11.0%) 31(13.3%) 57(12.1%)

>10times 175(73.8%) 163(70.0%) 338(71.9%)

Previouslyattendedanyformalridertraining

No 419(35.9%) 399(32.4%) 818(34.1%)

Yes 748(64.1%) 833(67.6%) 1581(65.9%)

Yearsheldadriverlicence

Mean(SD) 16.7(11.50) 16.5(11.39) 16.6(11.44)

Employmentstatus

Workingfulltime–morethan20hperweek 928(79.5%) 972(78.9%) 1900(79.2%)

Working(parttime–lessthan20hperweek 92(7.9%) 116(9.4%) 208(8.7%)

Schoolstudent 4(0.3%) 6(0.5%) 10(0.4%)

Tertiaryorotherstudent 96(8.2%) 93(7.5%) 189(7.9%)

Fulltimehomedutiesornotseekingwork 9(0.8%) 6(0.5%) 15(0.6%)

Retired/Pensioner 16(1.4%) 17(1.4%) 33(1.4%) Unemployed 22(1.9%) 22(1.8%) 44(1.8%) Levelofincome Lessthan$30,000 87(7.8%) 95(8.1%) 182(8.0%) $30,001–$50,000 170(15.3%) 181(15.5%) 351(15.4%) $50,001–$100,000 423(38.0%) 425(36.4%) 848(37.2%) $100,001–$150,000 253(22.7%) 261(22.3%) 514(22.5%) Morethan$150,000 180(16.2%) 206(17.6%) 386(16.9%)

Missing/Donotknow/Refused 0/19/35 0/30/34 0/49/69

Highestlevelofeducation

Stillattendingschool 1(0.1%) 1(0.1%) 2(0.1%)

Year11orless(didnotcompleteVCEorequivalent) 160(13.7%) 149(12.1%) 309(12.9%)

CompletedVCE(Year12orequivalent) 195(16.7%) 203(16.5%) 398(16.6%)

TradeorotherCertificate–orworkingtowardsthis 200(17.1%) 205(16.6%) 405(16.9%)

TertiaryDegreeorDiplomaorworkingtowardsthis 608(52.1%) 666(54.1%) 1274(53.1%)

Post-graduatedegree(Masters,PhD) 3(0.3%) 8(0.6%) 11(0.5%)

675completers,and461non-completers.Ofthe675completers, 671(99%)werematchedtoanappropriatecontrol.Allbaseline characteristicswerewell-matchedandhadfewstandardised dif-ferences.

3. Results

3.1. Participantcharacteristics

Atotalof2399participantscompletedthebaselineinterview;of these,1232wererandomisedtotheVicRideprogramand1167to thecontrolgroup.Themajority(80.7%)weremalesandtheaverage agewas35.3years.Participantcharacteristicsacrossthe interven-tionandcontrolgroups,includingage,motorcycletypeandriding exposure,werenotsignificantlydifferent(Table2).Almost two-thirds(n=720,62%)ofthoseallocatedtotheinterventiongroup

completedtheprogram, although29%(n=205)of these partici-pantsdidnotcompletethepre-programpreparationactivity.Most (94.3%)oftheriderswhocompletedtheridedidsoin metropoli-tanlocations:Somerton(40.6%),Kilsyth(33.1%),andCranbourne (20.6%).Asmallproportion(5.8%)participatedinrurallocations; Bendigo(5.1%)andWarragul(0.7%).Ofallparticipants,2128 com-pletedthethreemonth(88.7%) and2102(87.6%)the12-month interview.Thethreemonthinterviewsoccurredonaverageat144 dayssincethebaselineinterviewfortheinterventiongroup,and 145daysforcontrols.Twelvemonthinterviewswereonaverage 410dayssincethebaselineinterviewfortheinterventiongroup and411daysforcontrols.

3.2. Primaryoutcome

Thecompositecrashrateswere6.4%forcontroland5.8%for intervention groups atthree monthsand 11.7% for controland

Table3

EffectoftheVicrideprogram.

3Months 12Months

Univariate Multivariatea _{Univariate Multivariate}a

Combinedpolice/self-reportedcrashes

OR(95%CI) 0.90(0.65–1.26) 0.90(0.65–1.27) 0.99(0.77–1.27) 1.00(0.78–1.29) Police-recordedoffence(all)

RR(95%CI) – – 0.93(0.80–1.07) 0.91(0.78–1.06) Police-recordedcaroffence

RR(95%CI) – – 0.88(0.74–1.05) 0.87(0.73–1.04) Police-recordedmotorcycleoffence

RR(95%CI) – – 1.09(0.80–1.48) 1.15(0.87–1.53) Nearcrashes RR(95%CI) 0.88+_{(0.82–0.96) 0.91}ˆ_{(0.83–0.98) 1.00(0.92–1.09) 1.01(0.93–1.11)} Ridingexposure Beta(95%CI) 0.17(−0.16–0.51) 0.27(−0.33–0.58) 0.25(−0.79–0.58) 0.32ˆ_{(0.02–0.62)} Optimismbias Beta(95%CI) −0.05(−0.12–0.02) −0.05(−0.12–0.02) −0.02(−0.09–0.05) −0.03(−0.10–0.04) Riderconfidence Beta(95%CI) −0.06ˆ_{(−0.10,−0.01) −0.07}+_{(−0.12,−0.03) −0.07}ˆ_{(−0.11,−0.02) −0.07}+_{(−0.11,−0.03)} Driverattribution Beta(95%CI) −0.02(−0.06–0.02) −0.01(−0.05–0.02) −0.01(−0.05–0.03) 0.001(−0.04–0.04) Riderattribution Beta(95%CI) −0.09+_{(−0.14,−0.03) −0.06}ˆ_{(−0.10,−0.01) −0.07}+_{(−0.13,−0.02) −0.05}ˆ_{(−0.10,−0.001)} Safetybeliefs Beta(95%CI) 0.03(−0.03–0.09) 0.04(−0.10–0.09) −0.02(−0.08–0.04) <0.001(−0.05–0.05) Deviantbeliefs Beta(95%CI) −0.03(−0.06–0.05) 0.001(−0.04–0.04) −0.03(−0.08–0.03) −0.02(−0.06–0.03) MRMQconvenience Beta(95%CI) −0.02(−0.08–0.05) −0.03(−0.07–0.02) 0.03(−0.04–0.09) 0.03(−0.02–0.07) MRMQpleasure Beta(95%CI) −0.02(−0.05–0.02) −0.03(−0.05–0.001) −0.02(−0.06–0.02) −0.03(−0.06–0.001) MRMQspeeding Beta(95%CI) 0.003(−0.05–0.05) 0.01(−0.03–0.04) −0.02(−0.07–0.03) −0.02(−0.05–0.02) MRBQerrors Beta(95%CI) 0.01(−0.02–0.04) 0.02(−0.03–0.04) <0.001(−0.03–0.03) 0.01(−0.02–0.03) MRBQspeeding Beta(95%CI) 0.04(−0.02–0.10) 0.05ˆ_{(0.01–0.10) 0.06(−0.01–0.12) 0.06}ˆ_{(0.01–0.10)} MRBQstunts Beta(95%CI) 0.01(−0.04–0.03) 0.01(−0.03–0.03) −0.01(−0.03–0.14) −0.003(−0.03–0.03) MRBQprotectivegearuse

Beta(95%CI) 0.06(−0.03–0.14) 0.04(−0.03–0.10) 0.004(−0.08–0.09) −0.001(−0.07–0.07)

a_{Adjustedforage,genderandridingexposure(hours/week).}

ˆ_p<.05.

+_p<.01.

11.5%forintervention groupsat12-months.The oddsof crash-ing (composite) did not differ significantly between groups at threemonths(unadjustedOR=0.90,95%CI:0.65–1.26;adjusted OR=0.90,95%CI:0.65–1.27)or12months(unadjustedOR=0.99; 95%CI:0.77–1.27;adjustedOR=1.00,95%CI:0.78–1.29).

3.3. Secondaryoutcomes

Therelative risksdid not differ significantly between inter-ventionand controlsin relationto thenumber of days tofirst police-recordedcrash(unadjusted RR=1.07;95% CI:0.65–1.76; adjusted RR=0.95, 95% CI: 0.53–1.71) or for overall offences (adjusted RR=0.91, 95% CI: 0.78–1.06), car offences (adjusted RR=0.87, 95% CI: 0.73–1.04) or motorcycle offences (adjusted RR=1.15,95%CI:0.87–1.53).Interventionparticipantswereless likelythancontrolstoreportnearcrashesatthreemonths(adjusted RR=0.91;95%CI:0.83–0.98),althoughthiseffectwasnotsustained at12months(adjustedRR=1.01,95%CI:0.93–1.11).

Therewerenosignificantdifferencesinreportedridinghours inanaverageweekatthreemonthsbutat12monthsthe interven-tiongroupreportedridingsignificantlymorehoursthancontrols (mean5.6versus3.7hperweek;adjustedbetacoefficient=0.319; p=.0385).

Theonlysignificantdifferencesevidentforself-reportedrider attitudes(Table3)werecrashattributiontoridersandconfidence

inridingskills.Thescoresonthecrashattributionscalewere sig-nificantlylowerfortheinterventiongroupcomparedtothecontrol groupatboth three months(adjustedbetacoefficient=−0.057; p=.0139) and 12 months (adjusted beta coefficient=−0.049; p=.0450).Thatis,theinterventiongroupattributedthecauseof crashestoriders(asopposedtodrivers)significantlymorethan thecontrols.Theinterventiongroupreportedmoreconfidencein theirridingabilitythancontrolsatboththreemonths(adjusted betacoefficient=−0.073;p=.0013)and12months(adjustedbeta coefficient=−0.070;p=.0020).

No significant differences were evident for any of the self-reported MRMQ motivations for riding scales, or MRBQ riding behavioursexceptspeeding.Theinterventiongroupreportedmore speedingbehavioursthancontrolsatboththreemonths(adjusted betacoefficient=0.054;p=.0103)and12months(adjustedbeta coefficient=0.056;p=.0157).

3.4. Sensitivityanalyses

Sensitivityanalysesresultswerebroadlyconsistentwiththe mainresultsbasedonintention-to-treatanalyseswithafew excep-tions.Thesignificantprogrameffectonreducednearcrashesfound atthreemonthswasnolongersignificant.Thesignificantprogram effectonridingexposurefoundat12monthswasinsteadfound atthreeandnotat12months.Thesignificantprogrameffecton

crashattributiontoridersonlyremainedintheunivariatemodel andwasnolongersignificantinthemultivariatemodel.However, inallthreecases,boththeunadjustedandadjustedrelativeratios wereinthesamedirectionforboththree-and12-monthresults for both intention-to-treat and sensitivity analyses.Finally, the non-significantresultforself-reportedprotectivegearusebecame significantinthemultivariatemodelatthreemonthsonly.

4. Discussion

Wefoundnoeffectoftheon-roadcoachingprogramonnovice riders crashes.Riders inthe interventiongroup reportedfewer nearcrashesatthreemonths,buttheeffectwasnotsustainedat 12months;norwasitreplicatedinsensitivityanalysesincluding onlyriderswhocompletedtheprogram.Theinterventiongroup reportedmoreconfidenceinridingskills,moreattributionofcrash responsibilitiestoriders,morespeedingbehavioursandmore rid-inghoursinanaverageweekthancontrolriders,afteraccounting for theeffects of age,gender,and riding exposure. Therewere nodifferencesinpolice-recordedtrafficoffences,orinother self-reportmeasures.

Ourfindingsonalackofeffectoncrashesareconsistentwith previousridertrainingliterature,althoughthisisatleastinpart duetotheabsenceofa strongbody ofevidence(Kardamanidis etal.,2010).Itisalsoconsistentwiththedrivertrainingliterature whichshowsnoevidenceforeffectivenessofpost-licence train-inginreducingroadtrafficinjuriesorcrashes(LundandWilliams, 1985;Keretal.,2005).Thisisdespitebesteffortstodevelopthe programinkeepingwithbestpracticeprinciples.

Thefewernearcrashesreportedbyridersintheintervention groupthancontrolsat3monthsintheintention-to-treatanalysis couldbeattributedtoimprovedskillstoavoidcrashes,givenoneof theaimsoftheprogramwastoimprovehazardperceptionskills. Itispossiblethattheinterventiongroupdevelopedbetterskillsto anticipatetheroadandtrafficahead,detect,recogniseandreactto traffichazards.Otherrideranddrivertrainingprograms employ-ingsuchtrainingapproacheshavebeensuccessfulinimproving hazardperceptionskills(CrickandMcKenna,1991;Vidottoetal., 2011;Boele-Vos and deCraen, 2015), includingtransferto on-roaddriving(Pradhanetal.,2006).However,ifthesignificantly fewernearcrashesintheinterventiongroupwasanindicationof improvedhazardperceptionskillsitdidnotleadtosignificantcrash reductions.Eventhoughhazardperceptionskillsmaybelearntvia training,aweaklinkbetweenhazardperceptionskillsandcrash riskshas beensuggested (Sagberg and Bjornskau, 2006;Cheng etal.,2011;Beanlandetal.,2013);theprevioussmallrandomised trialconductedintheNetherlandswhichfoundtrained motorcy-cleridersexhibitedbetterhazardperceptiondidnotassesscrash outcomes(Boele-VosanddeCraen,2015).Nearcrashesare com-plexeventsandperceptionofthemmaydependonrider’sstageof ridingdevelopment.Neverthelessthiseffectonnearcrasheswas nolongerevidentat12months.

Ridersintheinterventiongroupreportedsignificantlygreater confidenceintheirridingskillsthanthoseinthecontrolgroup.A carefulbalancemustbeachievedintrainingtoensureridersdo notdevelopunrealisticconfidenceintheirability,asthismaylead togreaterrisktakingbehaviourandthereforehighercrashrisk; theinsightapproachisdesignedtoaddressthis(Gregersen,1996). Althoughitisdifficulttodeterminewhetherridershad unrealis-ticconfidenceintheirridingability,ourresultmaysuggestthat theinsighttrainingusedtoaddresstheoverestimationofpersonal ability(Gregersen,1996)wasnotsuccessful.Nonetheless,the pro-gramaimedtoimprovehazardperceptionsskillsandthepresent measureofconfidenceinskillsaddressedmostlyhazard percep-tionskills(threeoutofthefouritemswereinrelationtohazard

perceptionskills and oneitem onvehiclecontrol skills),which maymeanthattheincreasedconfidence reportedmightnot be unrealistic.However,iftheinterventiongroupinourstudyreally improvedtheirhazardperceptionskills(makingtheirconfidence realistic),thisdidnotleadtoanydetectablereductionsincrash risksorotherindicatorsofroadsafetybenefitssuchasreducedrisk takingincludingspeeding.

Theinterventiongroupalsoreportedstatisticallysignificantly morespeedingbehaviourscomparedtothecontrolgroup.A com-binationofgreaterconfidenceintheirridingskillsandapossible lowerperceptionofrisksasindicatedbyfewerreportingofnear crashesmayleadtogreaterrisktakingbehavioursuchas speed-ing. Links betweenlow risk perception and greater risk taking behaviour(BrownandGroeger,1988)aswellasbetween confi-denceandgreaterrisktakingbehaviour(Fuller,2005)havebeen observedamongdrivers.

Nosignificantdifferencesinridingexposurebetweenthetwo groupswereapparentatthreemonths,however,ridingexposure wassignificantlyhigherfortheinterventiongroupthanthecontrol groupat12months.Whileincreasedridingperseisnotanegative outcome,itscombinationwithgreaterrisktakingbehaviourssuch asspeedingmayputridersatagreaterriskofbeinginvolvedina motorcyclecrash.

The Crash Attribution scale measured the extent to which motorcyclistsattributecausesofcrashestodrivererrors(driver attribution)versusmotorcyclisterrors(motorcyclistattribution). Thereportedincreasedconfidenceinridingskillsinthe interven-tiongroupmaysuggestthosewhohavebeentrainedbelievethey arebetterridersthanotherridersandtheymaybemakingthe attri-butionofthecauseofcrashesto‘other’riderswhotheybelieveare worseridersthanthemselves.Otherstudiesshowsimilar observa-tionswherepeoplemaybeawarethattheirpeergroupisathigher riskforcrashescomparedwithothersingeneralbutstillrate them-selvesasiftheyarenotpartofthatgroup(FinnandBragg,1986; Horswilletal.,2004).Howeverourresultsmayalsosuggestthat interventionridersweremoreawareoracceptingoftherisksof ridersasopposedtodrivers.Inanycase,theverylowreliabilityof thisscale(Cronbach’salpharangingfrom0.35to0.43forthethree surveytime-points)mustbenoted,andcautionmustbemadein interpretingthissignificantresult.

Thiswasarandomisedtrialwithhighfollow-uprates. Selec-tion bias previously noted in a previous systematic review (Kardamanidisetal.,2010)duetofailuretoprogresstothenext leveloflicensingwasminimisedbyrecruitingnewly-licensed pro-visional riders.The compositecrashratewasfoundlowerthan anticipatedat11.6%onaverageandwiththelowprogram com-pletionrates,decreasedthestatisticalpowertodetectaprogram effect. However,as theeffect sizeevident was verysmall, and becauseparticipationintheprogramledtostatisticallysignificant increasesinbehavioursthatareassociatedwithincreasedcrash risk,itisunlikelythatevenwithamuchlargersamplesizethatany crashreductionwouldhavebeendetected.

Themeanageofstudyparticipantswas35.3years;80.7%were male.ThenoviceriderpopulationinVictoriainMarch2012had ameanageof33.6years,and84.4%weremales.Thetrial popula-tionwasthereforeinlinewithVictoria-wideageandgendernovice riderdemographics,althoughitislikelythatmoreriderslivingin metropolitanareaswererecruited,giventhedeliverylocationsfor theVicRideprogram.

Giventhesubstantialandgrowingcontributionofmotorcycle relatedcrashestotheburdenofglobaltrauma,thereisan impor-tantneedtofindeffectivewaystoimprovemotorcyclesafety.This trialofabestpracticeon-roadmotorcycleridercoachingprogram foundnoeffectoftheprogramonriskofcrashoronridingoffences, butfoundanincreaseinridingexposure,speedingbehavioursand riderconfidence,althoughthebeliefthatridersweremorelikely

thancardriverstoberesponsiblefortheircrashesalsoincreased. Whilethelatterfindingcouldindicatethat someaspectsofthe trainingwereeffective,thisdidnottranslateintoimprovedsafety. Systemsapproachestoroadsafetyshiftthefocusawayfroma sin-gularfocusonroaduserbehaviourtomodificationofthesystem frommultipleperspectives,includingroadsandroadsides, vehi-cles,speedandroadusers.Therearemultipleotherknowneffective interventionsforimprovingmotorcyclesafety(Kealletal.,2013) includingpolice enforcement (Christie et al., 2003; Rizziet al., 2011),safervehicles–includingdaytimerunninglights(Quddus etal.,2002;Wellsetal.,2004;Yuan,2000),anti-lockbrakes(Rizzi et al., 2011,2009, 2013; Teoh,2011), stability control systems (Rizzietal.,2011;Seinigeretal.,2008),alcoholinterlocks(Rizzi etal., 2011), helmets(Liu et al.,2008)and protective gearuse (Rizzietal.,2011;deRomeetal.,2011,2012),andblackspot treat-ments(Scullyetal.,2008).Giventheabsenceofroadsafetybenefits of ridertraining, and thesubstantial challenges in successfully implementingstatewideprograms,ridertrainingshouldbe con-sideredalesspromisingstrategythanotheraspectsofasafesystem approach.

Acknowledgements

The VicRide coaching program was developed on behalf of VicRoadsbytheMonashUniversityAccidentResearchCentrein conjunctionwithHondaRiderTrainingAustralia(HART)and Learn-ingSystemsAnalysiswithfundsfromtheVictorianGovernment MotorcycleSafetyLevy.TheVicRidetrialwasfundedbythe Vic-torianGovernmentMotorcycleSafetyLevy(contractnumberCN 7556). Rebecca Ivers wasfunded by research fellowshipsfrom theNational Health and Medical Research Council of Australia (NHMRC);TeresaSenserrickwasfundedbyresearchfellowships fromtheNHMRCandtheUniversityofNSW.

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