Road traffic injuries are the ninth leading cause of disability adjusted life years lost worldwide, and are expected to be the third leading cause by the year 2020 (Murray 1996). A disproportionate amount of this death and disability occurs in low and middle-income countries (Nantulya 2002). It is widely recognised that motorcyclists are a vulnerable group of road users, particularly in the low-income countries of South East Asia. In the United States and Australia, motorcyclists account for 5 and 11% of road users killed as a proportion of all road user fatalities respectively, compared to 57% in Malaysia, 42% in Indonesia, 27% in India and 36% in Thailand (Mohan 2002). As the burden of motorcycle death and injury is largely carried by developing countries, it is vital to identify effective, low-cost interventions that reduce motorcycle related death and injury. Motorcycles are over-represented in multi-vehicle collisions, particularly where the drivers of other types of vehicles fail to detect the motorcycle, and turn in front of the oncoming motorcyclist. It has been suggested that the conspicuity of the motorcycle and/or rider is an important factor in this type of crash (Williams 1979; Hole 1996; Thompson 1980), although there has also been debate as to how such causality is attributed (Cercarelli 1992; Thompson 1982). There are several ways to increase the conspicuity of the motorcycle and/or rider. These include daytime use of headlights and increasing colour and reflectivity of the motorcycle or rider in order to increase the contrast between motorcycle/rider and its background (Olson 1981). A recent Cochrane systematic review examined the role of conspicuity in preventing death and injuries to cyclists and pedestrians, and concluded that visibility aids improved drivers' responses in detecting and recognising pedestrians and cyclists (Kwan 2003). However, the review found no trials that studied whether such visibility aids improved safety for pedestrians and cyclists. The aim of this systematic review is to quantify the effectiveness of measures to increase conspicuity of motorcycles and/or motorcyclists in reducing the burden of motorcycle crash-related injury and death. (Author/publisher)
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