Birth and peanut balls × acute labor pain

Required evidence, verification status and materials actually read
Item	AVerification status	BReading scope	CReview item	DCurrent findings	EWhy unverified	FRequired materials and conditions	GFurther research
1	Partly verified	Full text not readStored summary read	N01 · Evidence conditionWhich acute labor-pain claim is being checked?Required	Preserve the selected acute labor-pain claim, subclaim C and the note describing a short-term signal from small unblinded trials. Parent C50 remains parent context. S02 S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Selected claim, original grade/note and parent context	Material needed: Subclaim score, status and axes are absent. Do not fill them from parent values. This records needed materials; no new research was executed.
2	Partly verified	Full text not readStored summary read	N02 · Evidence conditionWhich populations, epidural conditions and high-BMI groups were studied?Required	Payton concerns epidural laboring women; S02 records 90 participants and S03 high-BMI participants with 70 randomized/59 analyzed. S01 S02 S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Report-specific eligibility, parity, anesthesia and baseline conditions	Material needed: Exact S02/S03 eligibility/anesthesia, parity, BMI threshold, baseline pain and recruitment/exclusions are unlinked. Do not automatically transfer conditions between trials. This records needed materials; no new research was executed.
3	Partly verified	Full text not readStored summary read	N03 · Evidence conditionAre peanut balls, round birth balls and movement packages the same?Required	The original manuscript distinguishes ball shapes and ball-only versus positioning/pelvic-movement packages. Direct citations concern peanut balls. This table does not provide labor-ball or delivery instructions. S01 S02 S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Ball shape/device, positioning/movement and actual delivery of the intervention	Material needed: Ball specifications, positioning/movement components, providers, supervision and actual exposure are unlinked. Do not attribute varied package effects to a ball alone. This records needed materials; no new research was executed.
4	Unverified	Full text not readStored summary read	N04 · Evidence conditionWere controls, labor management and contact comparable?Supplementary	The parent's representative summary says standard care; the original manuscript records different trial protocols and controls. S01 S02 S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Standard care, anesthesia/analgesics, positioning/attention and cointerventions	Material needed: Report-specific controls/contact, anesthesia/analgesics, other labor management and intervention details are unlinked. Do not assign the representative control to every trial. This records needed materials; no new research was executed.
5	Partly verified	Full text not readStored summary read	N05 · Evidence conditionWhat are S02 pain and fatigue after 15 minutes?Required	Alan Dikmen's endpoints are pain/fatigue after 15 minutes and total labor duration. Preserve the positive pain/fatigue wording. S02	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Separate patient-reported scales, original times and assessors	Material needed: Scales, assessment windows, baseline/end values, units and between-group effects/CIs/P values are unlinked. Fatigue is not a substitute for pain. This records needed materials; no new research was executed.
6	Partly verified	Full text not readStored summary read	N06 · Evidence conditionWhat does the S02 sample of 90 establish?Required	Preserve the original S02 sample wording of 90 participants. S02	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Allocation/completion, arm-/endpoint-specific denominators and missing data	Material needed: Arm-specific allocation/completion, the 15-minute pain denominator, missing data/exclusions and analysis population are unlinked. Do not treat 90 as everyone analyzed or as one arm's denominator. This records needed materials; no new research was executed.
7	Partly verified	Full text not readStored summary read	N07 · Evidence conditionHow are S02 pain and total-duration P=.177 separated?Required	Preserve positive S02 pain/fatigue alongside null total labor duration P=.177. S02	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Separate attribution of acute pain and total duration	Material needed: Do not use duration P as pain P or replace duration/operative benefit with pain findings. Duration models and precision are also unlinked. This records needed materials; no new research was executed.
8	Partly verified	Full text not readStored summary read	N08 · Evidence conditionWhat is the scope of S03 pain P=.001?Required	Preserve original positive S03 pain P=.001 wording. S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	High-BMI pain measurement, timing, original estimate and CI	Material needed: Scales, times, arm-specific baseline/end values, between-group effects/CIs and clinical-importance thresholds are unlinked. One P value does not establish effect size or generalizability across labor conditions. This records needed materials; no new research was executed.
9	Partly verified	Full text not readStored summary read	N09 · Evidence conditionWhat do 70 randomized, 59 analyzed and completer wording mean?Required	Preserve S03's 70 randomized/59 analyzed and the citation flag separating completer and joint-endpoint findings. S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Arm-specific flow, attrition/exclusions and pain denominators	Material needed: Arm-specific losses/reasons, pain/duration denominators, missing data and all-randomized outcomes are unlinked. No new attrition counts, rates or denominators are calculated. This records needed materials; no new research was executed.
10	Partly verified	Full text not readStored summary read	N10 · Evidence conditionWhat does co-primary pain and active-labor duration require?Required	S03 is a high-BMI co-primary trial with pain and active-labor-duration endpoints. S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Prespecified joint contract, multiplicity and success rules	Material needed: Exact prespecified outcome hierarchy, joint success rules, multiplicity and amendments are unread. Positive pain does not establish success on both endpoints. This records needed materials; no new research was executed.
11	Partly verified	Full text not readStored summary read	N11 · Evidence conditionWhat do active-labor times 202.9/213.6 and P=.522 describe?Required	Preserve original active-labor duration 202.9±59.5 versus 213.6±67.5 minutes, P=.522. S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Duration/dispersion, groups, timing and separation from pain	Material needed: The meaning of ±, group correspondence, denominators and duration models/CIs are unlinked. Do not transfer this into pain effects, total labor duration or surgical prevention, or calculate a new difference. This records needed materials; no new research was executed.
12	Partly verified	Full text not readStored summary read	N12 · Evidence conditionWhat is Payton's epidural-duration/subgroup context?Required	S01 endpoints are first-stage and pushing duration. Preserve primiparous interaction P=.018, multiparous P=.057 and null pushing wording. S01	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	First-stage/parity/interaction and pushing scope	Material needed: Subgroup-duration P values are not selected pain values/effects. Exact pain, denominators, interaction models and prospective status are unlinked. This records needed materials; no new research was executed.
13	Partly verified	Full text not readStored summary read	N13 · Evidence conditionIs the parent's representative duration endpoint direct pain evidence?Required	The parent's representative population is a laboring-women trial without a numeric sample size; its recorded endpoint is first-stage/pushing duration. S01 S02 S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Original representative context versus direct pain reports	Material needed: Do not use this as S02/S03's representative primary pain endpoint or denominator. Link direct pain measurement separately by report. This records needed materials; no new research was executed.
14	Partly verified	Full text not readStored summary read	N14 · Evidence conditionWhat are allocation, concealment and blinding for patient-reported pain?Required	Preserve original manuscript/subclaim wording concerning small randomized trials and absent/difficult blinding. S02 S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Allocation, assessment/analysis roles, expectations and selection bias	Material needed: Report-specific concealment, pain-assessor/analyst blinding and anesthesia/contact/expectation matching are unlinked. Do not assign one bias value to every role. This records needed materials; no new research was executed.
15	Unverified	Full text not readStored summary read	N15 · Evidence conditionAre ITT/PP, baseline, repeats and missing data known?Required	Preserve the original statement that completer material was not interpreted as surgical prevention. S02 S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Pain target effect, models, repeats/baseline and sensitivity analyses	Material needed: Pain ITT/PP, baseline adjustment, repeated measurements, post-analgesic measurements and missing-data/sensitivity analyses are unlinked. This records needed materials; no new research was executed.
16	Partly verified	Full text not readStored summary read	N16 · Evidence conditionWhat is known about prespecification and NCT05276947?Required	Original S01/S02 registration fields read unconfirmed; S03 evidence records NCT05276947. S01 S02 S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Original registration, dates, pain hierarchy, amendments and SAP	Material needed: Original registry/protocol/SAP, hierarchy, amendments and multiplicity are unread. Identifiers or summaries do not establish verified prospective status. This records needed materials; no new research was executed.
17	Unverified	Full text not readStored summary read	N17 · Evidence conditionAre clinically important pain effects and precision available?Required	Preserve the original short-term positive pain signal from small unblinded trials. S02 S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Between-group estimates/CIs, meaningful change and sample-size plans	Material needed: Pain effects/CIs, scale-specific clinical-importance thresholds and sample plans are unlinked, leaving exact ball-specific effect size unverified. No new effects, CIs or numerical examples are created. This records needed materials; no new research was executed.
18	Unverified	Full text not readStored summary read	N18 · Evidence conditionAre analgesics, positioning and movement separated?Supplementary	The original manuscript records comparing differences in epidural status, ball shape, timing and positioning/pelvic movement. S01 S02 S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Anesthesia/analgesics, usual labor care, exposure and adherence	Material needed: Concurrent analgesics/care, intervention delivery/supervision and post-rescue-treatment outcome policy in direct pain reports are unlinked. Do not establish isolated ball or non-drug effects. This records needed materials; no new research was executed.
19	Unverified	Full text not readStored summary read	N19 · Evidence conditionDoes short-term pain establish operative or other obstetric outcomes?Required	The parent records uncertain precise reductions in operative delivery/analgesics and does not interpret vaginal delivery among all completers as prevention. S01 S02 S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Cesarean/instrumental delivery, analgesics and maternal/neonatal boundaries	Material needed: Do not transfer positive pain into shorter labor, surgical prevention or long-term neonatal/maternal effects. Original event counts, denominators and CIs are unlinked. This records needed materials; no new research was executed.
20	Unverified	Full text not readStored summary read	N20 · Evidence conditionAre persistence, other labor conditions and independent replication established?Required	Preserve short-term signals from small, differing programs. S01 supplies duration context; S02/S03 concern direct pain. S01 S02 S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Protocols/controls, ball shape, anesthesia, duration and shared cohorts	Material needed: Strict independent confirmation of the same pain/ball/control contract, persistence/other populations and unique-trial/participant totals are unconfirmed. No report/population totals are summed. This records needed materials; no new research was executed.
21	Unverified	Full text not readStored summary read	N21 · Evidence conditionWhat is known about funding, support and COI?Required	All three original evidence entries record unverified detailed funding. S01 S02 S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Funding, device/material support, employee authors and separate roles	Material needed: Do not fill product/ball support, employee authorship, COI or analysis/assessment/publication roles with no involvement or established independence. This records needed materials; no new research was executed.
22	Unverified	Full text not readStored summary read	N22 · Evidence conditionAre maternal/fetal harms, collection and denominators known?Supplementary	Preserve original parent Caution safety wording and its labor-safety context. S01 S02 S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Harm definitions, arm-specific events/denominators, timing and discontinuation/missing data	Material needed: Original fall/positioning-related and maternal/fetal/neonatal event counts/denominators, collection, discontinuation and missing data are unlinked. Pain or completer findings do not certify safety. This records needed materials; no new research was executed.
23	Unverified	Full text not readStored summary read	N23 · Evidence conditionWhat are vulnerable conditions, shared exposures and instruction limits?Supplementary	Preserve original parental safety wording as historical context; create no new labor-ball, delivery, treatment or action instructions. S01 S02 S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Labor/anesthesia-specific harms, alternative causes and persistence	Material needed: Population-/anesthesia-/time-specific harms, shared exposure and long-term maternal/neonatal material are unlinked. Unsupervised use or safety in other populations is not established. This records needed materials; no new research was executed.
24	Partly verified	Full text not readStored summary read	N24 · Evidence conditionAre original bibliography, languages, grades/axes and empty history preserved?Required	Preserve original PMID/DOI/journal wording. Retain parent C50/unrecorded precision, Korean/English, 2026-09-07, empty corrections/deliberation and selected C/note with absent score/status/axes. S01 S02 S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Original report wording, parent/subclaim distinction, unrecorded precision and dates	Material needed: Original external bibliography and historical cross-check wording do not establish review/certification in this work. No new grades, numbers or hypothetical examples. This records needed materials; no new research was executed.
25	Partly verified	Full text not readStored summary read	N25 · Evidence conditionWhat distinguishes summary reading from external links?Required	This work prepares materials from the complete stored summary and bibliography, distinguishing summary reading, unread external materials and source URLs. S01 S02 S03	The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.	Report-specific reading versus original papers, registration, plans and support access	Material needed: External papers, registration, protocols/SAPs and support originals are unread and access was not attempted. URLs or historical verification wording do not establish current reading or external link tests. This records needed materials; no new research was executed.

No items match your search or filter.

25 itemsWhat the statuses mean

Assessment scope

Stored-material review date: Not recorded
Original evidence cut-off: 2026-09-07
Scope actually checked: Existing review summaries and stored records of methodological application. Full papers, supplements, registrations, plans and original data were not read.
What the dates mean: This is the date the stored materials were checked, not the date of a new search of the clinical literature.
Population: The selected question is acute labor pain. S01 Payton provides epidural labor-duration background with no recorded numeric sample size. S02 Alan Dikmen records 90 participants; S03 Ozkececi records high-BMI participants with 70 randomized/59 analyzed. Exact eligibility, anesthesia, parity, BMI thresholds, baseline pain and arm-/endpoint-specific denominators are unverified.
Ingredient, formulation and route: The parent distinguishes round birth balls from peanut balls and ball-only use from positioning/pelvic-movement packages. The direct bibliographies concern peanut-ball reports. Ball specifications, providers, supervision, actual components and exposure are unverified. Results of varied programs are not assigned to a ball alone or turned into new instructions.
Dose: S02 pain/fatigue after 15 minutes is an original measurement time. Exact S03 pain timing/exposure is unverified and a program name is not a numeric dose. No new duration of use, repetition count or individualized delivery method is created or calculated from a measurement time.
Comparator: The parent comparator label is standard care. Actual controls, anesthesia/analgesics, positioning, contact, other labor management and delivery of the intervention are unverified by report. Epidural conditions or a representative comparator are not automatically assigned to all S02/S03 participants or treated as isolated ball/non-drug effects.
Measured outcome: The selected endpoint is patient-reported acute pain. Distinguish S02 positive 15-minute pain/fatigue from total labor duration P=.177, and S03 pain P=.001 from active-labor duration 202.9±59.5 versus 213.6±67.5 minutes/P=.522. S03 co-primary success rules are unverified. S01 first-stage subgroup/pushing durations are not direct pain estimates.
Duration: Preserve S02 measurement after 15 minutes and the acute scope of the index labor. Exact S03 pain windows, persistence, other stages and long-term maternal/neonatal outcomes are unverified. Distinguish total, active-labor, first-stage and pushing durations; do not extend pain signals into shorter labor or surgical prevention.
Questions outside this scope: Transferring acute pain/fatigue into total labor duration, operative delivery, reduced analgesics or long-term maternal/neonatal benefit; Substituting ball shapes, anesthesia, controls or positioning/pelvic-movement packages for the same ball-only intervention; Using duration P values as pain P values or upgrading positive pain within co-primary outcomes into joint success; Summing randomized/analyzed populations, subgroups, sheets or reports into new participant, unique-trial or independent-replication totals; Inheriting parent C50, axes or historical verification as missing subclaim values or a new verdict; Creating new effects, CIs, attrition counts/rates, grades, independence/safety certification or labor-ball, delivery or treatment instructions

Evidence and sources

The links below lead to the sources. A link alone does not mean the original source was read or its latest publication status verified.

S01 · Payton CL, et al. Randomized Controlled Trial of Use of the Peanut Ball During Labor. Nurs Womens Health. 2016. PMID: 26859467. DOI: 10.1097/NMC.0000000000000232.

PubMed

Material type: Randomized epidural peanut-ball trial
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Findings recorded in the stored summary: Primiparous interaction P=.018; multiparous P=.057; pushing null
Record level: For the selected pain question, this is epidural labor-duration background. Preserve first-stage primiparous interaction P=.018, multiparous P=.057 and null pushing time. Numeric sample size, direct pain values, subgroup denominators/models, prospective status and effects/CIs are unverified.
Study overlap and independent replication: Parent 2998 and the pain/duration-operative subclaim sheets share the same three reports. S01 provides epidural duration/subgroup background; S02/S03 concern direct pain, with different ball shapes, anesthesia, movement packages, controls and endpoints. Randomized/analyzed populations, subgroups, outcomes, sheets and reports are not summed into new participant, unique-trial or independent-replication totals. Cohort relationships, confirmed totals and independence are unverified.

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Stored existing review summary	Preserved copy of the complete parent-verdict stored summary	Stored summary	Summary read	Preserve original PubMed URL, PMID 26859467, DOI 10.1097/NMC.0000000000000232, PMCID unrecorded and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred.
External paper	Original bibliographic link or needed material; external public availability/access status unverified	Unread; access not attempted	Not read	Preserve original PubMed URL, PMID 26859467, DOI 10.1097/NMC.0000000000000232, PMCID unrecorded and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred.
Registration material	Original bibliographic link or needed material; external public availability/access status unverified	Unread; access not attempted	Not read	Preserve original PubMed URL, PMID 26859467, DOI 10.1097/NMC.0000000000000232, PMCID unrecorded and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred.
Protocol	Original bibliographic link or needed material; external public availability/access status unverified	Unread; access not attempted	Not read	Preserve original PubMed URL, PMID 26859467, DOI 10.1097/NMC.0000000000000232, PMCID unrecorded and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred.
Statistical analysis plan	Original bibliographic link or needed material; external public availability/access status unverified	Unread; access not attempted	Not read	Preserve original PubMed URL, PMID 26859467, DOI 10.1097/NMC.0000000000000232, PMCID unrecorded and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred.
Funding, product-support and COI material	Original bibliographic link or needed material; external public availability/access status unverified	Unread; access not attempted	Not read	Preserve original PubMed URL, PMID 26859467, DOI 10.1097/NMC.0000000000000232, PMCID unrecorded and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred.

S02 · Alan Dikmen H, et al. Effects of peanut ball use on perceived labor pain, fatigue, and mother's perception of childbirth: a randomized controlled trial. Arch Gynecol Obstet. 2025;311. PMID: 39103620. PMCID: PMC12055654. DOI: 10.1007/s00404-024-07656-2.

PubMed

Material type: Randomized acute pain and fatigue trial
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Findings recorded in the stored summary: Pain and fatigue positive; total labor duration P=.177
Record level: Direct acute-pain report. Distinguish 90 participants and positive pain/fatigue after 15 minutes from null total labor duration P=.177. Exact pain scales, effects/CIs/P values, arm-/endpoint-specific denominators, anesthesia and control are unverified. Duration P is not pain P.
Study overlap and independent replication: Parent 2998 and the pain/duration-operative subclaim sheets share the same three reports. S01 provides epidural duration/subgroup background; S02/S03 concern direct pain, with different ball shapes, anesthesia, movement packages, controls and endpoints. Randomized/analyzed populations, subgroups, outcomes, sheets and reports are not summed into new participant, unique-trial or independent-replication totals. Cohort relationships, confirmed totals and independence are unverified.

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Stored existing review summary	Preserved copy of the complete parent-verdict stored summary	Stored summary	Summary read	Preserve original PubMed URL, PMID 39103620, DOI 10.1007/s00404-024-07656-2, PMCID PMC12055654 and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred.
External paper	Original bibliographic link or needed material; external public availability/access status unverified	Unread; access not attempted	Not read	Preserve original PubMed URL, PMID 39103620, DOI 10.1007/s00404-024-07656-2, PMCID PMC12055654 and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred.
Registration material	Original bibliographic link or needed material; external public availability/access status unverified	Unread; access not attempted	Not read	Preserve original PubMed URL, PMID 39103620, DOI 10.1007/s00404-024-07656-2, PMCID PMC12055654 and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred.
Protocol	Original bibliographic link or needed material; external public availability/access status unverified	Unread; access not attempted	Not read	Preserve original PubMed URL, PMID 39103620, DOI 10.1007/s00404-024-07656-2, PMCID PMC12055654 and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred.
Statistical analysis plan	Original bibliographic link or needed material; external public availability/access status unverified	Unread; access not attempted	Not read	Preserve original PubMed URL, PMID 39103620, DOI 10.1007/s00404-024-07656-2, PMCID PMC12055654 and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred.
Funding, product-support and COI material	Original bibliographic link or needed material; external public availability/access status unverified	Unread; access not attempted	Not read	Preserve original PubMed URL, PMID 39103620, DOI 10.1007/s00404-024-07656-2, PMCID PMC12055654 and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred.

S03 · Ozkececi F, et al. The Effect of Peanut Ball Use on the Labour Process and Maternal-Neonatal Outcomes in Parturient Women With High Maternal Body Mass Index: A Randomized Controlled Trial. Int J Nurs Pract. 2026;32:e70144. PMID: 42026814. PMCID: PMC13106928. DOI: 10.1111/ijn.70144.

PubMed

Material type: Randomized co-primary trial in high-BMI participants
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Findings recorded in the stored summary: Pain P=.001; duration 202.9±59.5 vs 213.6±67.5 min, P=.522
Record level: High-BMI co-primary report. Distinguish 70 randomized/59 analyzed, pain P=.001 and active-labor duration 202.9±59.5 versus 213.6±67.5 minutes/P=.522. Pain scales, exact timing, effects/CIs, denominators, the meaning of ± and joint success rules are unverified. Completer results do not establish duration/surgical prevention.
Study overlap and independent replication: Parent 2998 and the pain/duration-operative subclaim sheets share the same three reports. S01 provides epidural duration/subgroup background; S02/S03 concern direct pain, with different ball shapes, anesthesia, movement packages, controls and endpoints. Randomized/analyzed populations, subgroups, outcomes, sheets and reports are not summed into new participant, unique-trial or independent-replication totals. Cohort relationships, confirmed totals and independence are unverified.

Public availability, access and reading status by material
Material	Public availability	Access status	Actually read	Notes
Stored existing review summary	Preserved copy of the complete parent-verdict stored summary	Stored summary	Summary read	Preserve original PubMed URL, PMID 42026814, DOI 10.1111/ijn.70144, PMCID PMC13106928 and bibliographic wording unchanged. The original evidence registration field exists and reads NCT05276947. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred.
External paper	Original bibliographic link or needed material; external public availability/access status unverified	Unread; access not attempted	Not read	Preserve original PubMed URL, PMID 42026814, DOI 10.1111/ijn.70144, PMCID PMC13106928 and bibliographic wording unchanged. The original evidence registration field exists and reads NCT05276947. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred.
Registration material	Original bibliographic link or needed material; external public availability/access status unverified	Unread; access not attempted	Not read	Preserve original PubMed URL, PMID 42026814, DOI 10.1111/ijn.70144, PMCID PMC13106928 and bibliographic wording unchanged. The original evidence registration field exists and reads NCT05276947. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred.
Protocol	Original bibliographic link or needed material; external public availability/access status unverified	Unread; access not attempted	Not read	Preserve original PubMed URL, PMID 42026814, DOI 10.1111/ijn.70144, PMCID PMC13106928 and bibliographic wording unchanged. The original evidence registration field exists and reads NCT05276947. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred.
Statistical analysis plan	Original bibliographic link or needed material; external public availability/access status unverified	Unread; access not attempted	Not read	Preserve original PubMed URL, PMID 42026814, DOI 10.1111/ijn.70144, PMCID PMC13106928 and bibliographic wording unchanged. The original evidence registration field exists and reads NCT05276947. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred.
Funding, product-support and COI material	Original bibliographic link or needed material; external public availability/access status unverified	Unread; access not attempted	Not read	Preserve original PubMed URL, PMID 42026814, DOI 10.1111/ijn.70144, PMCID PMC13106928 and bibliographic wording unchanged. The original evidence registration field exists and reads NCT05276947. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred.

Report counts versus independent study counts

Parent 2998 and the pain/duration-operative subclaim sheets share the same three reports. S01 provides epidural duration/subgroup background; S02/S03 concern direct pain, with different ball shapes, anesthesia, movement packages, controls and endpoints. Randomized/analyzed populations, subgroups, outcomes, sheets and reports are not summed into new participant, unique-trial or independent-replication totals. Cohort relationships, confirmed totals and independence are unverified.

Review criteria

Version 1.0 · Criteria record date 2026-10-06. These are Chamgap's own application conditions, informed by the referenced methods. They do not constitute official assessment-tool certification or a new efficacy score.

N01 · Which acute labor-pain claim is being checked?

Required materials and conditions: Selected claim, original grade/note and parent context
Conditions for verification: Material for Selected claim, original grade/note and parent context must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Selected claim, original grade/note and parent context with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N02 · Which populations, epidural conditions and high-BMI groups were studied?

Required materials and conditions: Report-specific eligibility, parity, anesthesia and baseline conditions
Conditions for verification: Material for Report-specific eligibility, parity, anesthesia and baseline conditions must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Report-specific eligibility, parity, anesthesia and baseline conditions with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N03 · Are peanut balls, round birth balls and movement packages the same?

Required materials and conditions: Ball shape/device, positioning/movement and actual delivery of the intervention
Conditions for verification: Material for Ball shape/device, positioning/movement and actual delivery of the intervention must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Ball shape/device, positioning/movement and actual delivery of the intervention with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N04 · Were controls, labor management and contact comparable?

Required materials and conditions: Standard care, anesthesia/analgesics, positioning/attention and cointerventions
Conditions for verification: Material for Standard care, anesthesia/analgesics, positioning/attention and cointerventions must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Supplementary
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Standard care, anesthesia/analgesics, positioning/attention and cointerventions with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N05 · What are S02 pain and fatigue after 15 minutes?

Required materials and conditions: Separate patient-reported scales, original times and assessors
Conditions for verification: Material for Separate patient-reported scales, original times and assessors must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Separate patient-reported scales, original times and assessors with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N06 · What does the S02 sample of 90 establish?

Required materials and conditions: Allocation/completion, arm-/endpoint-specific denominators and missing data
Conditions for verification: Material for Allocation/completion, arm-/endpoint-specific denominators and missing data must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Allocation/completion, arm-/endpoint-specific denominators and missing data with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N07 · How are S02 pain and total-duration P=.177 separated?

Required materials and conditions: Separate attribution of acute pain and total duration
Conditions for verification: Material for Separate attribution of acute pain and total duration must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Separate attribution of acute pain and total duration with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N08 · What is the scope of S03 pain P=.001?

Required materials and conditions: High-BMI pain measurement, timing, original estimate and CI
Conditions for verification: Material for High-BMI pain measurement, timing, original estimate and CI must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects High-BMI pain measurement, timing, original estimate and CI with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N09 · What do 70 randomized, 59 analyzed and completer wording mean?

Required materials and conditions: Arm-specific flow, attrition/exclusions and pain denominators
Conditions for verification: Material for Arm-specific flow, attrition/exclusions and pain denominators must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Arm-specific flow, attrition/exclusions and pain denominators with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N10 · What does co-primary pain and active-labor duration require?

Required materials and conditions: Prespecified joint contract, multiplicity and success rules
Conditions for verification: Material for Prespecified joint contract, multiplicity and success rules must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Prespecified joint contract, multiplicity and success rules with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N11 · What do active-labor times 202.9/213.6 and P=.522 describe?

Required materials and conditions: Duration/dispersion, groups, timing and separation from pain
Conditions for verification: Material for Duration/dispersion, groups, timing and separation from pain must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Duration/dispersion, groups, timing and separation from pain with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N12 · What is Payton's epidural-duration/subgroup context?

Required materials and conditions: First-stage/parity/interaction and pushing scope
Conditions for verification: Material for First-stage/parity/interaction and pushing scope must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects First-stage/parity/interaction and pushing scope with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N13 · Is the parent's representative duration endpoint direct pain evidence?

Required materials and conditions: Original representative context versus direct pain reports
Conditions for verification: Material for Original representative context versus direct pain reports must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Original representative context versus direct pain reports with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N14 · What are allocation, concealment and blinding for patient-reported pain?

Required materials and conditions: Allocation, assessment/analysis roles, expectations and selection bias
Conditions for verification: Material for Allocation, assessment/analysis roles, expectations and selection bias must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Allocation, assessment/analysis roles, expectations and selection bias with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N15 · Are ITT/PP, baseline, repeats and missing data known?

Required materials and conditions: Pain target effect, models, repeats/baseline and sensitivity analyses
Conditions for verification: Material for Pain target effect, models, repeats/baseline and sensitivity analyses must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Pain target effect, models, repeats/baseline and sensitivity analyses with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N16 · What is known about prespecification and NCT05276947?

Required materials and conditions: Original registration, dates, pain hierarchy, amendments and SAP
Conditions for verification: Material for Original registration, dates, pain hierarchy, amendments and SAP must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Original registration, dates, pain hierarchy, amendments and SAP with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N17 · Are clinically important pain effects and precision available?

Required materials and conditions: Between-group estimates/CIs, meaningful change and sample-size plans
Conditions for verification: Material for Between-group estimates/CIs, meaningful change and sample-size plans must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Between-group estimates/CIs, meaningful change and sample-size plans with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N18 · Are analgesics, positioning and movement separated?

Required materials and conditions: Anesthesia/analgesics, usual labor care, exposure and adherence
Conditions for verification: Material for Anesthesia/analgesics, usual labor care, exposure and adherence must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Supplementary
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Anesthesia/analgesics, usual labor care, exposure and adherence with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N19 · Does short-term pain establish operative or other obstetric outcomes?

Required materials and conditions: Cesarean/instrumental delivery, analgesics and maternal/neonatal boundaries
Conditions for verification: Material for Cesarean/instrumental delivery, analgesics and maternal/neonatal boundaries must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Cesarean/instrumental delivery, analgesics and maternal/neonatal boundaries with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N20 · Are persistence, other labor conditions and independent replication established?

Required materials and conditions: Protocols/controls, ball shape, anesthesia, duration and shared cohorts
Conditions for verification: Material for Protocols/controls, ball shape, anesthesia, duration and shared cohorts must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Protocols/controls, ball shape, anesthesia, duration and shared cohorts with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N21 · What is known about funding, support and COI?

Required materials and conditions: Funding, device/material support, employee authors and separate roles
Conditions for verification: Material for Funding, device/material support, employee authors and separate roles must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Funding, device/material support, employee authors and separate roles with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N22 · Are maternal/fetal harms, collection and denominators known?

Required materials and conditions: Harm definitions, arm-specific events/denominators, timing and discontinuation/missing data
Conditions for verification: Material for Harm definitions, arm-specific events/denominators, timing and discontinuation/missing data must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Supplementary
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Harm definitions, arm-specific events/denominators, timing and discontinuation/missing data with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N23 · What are vulnerable conditions, shared exposures and instruction limits?

Required materials and conditions: Labor/anesthesia-specific harms, alternative causes and persistence
Conditions for verification: Material for Labor/anesthesia-specific harms, alternative causes and persistence must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Supplementary
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Labor/anesthesia-specific harms, alternative causes and persistence with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N24 · Are original bibliography, languages, grades/axes and empty history preserved?

Required materials and conditions: Original report wording, parent/subclaim distinction, unrecorded precision and dates
Conditions for verification: Material for Original report wording, parent/subclaim distinction, unrecorded precision and dates must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Original report wording, parent/subclaim distinction, unrecorded precision and dates with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

N25 · What distinguishes summary reading from external links?

Required materials and conditions: Report-specific reading versus original papers, registration, plans and support access
Conditions for verification: Material for Report-specific reading versus original papers, registration, plans and support access must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Requirement and applicability: Required
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Why this condition is needed: This condition connects Report-specific reading versus original papers, registration, plans and support access with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Referenced methods and the sections actually reviewed

M03 · Cochrane Handbook 6.5 (2024), chapter updated 2023-08

Official methodology · §3.1, §3.2.1–3.2.3, MECIR C5/C7/C13

Referenced principle: Clearly record the question, eligibility conditions and reasons for changes, and distinguish variations in interventions.
Extent of review: Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed.

M04 · Cochrane Handbook 6.5.1 (2025), chapter updated 2025-03

Official methodology · §4.5, §4.6.1–4.6.3, MECIR C42

Referenced principle: Distinguish studies from reports and link them; do not omit a study solely because results are unreported.
Extent of review: Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed.

M08 · Cochrane Handbook 6.5 (2024), chapter updated 2019-10

Official methodology · §8.1–8.2.3, Table 8.2.a

Referenced principle: Define the outcome and effect of interest, then examine randomization, deviations, missing data, measurement and selective reporting.
Extent of review: Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed.

M15 · Cochrane Handbook 6.5 (2024), chapter updated 2023-08

Official methodology · §15.2.4, §15.3.1–15.3.3

Referenced principle: Distinguish effect estimates, intervals, importance and applicability. Sample size alone does not determine precision.
Extent of review: Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed.

M19 · Cochrane Handbook 6.5 (2024), chapter updated 2019-10

Official methodology · §19.1.2, §19.2.1–19.2.4

Referenced principle: Harm questions may require different designs, populations and follow-up from efficacy questions. Case reports do not establish incidence rates.
Extent of review: Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed.

What the statuses mean

Met: A state used when required evidence is confirmed after user review. This production does not declare that review complete.
Partly verified: Some information in the stored summary is linked into the table. External comparison/content review is not complete.
Unverified: The article leaves this unverified, or required material is absent from the current stored summary. This is distinct from zero, absence or safety.
Review incomplete: User review pending.
Not reported: Not reported within the stored material actually read; not extended to the entire primary paper.
Inaccessible: Means an actual access failure. Access not attempted here is not assigned this state.
Not applicable: Not used as a substitute for an evidence gap.
Conflicting data: Requires an observed disagreement under the same comparison criteria; not automatically judged in this production.
Insufficient evidence for the conditions: Marks a gap in additional material required by the selected conditions; not a new efficacy grade.

Change history

2026-10-16 · Public page/material version 1.0

The public page and data were prepared from the existing 25 items. No new clinical search, verification-status change or scoring was performed.

The stored-material review date (Not recorded) and original evidence cut-off (2026-09-07) were retained unchanged.

Researcher downloads

These materials provide the same evidence, scope and verification status as this page.

View all item details

N01 · Which acute labor-pain claim is being checked?

Current findings: Preserve the selected acute labor-pain claim, subclaim C and the note describing a short-term signal from small unblinded trials. Parent C50 remains parent context.
Verification status: Partly verified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Subclaim score, status and axes are absent. Do not fill them from parent values.
Required materials and conditions: Selected claim, original grade/note and parent context
Materials to obtain first: Subclaim score, status and axes are absent. Do not fill them from parent values.
Further research: Material needed: Subclaim score, status and axes are absent. Do not fill them from parent values. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Selected claim, original grade/note and parent context must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Selected claim, original grade/note and parent context with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S02 S03

N02 · Which populations, epidural conditions and high-BMI groups were studied?

Current findings: Payton concerns epidural laboring women; S02 records 90 participants and S03 high-BMI participants with 70 randomized/59 analyzed.
Verification status: Partly verified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Exact S02/S03 eligibility/anesthesia, parity, BMI threshold, baseline pain and recruitment/exclusions are unlinked. Do not automatically transfer conditions between trials.
Required materials and conditions: Report-specific eligibility, parity, anesthesia and baseline conditions
Materials to obtain first: Exact S02/S03 eligibility/anesthesia, parity, BMI threshold, baseline pain and recruitment/exclusions are unlinked. Do not automatically transfer conditions between trials.
Further research: Material needed: Exact S02/S03 eligibility/anesthesia, parity, BMI threshold, baseline pain and recruitment/exclusions are unlinked. Do not automatically transfer conditions between trials. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Report-specific eligibility, parity, anesthesia and baseline conditions must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Report-specific eligibility, parity, anesthesia and baseline conditions with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S01 S02 S03

N03 · Are peanut balls, round birth balls and movement packages the same?

Current findings: The original manuscript distinguishes ball shapes and ball-only versus positioning/pelvic-movement packages. Direct citations concern peanut balls. This table does not provide labor-ball or delivery instructions.
Verification status: Partly verified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Ball specifications, positioning/movement components, providers, supervision and actual exposure are unlinked. Do not attribute varied package effects to a ball alone.
Required materials and conditions: Ball shape/device, positioning/movement and actual delivery of the intervention
Materials to obtain first: Ball specifications, positioning/movement components, providers, supervision and actual exposure are unlinked. Do not attribute varied package effects to a ball alone.
Further research: Material needed: Ball specifications, positioning/movement components, providers, supervision and actual exposure are unlinked. Do not attribute varied package effects to a ball alone. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Ball shape/device, positioning/movement and actual delivery of the intervention must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Ball shape/device, positioning/movement and actual delivery of the intervention with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S01 S02 S03

N04 · Were controls, labor management and contact comparable?

Current findings: The parent's representative summary says standard care; the original manuscript records different trial protocols and controls.
Verification status: Unverified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Report-specific controls/contact, anesthesia/analgesics, other labor management and intervention details are unlinked. Do not assign the representative control to every trial.
Required materials and conditions: Standard care, anesthesia/analgesics, positioning/attention and cointerventions
Materials to obtain first: Report-specific controls/contact, anesthesia/analgesics, other labor management and intervention details are unlinked. Do not assign the representative control to every trial.
Further research: Material needed: Report-specific controls/contact, anesthesia/analgesics, other labor management and intervention details are unlinked. Do not assign the representative control to every trial. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Standard care, anesthesia/analgesics, positioning/attention and cointerventions must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Standard care, anesthesia/analgesics, positioning/attention and cointerventions with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S01 S02 S03

N05 · What are S02 pain and fatigue after 15 minutes?

Current findings: Alan Dikmen's endpoints are pain/fatigue after 15 minutes and total labor duration. Preserve the positive pain/fatigue wording.
Verification status: Partly verified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Scales, assessment windows, baseline/end values, units and between-group effects/CIs/P values are unlinked. Fatigue is not a substitute for pain.
Required materials and conditions: Separate patient-reported scales, original times and assessors
Materials to obtain first: Scales, assessment windows, baseline/end values, units and between-group effects/CIs/P values are unlinked. Fatigue is not a substitute for pain.
Further research: Material needed: Scales, assessment windows, baseline/end values, units and between-group effects/CIs/P values are unlinked. Fatigue is not a substitute for pain. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Separate patient-reported scales, original times and assessors must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Separate patient-reported scales, original times and assessors with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S02

N06 · What does the S02 sample of 90 establish?

Current findings: Preserve the original S02 sample wording of 90 participants.
Verification status: Partly verified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Arm-specific allocation/completion, the 15-minute pain denominator, missing data/exclusions and analysis population are unlinked. Do not treat 90 as everyone analyzed or as one arm's denominator.
Required materials and conditions: Allocation/completion, arm-/endpoint-specific denominators and missing data
Materials to obtain first: Arm-specific allocation/completion, the 15-minute pain denominator, missing data/exclusions and analysis population are unlinked. Do not treat 90 as everyone analyzed or as one arm's denominator.
Further research: Material needed: Arm-specific allocation/completion, the 15-minute pain denominator, missing data/exclusions and analysis population are unlinked. Do not treat 90 as everyone analyzed or as one arm's denominator. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Allocation/completion, arm-/endpoint-specific denominators and missing data must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Allocation/completion, arm-/endpoint-specific denominators and missing data with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S02

N07 · How are S02 pain and total-duration P=.177 separated?

Current findings: Preserve positive S02 pain/fatigue alongside null total labor duration P=.177.
Verification status: Partly verified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Do not use duration P as pain P or replace duration/operative benefit with pain findings. Duration models and precision are also unlinked.
Required materials and conditions: Separate attribution of acute pain and total duration
Materials to obtain first: Do not use duration P as pain P or replace duration/operative benefit with pain findings. Duration models and precision are also unlinked.
Further research: Material needed: Do not use duration P as pain P or replace duration/operative benefit with pain findings. Duration models and precision are also unlinked. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Separate attribution of acute pain and total duration must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Separate attribution of acute pain and total duration with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S02

N08 · What is the scope of S03 pain P=.001?

Current findings: Preserve original positive S03 pain P=.001 wording.
Verification status: Partly verified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Scales, times, arm-specific baseline/end values, between-group effects/CIs and clinical-importance thresholds are unlinked. One P value does not establish effect size or generalizability across labor conditions.
Required materials and conditions: High-BMI pain measurement, timing, original estimate and CI
Materials to obtain first: Scales, times, arm-specific baseline/end values, between-group effects/CIs and clinical-importance thresholds are unlinked. One P value does not establish effect size or generalizability across labor conditions.
Further research: Material needed: Scales, times, arm-specific baseline/end values, between-group effects/CIs and clinical-importance thresholds are unlinked. One P value does not establish effect size or generalizability across labor conditions. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for High-BMI pain measurement, timing, original estimate and CI must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects High-BMI pain measurement, timing, original estimate and CI with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S03

N09 · What do 70 randomized, 59 analyzed and completer wording mean?

Current findings: Preserve S03's 70 randomized/59 analyzed and the citation flag separating completer and joint-endpoint findings.
Verification status: Partly verified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Arm-specific losses/reasons, pain/duration denominators, missing data and all-randomized outcomes are unlinked. No new attrition counts, rates or denominators are calculated.
Required materials and conditions: Arm-specific flow, attrition/exclusions and pain denominators
Materials to obtain first: Arm-specific losses/reasons, pain/duration denominators, missing data and all-randomized outcomes are unlinked. No new attrition counts, rates or denominators are calculated.
Further research: Material needed: Arm-specific losses/reasons, pain/duration denominators, missing data and all-randomized outcomes are unlinked. No new attrition counts, rates or denominators are calculated. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Arm-specific flow, attrition/exclusions and pain denominators must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Arm-specific flow, attrition/exclusions and pain denominators with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S03

N10 · What does co-primary pain and active-labor duration require?

Current findings: S03 is a high-BMI co-primary trial with pain and active-labor-duration endpoints.
Verification status: Partly verified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Exact prespecified outcome hierarchy, joint success rules, multiplicity and amendments are unread. Positive pain does not establish success on both endpoints.
Required materials and conditions: Prespecified joint contract, multiplicity and success rules
Materials to obtain first: Exact prespecified outcome hierarchy, joint success rules, multiplicity and amendments are unread. Positive pain does not establish success on both endpoints.
Further research: Material needed: Exact prespecified outcome hierarchy, joint success rules, multiplicity and amendments are unread. Positive pain does not establish success on both endpoints. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Prespecified joint contract, multiplicity and success rules must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Prespecified joint contract, multiplicity and success rules with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S03

N11 · What do active-labor times 202.9/213.6 and P=.522 describe?

Current findings: Preserve original active-labor duration 202.9±59.5 versus 213.6±67.5 minutes, P=.522.
Verification status: Partly verified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: The meaning of ±, group correspondence, denominators and duration models/CIs are unlinked. Do not transfer this into pain effects, total labor duration or surgical prevention, or calculate a new difference.
Required materials and conditions: Duration/dispersion, groups, timing and separation from pain
Materials to obtain first: The meaning of ±, group correspondence, denominators and duration models/CIs are unlinked. Do not transfer this into pain effects, total labor duration or surgical prevention, or calculate a new difference.
Further research: Material needed: The meaning of ±, group correspondence, denominators and duration models/CIs are unlinked. Do not transfer this into pain effects, total labor duration or surgical prevention, or calculate a new difference. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Duration/dispersion, groups, timing and separation from pain must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Duration/dispersion, groups, timing and separation from pain with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S03

N12 · What is Payton's epidural-duration/subgroup context?

Current findings: S01 endpoints are first-stage and pushing duration. Preserve primiparous interaction P=.018, multiparous P=.057 and null pushing wording.
Verification status: Partly verified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Subgroup-duration P values are not selected pain values/effects. Exact pain, denominators, interaction models and prospective status are unlinked.
Required materials and conditions: First-stage/parity/interaction and pushing scope
Materials to obtain first: Subgroup-duration P values are not selected pain values/effects. Exact pain, denominators, interaction models and prospective status are unlinked.
Further research: Material needed: Subgroup-duration P values are not selected pain values/effects. Exact pain, denominators, interaction models and prospective status are unlinked. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for First-stage/parity/interaction and pushing scope must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects First-stage/parity/interaction and pushing scope with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S01

N13 · Is the parent's representative duration endpoint direct pain evidence?

Current findings: The parent's representative population is a laboring-women trial without a numeric sample size; its recorded endpoint is first-stage/pushing duration.
Verification status: Partly verified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Do not use this as S02/S03's representative primary pain endpoint or denominator. Link direct pain measurement separately by report.
Required materials and conditions: Original representative context versus direct pain reports
Materials to obtain first: Do not use this as S02/S03's representative primary pain endpoint or denominator. Link direct pain measurement separately by report.
Further research: Material needed: Do not use this as S02/S03's representative primary pain endpoint or denominator. Link direct pain measurement separately by report. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Original representative context versus direct pain reports must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Original representative context versus direct pain reports with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S01 S02 S03

N14 · What are allocation, concealment and blinding for patient-reported pain?

Current findings: Preserve original manuscript/subclaim wording concerning small randomized trials and absent/difficult blinding.
Verification status: Partly verified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Report-specific concealment, pain-assessor/analyst blinding and anesthesia/contact/expectation matching are unlinked. Do not assign one bias value to every role.
Required materials and conditions: Allocation, assessment/analysis roles, expectations and selection bias
Materials to obtain first: Report-specific concealment, pain-assessor/analyst blinding and anesthesia/contact/expectation matching are unlinked. Do not assign one bias value to every role.
Further research: Material needed: Report-specific concealment, pain-assessor/analyst blinding and anesthesia/contact/expectation matching are unlinked. Do not assign one bias value to every role. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Allocation, assessment/analysis roles, expectations and selection bias must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Allocation, assessment/analysis roles, expectations and selection bias with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S02 S03

N15 · Are ITT/PP, baseline, repeats and missing data known?

Current findings: Preserve the original statement that completer material was not interpreted as surgical prevention.
Verification status: Unverified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Pain ITT/PP, baseline adjustment, repeated measurements, post-analgesic measurements and missing-data/sensitivity analyses are unlinked.
Required materials and conditions: Pain target effect, models, repeats/baseline and sensitivity analyses
Materials to obtain first: Pain ITT/PP, baseline adjustment, repeated measurements, post-analgesic measurements and missing-data/sensitivity analyses are unlinked.
Further research: Material needed: Pain ITT/PP, baseline adjustment, repeated measurements, post-analgesic measurements and missing-data/sensitivity analyses are unlinked. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Pain target effect, models, repeats/baseline and sensitivity analyses must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Pain target effect, models, repeats/baseline and sensitivity analyses with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S02 S03

N16 · What is known about prespecification and NCT05276947?

Current findings: Original S01/S02 registration fields read unconfirmed; S03 evidence records NCT05276947.
Verification status: Partly verified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Original registry/protocol/SAP, hierarchy, amendments and multiplicity are unread. Identifiers or summaries do not establish verified prospective status.
Required materials and conditions: Original registration, dates, pain hierarchy, amendments and SAP
Materials to obtain first: Original registry/protocol/SAP, hierarchy, amendments and multiplicity are unread. Identifiers or summaries do not establish verified prospective status.
Further research: Material needed: Original registry/protocol/SAP, hierarchy, amendments and multiplicity are unread. Identifiers or summaries do not establish verified prospective status. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Original registration, dates, pain hierarchy, amendments and SAP must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Original registration, dates, pain hierarchy, amendments and SAP with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S01 S02 S03

N17 · Are clinically important pain effects and precision available?

Current findings: Preserve the original short-term positive pain signal from small unblinded trials.
Verification status: Unverified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Pain effects/CIs, scale-specific clinical-importance thresholds and sample plans are unlinked, leaving exact ball-specific effect size unverified. No new effects, CIs or numerical examples are created.
Required materials and conditions: Between-group estimates/CIs, meaningful change and sample-size plans
Materials to obtain first: Pain effects/CIs, scale-specific clinical-importance thresholds and sample plans are unlinked, leaving exact ball-specific effect size unverified. No new effects, CIs or numerical examples are created.
Further research: Material needed: Pain effects/CIs, scale-specific clinical-importance thresholds and sample plans are unlinked, leaving exact ball-specific effect size unverified. No new effects, CIs or numerical examples are created. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Between-group estimates/CIs, meaningful change and sample-size plans must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Between-group estimates/CIs, meaningful change and sample-size plans with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S02 S03

N18 · Are analgesics, positioning and movement separated?

Current findings: The original manuscript records comparing differences in epidural status, ball shape, timing and positioning/pelvic movement.
Verification status: Unverified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Concurrent analgesics/care, intervention delivery/supervision and post-rescue-treatment outcome policy in direct pain reports are unlinked. Do not establish isolated ball or non-drug effects.
Required materials and conditions: Anesthesia/analgesics, usual labor care, exposure and adherence
Materials to obtain first: Concurrent analgesics/care, intervention delivery/supervision and post-rescue-treatment outcome policy in direct pain reports are unlinked. Do not establish isolated ball or non-drug effects.
Further research: Material needed: Concurrent analgesics/care, intervention delivery/supervision and post-rescue-treatment outcome policy in direct pain reports are unlinked. Do not establish isolated ball or non-drug effects. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Anesthesia/analgesics, usual labor care, exposure and adherence must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Anesthesia/analgesics, usual labor care, exposure and adherence with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S01 S02 S03

N19 · Does short-term pain establish operative or other obstetric outcomes?

Current findings: The parent records uncertain precise reductions in operative delivery/analgesics and does not interpret vaginal delivery among all completers as prevention.
Verification status: Unverified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Do not transfer positive pain into shorter labor, surgical prevention or long-term neonatal/maternal effects. Original event counts, denominators and CIs are unlinked.
Required materials and conditions: Cesarean/instrumental delivery, analgesics and maternal/neonatal boundaries
Materials to obtain first: Do not transfer positive pain into shorter labor, surgical prevention or long-term neonatal/maternal effects. Original event counts, denominators and CIs are unlinked.
Further research: Material needed: Do not transfer positive pain into shorter labor, surgical prevention or long-term neonatal/maternal effects. Original event counts, denominators and CIs are unlinked. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Cesarean/instrumental delivery, analgesics and maternal/neonatal boundaries must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Cesarean/instrumental delivery, analgesics and maternal/neonatal boundaries with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S01 S02 S03

N20 · Are persistence, other labor conditions and independent replication established?

Current findings: Preserve short-term signals from small, differing programs. S01 supplies duration context; S02/S03 concern direct pain.
Verification status: Unverified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Strict independent confirmation of the same pain/ball/control contract, persistence/other populations and unique-trial/participant totals are unconfirmed. No report/population totals are summed.
Required materials and conditions: Protocols/controls, ball shape, anesthesia, duration and shared cohorts
Materials to obtain first: Strict independent confirmation of the same pain/ball/control contract, persistence/other populations and unique-trial/participant totals are unconfirmed. No report/population totals are summed.
Further research: Material needed: Strict independent confirmation of the same pain/ball/control contract, persistence/other populations and unique-trial/participant totals are unconfirmed. No report/population totals are summed. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Protocols/controls, ball shape, anesthesia, duration and shared cohorts must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Protocols/controls, ball shape, anesthesia, duration and shared cohorts with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S01 S02 S03

N21 · What is known about funding, support and COI?

Current findings: All three original evidence entries record unverified detailed funding.
Verification status: Unverified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Do not fill product/ball support, employee authorship, COI or analysis/assessment/publication roles with no involvement or established independence.
Required materials and conditions: Funding, device/material support, employee authors and separate roles
Materials to obtain first: Do not fill product/ball support, employee authorship, COI or analysis/assessment/publication roles with no involvement or established independence.
Further research: Material needed: Do not fill product/ball support, employee authorship, COI or analysis/assessment/publication roles with no involvement or established independence. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Funding, device/material support, employee authors and separate roles must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Funding, device/material support, employee authors and separate roles with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S01 S02 S03

N22 · Are maternal/fetal harms, collection and denominators known?

Current findings: Preserve original parent Caution safety wording and its labor-safety context.
Verification status: Unverified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Original fall/positioning-related and maternal/fetal/neonatal event counts/denominators, collection, discontinuation and missing data are unlinked. Pain or completer findings do not certify safety.
Required materials and conditions: Harm definitions, arm-specific events/denominators, timing and discontinuation/missing data
Materials to obtain first: Original fall/positioning-related and maternal/fetal/neonatal event counts/denominators, collection, discontinuation and missing data are unlinked. Pain or completer findings do not certify safety.
Further research: Material needed: Original fall/positioning-related and maternal/fetal/neonatal event counts/denominators, collection, discontinuation and missing data are unlinked. Pain or completer findings do not certify safety. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Harm definitions, arm-specific events/denominators, timing and discontinuation/missing data must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Harm definitions, arm-specific events/denominators, timing and discontinuation/missing data with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S01 S02 S03

N23 · What are vulnerable conditions, shared exposures and instruction limits?

Current findings: Preserve original parental safety wording as historical context; create no new labor-ball, delivery, treatment or action instructions.
Verification status: Unverified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Population-/anesthesia-/time-specific harms, shared exposure and long-term maternal/neonatal material are unlinked. Unsupervised use or safety in other populations is not established.
Required materials and conditions: Labor/anesthesia-specific harms, alternative causes and persistence
Materials to obtain first: Population-/anesthesia-/time-specific harms, shared exposure and long-term maternal/neonatal material are unlinked. Unsupervised use or safety in other populations is not established.
Further research: Material needed: Population-/anesthesia-/time-specific harms, shared exposure and long-term maternal/neonatal material are unlinked. Unsupervised use or safety in other populations is not established. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Labor/anesthesia-specific harms, alternative causes and persistence must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Labor/anesthesia-specific harms, alternative causes and persistence with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S01 S02 S03

N24 · Are original bibliography, languages, grades/axes and empty history preserved?

Current findings: Preserve original PMID/DOI/journal wording. Retain parent C50/unrecorded precision, Korean/English, 2026-09-07, empty corrections/deliberation and selected C/note with absent score/status/axes.
Verification status: Partly verified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: Original external bibliography and historical cross-check wording do not establish review/certification in this work. No new grades, numbers or hypothetical examples.
Required materials and conditions: Original report wording, parent/subclaim distinction, unrecorded precision and dates
Materials to obtain first: Original external bibliography and historical cross-check wording do not establish review/certification in this work. No new grades, numbers or hypothetical examples.
Further research: Material needed: Original external bibliography and historical cross-check wording do not establish review/certification in this work. No new grades, numbers or hypothetical examples. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Original report wording, parent/subclaim distinction, unrecorded precision and dates must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Original report wording, parent/subclaim distinction, unrecorded precision and dates with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S01 S02 S03

N25 · What distinguishes summary reading from external links?

Current findings: This work prepares materials from the complete stored summary and bibliography, distinguishing summary reading, unread external materials and source URLs.
Verification status: Partly verified
Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread
Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.
Reason for missing information: External papers, registration, protocols/SAPs and support originals are unread and access was not attempted. URLs or historical verification wording do not establish current reading or external link tests.
Required materials and conditions: Report-specific reading versus original papers, registration, plans and support access
Materials to obtain first: External papers, registration, protocols/SAPs and support originals are unread and access was not attempted. URLs or historical verification wording do not establish current reading or external link tests.
Further research: Material needed: External papers, registration, protocols/SAPs and support originals are unread and access was not attempted. URLs or historical verification wording do not establish current reading or external link tests. This records needed materials; no new research was executed.
Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.
Conditions for verification: Material for Report-specific reading versus original papers, registration, plans and support access must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.
Why this condition is needed: This condition connects Report-specific reading versus original papers, registration, plans and support access with acute labor pain, ball shape and positioning/movement packages, anesthesia and controls, report-specific times and denominators, patient-reported pain, duration/operative outcomes, support and harms.
Application exceptions: Preserve original subclaim C, the short-term signal from several small unblinded trials, and absent score, status and axes. Distinguish ball shape, accompanying movement, anesthesia, control, timing and pain/fatigue/duration/operative outcomes. Do not sum randomized/analysis denominators or transfer pain P values into duration/cesarean benefit. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.
Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.

Related sources S01 S02 S03