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Research Article

School Playground Surfacing and Arm Fractures in Children: A Cluster Randomized Trial Comparing Sand to Wood Chip Surfaces

  • Andrew W. Howard mail,

    andrew.howard@sickkids.ca

    Affiliations: Division of Orthopaedic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada, Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada

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  • Colin Macarthur,

    Affiliation: Bloorview Kids Rehab, Toronto, Ontario, Canada

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  • Linda Rothman,

    Affiliation: Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada

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  • Andrew Willan,

    Affiliation: Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada

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  • Alison K. Macpherson

    Affiliation: Department of Kinesiology, York University, Toronto, Canada

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  • Published: December 15, 2009
  • DOI: 10.1371/journal.pmed.1000195

Reader Comments (11)

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Competing Interest

Posted by bob300 on 04 Mar 2010 at 12:47 GMT

It is my understanding that this study was sponsored by the Hospital for Sick Children and that the study’s’ author, Dr. Andrew Howard, is a department head at the Hospital for Sick Children. It is also my understanding that the Playground Division representative of the company that supplied the granitic sand used in the study is the son of a fellow department head at the Hospital for Sick Children.

Should this be the case, I feel that sufficient opportunity exists for bias within the study, its’ sponsors and the author and that this dynamic should have been declared as a competing interest.

No competing interests declared.

RE: Competing Interest

Rogerwill replied to bob300 on 23 Mar 2010 at 14:35 GMT

This would be outrageous if it is true. It would explain to me some of the verbiage from the author's discussion which seemed to come directly from the sand supplier's marketing material. Perhaps the author could confirm or deny any association with the sand supplier.

Competing interests declared: EWF supplier

Conspicuous in their silence

Rogerwill replied to Rogerwill on 19 Aug 2010 at 02:26 GMT

Well it's been 5 months now and the author, Sick Kids and the Publisher are all conspicuous in their silence on this. There is a blatant conflict of interest here and it should be highlighted before this study fizzles off into oblivian. The integrity of this study has been compromised. The author has commented on the need to avoid commercial bias yet the study seems thick with it.

Competing interests declared: EWF supplier

RE: Response to posting about potential competing interest

GinnyBarbour replied to Rogerwill on 22 Aug 2010 at 21:32 GMT

We put the above concerns to the author shortly after they were posted in March, he responded promptly (on the 22nd March) and we were were satisfied with the author’s response. It is our error that they were not posted here but here is a summary of the author's responses for the record.

The individual mentioned (the "representative of the company" worked for one granitic sand company which has been a supplier to the Toronto District School Board (TDSB) before this study and also during this study. The author believes that this company supplies all or most of the granitic sand to TDSB before and during this study, but the author affirms that he (the author) has nothing to do with any of the supply or installation of playgrounds, or the tendering process.

The role of the author was limited to recommending a granitic sand or a fibar (sic) surface according to a randomization schedule for consenting schools, and this was sent via the school superintendent. During the time that the author was preparing the funding application, he requested some information from the individual mentioned regarding the mechanical properties of granitic sand and had a discussion with him about mechanical testing. He and his company did not, however, contribute in any way to the design, conduct, or reporting of the trial.

The father of the individual mentioned has long since retired from the hospital for sick children. He has not worked at the hospital during the time that the author has worked here (since 1999). The author affirms that he has no professional relationship with the father.

In addition the author notes that he is not a department head here, although he does head some programs. The hospital was not the funder of the study, but was a site where the study took place. The hospital administered the funds for CIHR.

The author has stated that he did not meet the individual mentioned through his father and has no personal or professional relationship with the individual’s father. The author’s relationship with the individual mentioned is limited to him providing the author with some information about granitic sand before the study was funded or started.

The author notes therefore that he is comfortable that there is no competing personal, professional, or financial competing interest in any of the above.


Ginny Barbour




Dr Virginia Barbour
Chief Editor, PLoS Medicine
Public Library of Science
e: vbarbour@plos.org

No competing interests declared.

RE: RE: Response to posting about potential competing interest

Rogerwill replied to GinnyBarbour on 23 Aug 2010 at 02:32 GMT

It is interesting that the author did not contact the EWF supplier regarding the testing or mechanical properties of EWF and in fact had no contact whatsoever with the EWF supplier. If the author had an information providing relationship with the sand supplier before the study was funded or started, why did he not have a similar relationship with the EWF supplier. Consultation with only one of the stakeholders is an imbalance that provides an opportunity for bias and suggests positioning for a perceived end result.

Competing interests declared: EWF supplier