SISTEMA DE DESARROLLO POLICIAL

2.3.1 Background

Since the prevalence of bicycle crashes is increasing, it is important to understand the long-term impact of crash involvement on physical, psychological and social outcomes for both group and non-group riders. In addition, since State and Federal governments in Australia aim to encourage cycling as a form of transport and as a fitness/ leisure activity (Austroads, 2010; Department of Transport, 2014), it is essential to understand how crash involvement affects participation in cycling, for different types of riders. To date, very few studies have examined the long-term outcomes of bicycle crashes. This section summarises current evidence on the physical, psychological and social outcomes of bicycle crashes, cycling participation after a crash and risk factors for negative outcomes for group and non-group cyclists.

2.3.2 Physical, psychological and social outcomes of bicycle crashes

The long-term impact of crash involvement for motor vehicle occupants has been extensively studied with outcomes including physical (e.g. pain), psychological (e.g. post-traumatic stress disorder (PTSD), anxiety, depression, travel phobia) and social (e.g. employment and financial difficulties) effects (Craig et al., 2016; Ehring, Ehlers, & Glucksman, 2006; Mayou & Bryant, 2003; Üzümcüoğlu et al., 2016).

Only a small number of studies have examined long-term crash outcomes for cyclists specifically. A United Kingdom (UK)-based study of road users admitted to the Emergency Department (ED) included 146 cyclists and found that one year after their crash, 19% had PTSD, 6% had an episode of depression, 18% had an episode of anxiety and 17% had travel phobia (Mayou & Bryant, 2003). The second study of French road users included 101 cyclists and found that two years after the crash, 57% reported a good physical recovery, 39% reported negative impact on leisure or sport activities, 27% reported negative impact on occupation or studies, 23% on family life and 12% reported financial difficulties (Tournier et al., 2014). A third study which included over 400 injured cyclists in Sweden found that 44% reported problems in health-related quality of life (HRQOL) with the most common problems being in the pain/ discomfort and anxiety/ depression domains (Ohlin, Berg, Lie, & Algurén, 2017).

24 Finally, a recent Australian study of 186 cyclists hospitalised due to a crash in Victoria, found that by 12 months post-crash, the majority (95%) had returned to work but 54% did not report a complete functional recovery (B. Beck et al., 2016).

Three of these studies also compared the outcomes of cyclists injured in a crash to other road users and agreed that overall, the types of negative outcomes experienced by cyclists, were very similar to other road users (Mayou & Bryant, 2003; Ohlin et al.; Tournier et al., 2014). Interestingly, injured cyclists reported significantly better physical recovery (Mayou & Bryant, 2003; Tournier et al., 2014), less problems in HRQOL (Ohlin et al., 2017) and less negative impact on leisure or sports activities (Tournier et al., 2014) than other road users, even after controlling for injury characteristics. This is likely due to cyclists having a higher level of health and fitness than other road users, promoting better recovery from their injuries (Ohlin et al., 2017). It should also be noted that Mayou et al. reported that a higher proportion (17%) of cyclists experienced travel phobia one year after the crash, than drivers and pedestrians, but this proportion was lower than for passengers and motorcyclists (Mayou & Bryant, 2003). The term ‘travel phobia’ has been used to describe an avoidance or reduction in travel, with necessary travel causing marked discomfort (Taylor, Deane, & Podd, 2002). This suggests that travel phobia may be a particular issue for cyclists following a crash that could impact on their return to cycling.

2.3.3 Return to cycling, cessation and avoidance after a crash

While research suggests that driving avoidance may commonly occur following a crash (Taylor et al., 2002), the impact of bicycle crashes on return to cycling, cycling cessation and cycling avoidance have not yet been investigated.

An early prospective study conducted in the UK found that among motorcyclists involved in a crash, only 38% had returned to motorcycling one year post-crash, 36% had returned to car driving but not motorcycling and 27% had not returned to either (Mayou & Bryant, 1994). In contrast, most car drivers in the same study had returned to driving but several restricted or avoided travel following the crash (Mayou & Bryant, 1994). Avoidance of driving/ riding following a crash has been reported to

25 range from occasional reluctance in particular situations (e.g. bad weather, heavy traffic) to complete avoidance altogether (A. E. Stewart & St Peter, 2004).

While evidence suggests that the physical, psychological and social outcomes of crash involvement are quite similar among road user groups (Ohlin et al., 2017), it is possible that the impact on return to cycling may be greater than return to driving. Since riding a bicycle requires a much higher level of physical ability and exertion than driving, the remaining effects of injuries may impact more on return to cycling. In addition, there are likely to be other transport options available to cyclists that are perceived to be easier, convenient and less risky such as driving or using public transport. Since cyclists participate for a variety of different reasons (e.g. commuting, fitness, training, social), it is possible that certain types of cyclists may be more likely to return to cycling following a crash than others. Group riders who participate more for social/ enjoyment reasons for example, may be more likely to return to cycling that commuters who can choose other transport options. This requires further investigation.

2.3.4 Risk factors for negative outcomes after bicycle crash

Risk factors for poor psychological and social outcomes have been extensively examined following motor vehicle crashes. For example, a systematic review found that consistent predictors of PTSD after a crash included perceived threat to life, lack of social support, higher Acute Stress Disorder symptom severity, persistent physical problems, previous emotional problems, previous anxiety disorder and involvement in litigation/ compensation (Heron-Delaney, Kenardy, Charlton, & Matsuoka, 2013). While little research has examined risk factors for negative outcomes for cyclists, it is reasonable to think they would be similar to other road users.

To date, studies which included cyclists and examined risk factors for negative outcomes of crashes have found that younger people showed better physical recovery, collision with a motor vehicle predicted negative impact on physical recovery, occupation/ studies and familial/ affective life and a history of psychological problems related to financial impact two years post-crash (Tournier et al., 2014). In addition, females reported more problems in HRQOL after crash involvement than males (Ohlin et al., 2017).

26 No information exists on risk factors for cycling cessation or avoidance after a crash. Anecdotal evidence suggests that for more serious group riders, involvement in a crash may be a normalised or expected part of participation and even serve as a rite of passage into the sport (Albert, 1999). The group also often assumes the rider will return when possible (Albert, 1999). It is therefore possible that group riders are at a lower risk of cessation or avoidance following a crash. It would be useful to determine whether factors such as demographics, crash characteristics, injury type and severity, cycling experience and type of rider (group/ non-group rider) are associated with return to cycling, so that those at risk of cessation could be supported to make a safe return to cycling where possible.

2.3.5

Overall, long-term physical, psychological and social outcomes of road traffic crashes have been extensively investigated in the literature. While there is limited information on these outcomes for cyclists specifically, current evidence supports that cyclists experience the same type of negative outcomes as other road users following a crash, but that they may actually recover better in several areas.

There is a major gap in the evidence surrounding the impact of crash involvement on return to cycling, cycling cessation and cycling avoidance. Since the WA government aims to increase cycling participation rates, cycling cessation or avoidance following a crash are important negative outcomes. In order to prevent cycling cessation where possible, it is essential to understand how crash involvement affects cycling cessation and avoidance for different types of riders, including group and non-group riders.

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