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Disposable pull-ups versus disposable nappies for children with a disability.

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VOL: 100, ISSUE: 20, PAGE NO: 64

Margaret Macaulay, RN, DN, is research nurse

Lena Pettersson, MSc, BSc, RN, is project manager; Mandy Fader, PhD, BSc, PGDip, RN, is nurse director; Alan Cottenden, PhD, MA, MIPEM, MIMMM, CEng, is director; all at CPE Network, University College London; Rodney Brooks, PhD, BSc, is statistician, Department of Statistical Science, London

Prescribers are under rising pressure to provide the pull-up style pad, which is about 50 per cent more expensive than a disposable nappy. However, there is no published research to inform the use of this design.

Prescribers are under rising pressure to provide the pull-up style pad, which is about 50 per cent more expensive than a disposable nappy. However, there is no published research to inform the use of this design.

Aims of the study
- It sought to:

- Evaluate all disposable pull-ups for children (n=5) available in the UK in 2002 (Table 1);

- Compare this design group as a whole with a representative sample of five disposable nappies (Table 2);

- Establish parent/child design preference;

- Provide users, prescribers and purchasers with the necessary information to enable them to utilise the designs appropriately.

Method
Sixty-one families with children who have learning/physical disabilities participated in the randomised crossover study. Every subject evaluated each product for up to one week. The maximum evaluation period was 10 weeks. Qualitative and quantitative data were collected using the following assessment tools:

- Product performance questionnaire A 19-point questionnaire was completed for each product. It rated key aspects of product performance such as absorbency, fit and comfort as 'good', 'OK' or 'poor';

- Design performance questionnaire This was completed after testing all the nappies and again after testing all the pull-ups. They were rated for overall design performance;

- Design preference questionnaire This was completed after both product designs had been evaluated, indicating the carers'/child's design preference;

- Pad leakage diaries Wet pad weights, amount of leakage ('none', 'a little' or 'a lot') and time of use (such as day or night) were recorded;

Results
Most of the pull-ups and nappies performed well and similarly to the other products within their design group for a range of key performance characteristics.

However, there were some statistically significant differences between the pull-ups (p=0.005).

Pampers Easy Up pants performed best for overall opinion but Libero Up & Go and Huggies Drinite also performed well for most aspects of product performance.

Poor performance of some products was related to difficulties with fit and poor leakage performance.

Overall, there was little difference between the pull-up design and the nappy design. However, most carers did state a preference for one or other design based on their child's individual needs.

Nappies were statistically significantly more popular for night use, probably because the children's carers perceived nappies to be more absorbent and easier to fit snugly.

The detailed carer comments helped to clarify important issues about the use of absorbent products for this group of children.

Key aspects of product performance, identified in previous evaluations of absorbent pads for adults (Medical Devices Agency, 2002; MDA, 1999), were also important to carers and children in this study. These included leakage performance, comfort, and fit.

Other aspects of product performance highlighted as very important included discreetness in relation to ease of changing the product, the opportunity afforded by the pull-ups to aid independence in toileting, and the look of the product for the older child.

Analysis of carer comments enabled child characteristics to be identified, which are helpful in the selection of the appropriate design (nappies or pull-ups) for individual children (Box 1).

Conclusion
Disposable nappies are generally the product of choice for night use for children with disabilities. However, during the day using disposable pull-ups can be preferable for children who have specific requirements.

Pull-ups are 50 per cent more expensive than nappies but this cost can be justified if careful individual assessment is performed.

FURTHER INFORMATION
For copies of the report, contact the Medicines and Healthcare Products Regulatory Agency, Business Services, 9th Floor, Hannibal House, Elephant and Castle, London SE1 6QT; Tel: 0207 972 8360; Fax: 0207 972 8113; E-Mail: devices@mhra.qsi.gov.uk

A full list of all the Disability reports available is on the MHRA website at www.mhra.gov.uk

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