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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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The end result

Posted by Rogerwill on 27 Feb 2010 at 13:54 GMT

Now that the industry has had a good opportunity to digest this study, it is clear that it has been rejected by most as being inaccurate and not useful. It has also become clear that its results and conclusions will never be used in the ongoing development of our national standard. Examination of the data has shown it to be a study of the improper use of an obsolete product, pitted against a difficult to get product that is on its way out as a mainstream surface due to its inaccessibility. It is unfortunate that so much effort and funding has been wasted here and perhaps a lesson to be learned is that future studies on playground injuries should always involve the industry experts.

Competing interests declared: EWF manufacturer

RE: The end result

Andrew_Howard replied to Rogerwill on 03 Mar 2010 at 22:50 GMT

Randomized controlled trials have revolutionized the evaluation of interventions in medicine, surgery, and public health. An unbiased evaluation of alternatives based on outcomes which are important to patients is the best way to guide a decision.

Neither product evaluated in this trial was obsolete, neither was difficult to get, and neither was used improperly according to an independent evaluator applying CSA standards using a physical inspection of each playground with depth measurements and instrumented headform drop testing.

Clear or subtle commercial bias needs to be avoided in randomized trials or in other evaluations for a variety of reasons which are well studied and well documented.

The 'experts' in playground injury will be those who can evaluate new information with an open mind and without bias.

For a more balanced commentary on the generalizability and applicability of this study, please see the CAPP-online comment from January 21st.

Competing interests declared: study author

RE: RE: The end result

Rogerwill replied to Andrew_Howard on 04 Mar 2010 at 02:15 GMT

As the supplier of the EWF product used in the study, I can tell you, without doubt, that the EWF used in the study, is obsolete and no longer available. As an EWF manufacturer, I can tell you that it was most definately not used according to our specifications and as a member of the CSA technical committee, I can tell you that CSA standard was not applied properly. Further, as a supplier of granitic sand, I can tell you that this product is difficult to get in most parts of Canada.

Making these statements is further highlighting a lack of understanding of our industry and is not advancing your argument.

The CAPP article clearly highlights that Granitic Sand is not readilly available to all parts of Canada and also comments that the study's findings do not warrant changes to our national standard.

Competing interests declared: EWG/Granitic Sand supplier.

RE: RE: RE: The end result

bob300 replied to Rogerwill on 27 Mar 2010 at 18:05 GMT

Here is another balanced article from the National Recreation and Park Association (NRPA) – National Playground Safety Institute (NPSI) and the Canadian Parks and Recreation Association (CPRA) – Canadian Playground Safety Institute (CPSI):

Jan. 15, 2010
Virginia Barbour, Chief Editor
PLoS Medicine
185 Berry St., Suite 3100
San Francisco, CA 94107
Re: Howard AW, Macarthur C, Rothman L, Willan A, Macpherson AK (2009) School Playground
Surfacing and Arm Fractures in Children: A Cluster Randomized Trial Comparing Sand to Wood Chip
Surfaces. PLoS Med 6(12): e1000195. doi:10.1371/journal.pmed.1000195
Dear Dr. Barbour:
The comments submitted in this letter are in reference to the journal article, “School Playground
Surfacing and Arm Fractures in Children: A Cluster Randomized Trial Comparing Sand to Wood Chip
Surfaces,” by Howard et al., edited by Theo Vos at the University of Queensland, Australia, and
published on Dec. 15, 2009.
The recently published study by Howard et al. (2009) comparing two types of school playground
surfacing materials is troubling. It appears to be a well-thought-out scientific study whose findings should
be taken as factual, empirical data that brought the researchers to an undisputable conclusion—that sand
will reduce fractures when compared to engineered wood fibre surfacing systems, however, this
conclusion will be misinterpreted by those who read the abstract of the research.
While the study does help establish a protocol for another future study on long-bone fractures, it is flawed
in its conclusion that owner/operators should install this type of sand in lieu of engineered wood fibre
surfaces (especially for those that read the abstract alone). When the research team looked at reducing
fractures from falls on playgrounds, which were neither life threatening nor debilitating, it seems the team
failed to make any reference to the purpose of the Canadian Public Playground Safety Standard (CSA
Z614-07 Children’s Playspaces and Equipment), the ASTM F1487 Standard Consumer Safety
Performance Specification for Playground Equipment for Public Use (U.S. equivalent to CSA Z614-07),
or the ASTM F1292 Standard Specification for Impact Attenuation of Surfacing Materials Within the Use
Zone of Playground Equipment. The purpose of these playground safety surfacing-related standards is to
reduce serious life-threatening and permanently-debilitating head injuries from falls to the surface. Head
injuries resulting from a playground fall should be the leading consideration when an owner/operator is
selecting a resilient surface for playground use. Published playground safety standards have evaluated
engineered wood fibres to have a critical height 50cm (approx. 20 inches) greater than that of sand.
Critical height is a more important consideration, and long-bone injury prevention should be a secondary
consideration. In addition, the study failed to mention the various accessibility (CSA, ABES, ADA/ABA)
requirements for new public playground areas. It is a requirement in the U.S. and many jurisdictions in
Canada to adhere to these standards, and there is no tolerance for non-compliance. Sand does not comply
with the CSA, ABES, ADA/ABA requirements for accessibility.
The article mentions a specific type of sand found in a particular quarry that is not readily available
throughout Canada and not available at all in the U.S. or anywhere else in the world. This one
particular brand of sand is of such high quality that it was shipped from Huntsville, Ontario to
Sydney, Australia for use on beach-volleyball courts during the 2002 summer Olympics. A great
majority of sands used in public playgrounds are not of such high quality. Yet, this study leads
readers to believe that “sand” is better, when really only one particular kind of sand is better in only
one category—a category that many would view as secondary in importance.
In addition, the study refers specifically to FIBAR—a trademarked surface system that complies with
the ASTM F2075 Standard Specification for Engineered Wood Fiber for Use as a Playground Safety
Surface Under and Around Playground Equipment—as the type of system used for the study.
However, it is to our understanding that the sites used in the testing contained FIBERTOP or Zeager
Bros. engineered wood fibre products. FIBAR is often misused as a generic term for engineered
wood fibre, and the misuse can do harm to the company who owns the FIBAR name.
This study along with others completed in the past falls short in two categories: 1) It does not give
owners/operators of public play areas the necessary and complete information required to provide good
guidance for surface system selection; and, 2) It does not provide pertinent information to guide them in
making further decisions related to making their system more accessible or more impact attenuating in
relationship to the standard requirements.
Many of us involved at ground zero in the ongoing discussion of compliant and effective playground
safety surfacing systems and playground safety training agree there is a great need for a comprehensive
study on the effectiveness of our current playground surfacing safety standards. What is needed is a better
thought out methodology that involves many very informed professionals from the playground safety
arena. The process must assure the involvement of all the stakeholders in this discussion of proper
surfacing for public playgrounds. We need to make sure that the study identifies the threshold points for
when long-bone fractures and serious head injuries are most likely to occur, so we may begin to better
understand the effectiveness of our current standard thresholds. We need to look at not just impact
attenuation and the effects of friction resistance of various surface types, but the cost/benefit factors
related to any proposed changes to our current safety requirements. What we do know is the softer (less
firm) the surface system, the less stable (less accessible) the surface system, and the more energy required
to navigate across the surface system. This works in reverse. The more firm, the more accessible the
surface is, but the less impact attenuating the surface system provides.
The question for society to answer is, “What is most or more important?” Should emphasis be placed on:
less or no serious head injuries, less or fewer long-bone fractures, or more access for all people to public
playground environments?
Thank you for your time and attention to the issues outlined here. Enclosed with this letter is a copy of a
newsletter by Rolf Huber of Everplay International, Inc., which addresses the issue of studying injuries
related to playground surfacing. Please feel free to send copies of this letter and enclosure to the authors
for consideration in reworking their current study, or in the creation of future studies about injuries related
to playground surfacing. Please do not hesitate to contact us with any further questions.
Sincerely,
National Recreation and Park Association (NRPA) – National Playground Safety Institute (NPSI)
Canadian Parks and Recreation Association (CPRA) – Canadian Playground Safety Institute (CPSI)
Enc. (1)

No competing interests declared.