{ "schema_version": "chamgap-public-evidence-check-1.0", "public_id": "v2998-s1", "verdict_number": "2998", "title": "Birth and peanut balls × labor duration or cesarean prevention", "view_version": "1.0", "view_created_date": "2026-10-16", "criteria_version": "1.0", "criteria_date": "2026-10-06", "review_date": null, "legacy_evidence_date": "2026-09-07", "review_scope": { "materials_read": "Existing review summaries and stored records of methodological application", "clinical_papers_directly_read": false, "new_clinical_search": false, "limitation": "Existing stored summary and preserved methodology application records. External papers, abstracts, registration, protocols, SAPs, original result tables and support disclosures are unread, and review of existing content remains incomplete.", "date_meaning": "This is the date the stored materials were checked, not the date of a new search of the clinical literature." }, "claim_context": { "population": "R01 Payton concerns epidural laboring women, with no recorded numeric sample size. R02 Alan Dikmen records 90 participants; R03 Ozkececi records high-BMI participants with 70 randomized/59 analyzed. Arm-specific eligibility, parity, BMI thresholds, anesthesia/analgesics, maternal/fetal status and duration-/operative-event denominators are unverified.", "intervention": "Distinguish round birth balls from peanut balls and ball-only use from positioning/pelvic-movement packages. The direct bibliographies concern peanut-ball reports. Ball specifications, components, supervision, actual use and accompanying labor management are unverified by report. Unidentified earlier combined programs are not turned into new trials and their signals are not assigned to a ball alone.", "dose": "The parent descriptions of use timing, frequency and movements identify research context. R02 pain/fatigue after 15 minutes is a measurement time, not a duration-shortening effect or duration of ball use. Exact exposure and adherence are unverified; no new total exposure, repetition count or delivery method is calculated or recommended.", "comparator": "The parent comparator label is standard care. Distinguish R01 epidural conditions from report-specific actual controls, analgesics, positioning, contact and obstetric management. A representative comparator is not applied to every report and does not establish an isolated ball or non-drug effect.", "endpoint": "The selected question concerns labor duration and cesarean prevention. Distinguish R01 first-stage primiparous interaction P=.018, multiparous P=.057 and null pushing time; R02 total labor duration P=.177; and R03 active-labor duration 202.9±59.5 versus 213.6±67.5 minutes/P=.522. R03 pain P=.001 is separate from unverified co-primary success rules and arm-specific cesarean events/effects/CIs.", "duration": "Distinguish total labor, active labor, first-stage and pushing intervals within the index labor. Their starts, ends and time origins, operative-event timing, recovery, subsequent delivery and long-term maternal/neonatal follow-up are unverified. Short pain/duration signals do not establish sustained benefit or safety.", "excluded_extensions": [ "Transferring positive pain/fatigue into shorter total labor, fewer cesarean/instrumental deliveries or less analgesic use", "Extending a primiparous interaction into the same benefit for all women, multiparous participants or every labor stage", "Transferring vaginal delivery among completers into operative prevention for all randomized participants", "Combining ball/movement packages, anesthesia, controls or time intervals as the same intervention/endpoint", "Substituting null P values for zero effect/equivalence, ± for CIs, or positive pain for joint success", "Summing randomized/analyzed populations, subgroups, both sheets or reports into new participant, unique-trial or independent-replication totals", "Creating new effects, CIs, attrition counts/rates, grades, independence/safety certification or labor-ball, delivery or treatment instructions" ] }, "requirements": [ { "item_id": "N01", "question_type": "Evidence condition", "question": "Which labor-duration and cesarean claim is being checked?", "needed": "Selected subclaim and original grade/note", "role": "Required", "role_reason": "This condition connects Selected subclaim and original grade/note with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Selected subclaim and original grade/note must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Direct results by duration endpoint, original cesarean material and selected-question boundaries. Parent scores or pain efficacy do not fill absent subclaim values. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "The selected subclaim concerns shorter labor or cesarean prevention and retains original grade D. Preserve the note that overall duration and operative events were not consistently established. Subclaim score/status are absent and distinct from parent pain C50.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Direct results by duration endpoint, original cesarean material and selected-question boundaries. Parent scores or pain efficacy do not fill absent subclaim values.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Direct results by duration endpoint, original cesarean material and selected-question boundaries. Parent scores or pain efficacy do not fill absent subclaim values." }, { "item_id": "N02", "question_type": "Evidence condition", "question": "What was total labor duration in the trial of 90 participants?", "needed": "Direct total-labor-duration results", "role": "Required", "role_reason": "This condition connects Direct total-labor-duration results with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Direct total-labor-duration results must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Total-duration definition, arm values, between-group effects/95% CIs, denominators and analysis model. P=.177 does not certify zero duration effect or equivalence. This records needed materials; no new research was executed.", "current_reports": [ "R02" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "The peanut-ball trial of 90 participants separately records positive pain/fatigue after 15 minutes of application and total labor duration P=.177. Its null total-duration result is not replaced by positive pain.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Total-duration definition, arm values, between-group effects/95% CIs, denominators and analysis model. P=.177 does not certify zero duration effect or equivalence.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Total-duration definition, arm values, between-group effects/95% CIs, denominators and analysis model. P=.177 does not certify zero duration effect or equivalence." }, { "item_id": "N03", "question_type": "Evidence condition", "question": "What was active-labor duration in the high-BMI trial?", "needed": "Active-labor duration and pain as joint outcomes", "role": "Required", "role_reason": "This condition connects Active-labor duration and pain as joint outcomes with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Active-labor duration and pain as joint outcomes must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Active-labor start/end criteria, arm-specific analysis denominators, statistical meaning of ±, between-group effects/CIs and joint pain/duration hierarchy. This records needed materials; no new research was executed.", "current_reports": [ "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "The trial with 70 randomized/59 analyzed records pain P=.001 and active-labor duration 202.9±59.5 versus 213.6±67.5 minutes/P=.522. Active labor is not substituted for total labor and no new difference is calculated.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Active-labor start/end criteria, arm-specific analysis denominators, statistical meaning of ±, between-group effects/CIs and joint pain/duration hierarchy.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Active-labor start/end criteria, arm-specific analysis denominators, statistical meaning of ±, between-group effects/CIs and joint pain/duration hierarchy." }, { "item_id": "N04", "question_type": "Evidence condition", "question": "Whose first-stage results are reported in the epidural trial?", "needed": "Duration outcomes by parity subgroup", "role": "Required", "role_reason": "This condition connects Duration outcomes by parity subgroup with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Duration outcomes by parity subgroup must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Exact interaction and between-group test comparisons, parity-specific denominators, effects/CIs and prospective subgroup plans. Subgroups are not counted as new independent replications. This records needed materials; no new research was executed.", "current_reports": [ "R01" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "The 2016 epidural peanut-ball trial records first-stage primiparous interaction P=.018 and multiparous P=.057. These are not transferred into the same shorter duration for all women or specific between-group effects/CIs.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Exact interaction and between-group test comparisons, parity-specific denominators, effects/CIs and prospective subgroup plans. Subgroups are not counted as new independent replications.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Exact interaction and between-group test comparisons, parity-specific denominators, effects/CIs and prospective subgroup plans. Subgroups are not counted as new independent replications." }, { "item_id": "N05", "question_type": "Evidence condition", "question": "Were pushing time and the first stage distinguished?", "needed": "Direct pushing-time results", "role": "Required", "role_reason": "This condition connects Direct pushing-time results with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Direct pushing-time results must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Pushing-time start/end definitions, arm values, effects/CIs, exact P values and denominators. A null result does not certify a difference of 0 minutes. This records needed materials; no new research was executed.", "current_reports": [ "R01" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "Payton records null pushing time alongside first-stage descriptions for primiparous/multiparous participants. A first-stage subgroup signal is not transferred into shorter pushing time.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Pushing-time start/end definitions, arm values, effects/CIs, exact P values and denominators. A null result does not certify a difference of 0 minutes.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Pushing-time start/end definitions, arm values, effects/CIs, exact P values and denominators. A null result does not certify a difference of 0 minutes." }, { "item_id": "N06", "question_type": "Evidence condition", "question": "Were different labor-duration intervals distinguished?", "needed": "Correspondence of time intervals, origins and endpoints", "role": "Required", "role_reason": "This condition connects Correspondence of time intervals, origins and endpoints with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Correspondence of time intervals, origins and endpoints must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Interval-specific clinical definitions, time origins, labor stages, time-specific denominators and direct comparison tables. No new pooled duration effect is calculated. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "The three reports have different endpoints: first-stage/pushing, pain/fatigue after 15 minutes/total duration, and pain/active-labor duration. They are not combined as the same time endpoint and P values are not copied into other intervals.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Interval-specific clinical definitions, time origins, labor stages, time-specific denominators and direct comparison tables. No new pooled duration effect is calculated.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Interval-specific clinical definitions, time origins, labor stages, time-specific denominators and direct comparison tables. No new pooled duration effect is calculated." }, { "item_id": "N07", "question_type": "Evidence condition", "question": "Are direct cesarean-prevention event data available?", "needed": "Cesarean events by arm and direct comparisons", "role": "Required", "role_reason": "This condition connects Cesarean events by arm and direct comparisons with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Cesarean events by arm and direct comparisons must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Arm-specific cesarean definitions, indications, randomized/analysis denominators, events, between-group effects/CIs and prospective endpoints. Unverified data do not mean 0 events or no preventive effect. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "The parent records that findings cannot be extended into ball-only cesarean prevention and that a precise reduction was not established. Stored bibliographies/evidence summaries lack arm-specific cesarean event counts and effects/CIs.", "condition_status": "Unverified", "status_reason": "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.", "missingness": "Arm-specific cesarean definitions, indications, randomized/analysis denominators, events, between-group effects/CIs and prospective endpoints. Unverified data do not mean 0 events or no preventive effect.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Arm-specific cesarean definitions, indications, randomized/analysis denominators, events, between-group effects/CIs and prospective endpoints. Unverified data do not mean 0 events or no preventive effect." }, { "item_id": "N08", "question_type": "Evidence condition", "question": "Does vaginal delivery among completers establish operative prevention?", "needed": "Delivery route and missingness for all randomized participants", "role": "Required", "role_reason": "This condition connects Delivery route and missingness for all randomized participants with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Delivery route and missingness for all randomized participants must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Delivery routes for all randomized participants, analysis exclusions, surgery/attrition reasons, arm-specific events and handling of missing data. Completer selection is not transferred into prevention for everyone randomized. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "The parent explanation did not interpret vaginal delivery among completers as operative prevention. The current summary is not used to assign report-specific event denominators or exclusion reasons to that statement.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Delivery routes for all randomized participants, analysis exclusions, surgery/attrition reasons, arm-specific events and handling of missing data. Completer selection is not transferred into prevention for everyone randomized.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Delivery routes for all randomized participants, analysis exclusions, surgery/attrition reasons, arm-specific events and handling of missing data. Completer selection is not transferred into prevention for everyone randomized." }, { "item_id": "N09", "question_type": "Evidence condition", "question": "Are the ball itself and positioning/movement packages separated?", "needed": "Ball shape and combined-program components", "role": "Required", "role_reason": "This condition connects Ball shape and combined-program components with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Ball shape and combined-program components must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Report-specific ball shapes, ball-only/movement components, matched controls and accompanying management. No new bibliography, denominator or independent trial is created for unidentified earlier combined trials. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "The original distinguishes round birth balls from peanut balls and ball-only use from positioning/pelvic-movement packages. Duration signals from earlier combined movement programs do not establish ball-only cesarean effects.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Report-specific ball shapes, ball-only/movement components, matched controls and accompanying management. No new bibliography, denominator or independent trial is created for unidentified earlier combined trials.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Report-specific ball shapes, ball-only/movement components, matched controls and accompanying management. No new bibliography, denominator or independent trial is created for unidentified earlier combined trials." }, { "item_id": "N10", "question_type": "Evidence condition", "question": "Are epidural, parity and high-BMI populations the same?", "needed": "Report-specific populations and baseline conditions", "role": "Required", "role_reason": "This condition connects Report-specific populations and baseline conditions with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Report-specific populations 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.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Report-specific eligibility, parity, BMI thresholds, epidural/analgesic use, fetal/maternal status and arm-specific baselines. Details absent from the summary remain unverified. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "Payton concerns epidural labor and Ozkececi high-BMI participants. The original records differences in epidural status, parity, ball shape and use timing; reports are not pooled as the same maternal population.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Report-specific eligibility, parity, BMI thresholds, epidural/analgesic use, fetal/maternal status and arm-specific baselines. Details absent from the summary remain unverified.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Report-specific eligibility, parity, BMI thresholds, epidural/analgesic use, fetal/maternal status and arm-specific baselines. Details absent from the summary remain unverified." }, { "item_id": "N11", "question_type": "Evidence condition", "question": "What are the original randomized, analysis and endpoint denominators?", "needed": "Participant flow and endpoint denominators by report", "role": "Required", "role_reason": "This condition connects Participant flow and endpoint denominators by report with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Participant flow and endpoint denominators by report must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Arm-specific randomized/analysis flow, exclusion reasons and duration/cesarean endpoint denominators. Report sample sizes are not summed and the same cohort is not counted as additional participants. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "Payton sample size is worded as a randomized trial in laboring women; exact numbers are unverified. Preserve Alan Dikmen 90 participants and Ozkececi 70 randomized/59 analyzed. No new attrition count or rate is calculated.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Arm-specific randomized/analysis flow, exclusion reasons and duration/cesarean endpoint denominators. Report sample sizes are not summed and the same cohort is not counted as additional participants.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Arm-specific randomized/analysis flow, exclusion reasons and duration/cesarean endpoint denominators. Report sample sizes are not summed and the same cohort is not counted as additional participants." }, { "item_id": "N12", "question_type": "Evidence condition", "question": "Are positive pain, null duration and the co-primary hierarchy distinguished?", "needed": "Prospective joint-outcome, multiplicity and subgroup plans", "role": "Required", "role_reason": "This condition connects Prospective joint-outcome, multiplicity and subgroup plans with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Prospective joint-outcome, multiplicity and subgroup plans must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Registration, protocol, SAP, joint-outcome success criteria, multiplicity, subgroup plans and change history. Original parent axes are preserved without regrading. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "Ozkececi is recorded as a co-primary randomized trial, with positive pain separated from null duration. Payton subgroup interactions and registration identifier NCT05276947 alone are not presented as verification of prospective hierarchy, adjustment or analysis changes.", "condition_status": "Unverified", "status_reason": "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.", "missingness": "Registration, protocol, SAP, joint-outcome success criteria, multiplicity, subgroup plans and change history. Original parent axes are preserved without regrading.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Registration, protocol, SAP, joint-outcome success criteria, multiplicity, subgroup plans and change history. Original parent axes are preserved without regrading." }, { "item_id": "N13", "question_type": "Evidence condition", "question": "Do analgesic use and instrumental delivery support the same conclusion?", "needed": "Clinical events and directness by outcome", "role": "Required", "role_reason": "This condition connects Clinical events and directness by outcome with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Clinical events and directness by outcome must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Outcome-specific definitions, original values, arm denominators, effects/CIs and clinical decision criteria. Unverified outcomes are distinguished from the selected question. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "The parent records that precise reductions in analgesic use, cesarean and instrumental delivery were not established. Pain signals or duration subgroup effects are not transferred into these clinical outcomes.", "condition_status": "Unverified", "status_reason": "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.", "missingness": "Outcome-specific definitions, original values, arm denominators, effects/CIs and clinical decision criteria. Unverified outcomes are distinguished from the selected question.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Outcome-specific definitions, original values, arm denominators, effects/CIs and clinical decision criteria. Unverified outcomes are distinguished from the selected question." }, { "item_id": "N14", "question_type": "Evidence condition", "question": "Are the size and clinical importance of duration signals known?", "needed": "Between-group duration estimates and uncertainty", "role": "Required", "role_reason": "This condition connects Between-group duration estimates and uncertainty with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Between-group duration estimates and uncertainty must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Between-group estimands, models, variance definitions, prospective importance thresholds and stage-specific analysis tables. No new differences, CIs, effects or grades are calculated. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "Some P values and arm-specific active-labor durations are preserved, but exact between-group duration effects/95% CIs and clinical-importance thresholds are unverified. ± is not read as a CI and no hypothetical duration-reduction example is created.", "condition_status": "Unverified", "status_reason": "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.", "missingness": "Between-group estimands, models, variance definitions, prospective importance thresholds and stage-specific analysis tables. No new differences, CIs, effects or grades are calculated.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Between-group estimands, models, variance definitions, prospective importance thresholds and stage-specific analysis tables. No new differences, CIs, effects or grades are calculated." }, { "item_id": "N15", "question_type": "Evidence condition", "question": "Can findings extend to other deliveries or later outcomes?", "needed": "Index-labor outcomes and subsequent follow-up", "role": "Required", "role_reason": "This condition connects Index-labor outcomes and subsequent follow-up with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Index-labor outcomes and subsequent follow-up must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Measurement timing, recovery follow-up, care settings, accompanying management and direct results. No labor-ball use, delivery, analgesic or treatment instructions are created. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "The selected question concerns duration/operative outcomes of the index labor, distinct from immediate pain/fatigue after 15 minutes. Recovery, subsequent deliveries and sustained benefit in other care settings are not established by the original material.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Measurement timing, recovery follow-up, care settings, accompanying management and direct results. No labor-ball use, delivery, analgesic or treatment instructions are created.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Measurement timing, recovery follow-up, care settings, accompanying management and direct results. No labor-ball use, delivery, analgesic or treatment instructions are created." }, { "item_id": "N16", "question_type": "Evidence condition", "question": "Are the same reports or populations counted as new independent trials?", "needed": "Study, report and cohort linkage", "role": "Required", "role_reason": "This condition connects Study, report and cohort linkage with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Study, report and cohort linkage must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Original study/report identifiers and cohort/analysis-population linkage. Unique-trial counts, unique-participant totals and independent replication are unverified. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "The parent and both subclaim sheets share the same three-report context. Sheets, reports, crossover periods, subgroups and repeated measurements are not summed into new independent trials or participants.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Original study/report identifiers and cohort/analysis-population linkage. Unique-trial counts, unique-participant totals and independent replication are unverified.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Original study/report identifiers and cohort/analysis-population linkage. Unique-trial counts, unique-participant totals and independent replication are unverified." }, { "item_id": "N17", "question_type": "Evidence condition", "question": "Which materials were actually read?", "needed": "Reading scope of stored summaries and external originals", "role": "Required", "role_reason": "This condition connects Reading scope of stored summaries and external originals with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Reading scope of stored summaries and external originals must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Actual originals, appendices, registration/planning materials and reading records. No new clinical material was searched and no external access was verified in this work. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "The complete parent JSON was read for production and preserved byte for byte. External abstracts, full texts, registration, protocols and SAPs are unread. URLs, PMCIDs and registration identifiers are not labeled as actual reading or successful access.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Actual originals, appendices, registration/planning materials and reading records. No new clinical material was searched and no external access was verified in this work.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Actual originals, appendices, registration/planning materials and reading records. No new clinical material was searched and no external access was verified in this work." }, { "item_id": "N18", "question_type": "Evidence condition", "question": "Where do the original bibliography and registration identifiers appear?", "needed": "Sources of bibliographic and registration identity", "role": "Required", "role_reason": "This condition connects Sources of bibliographic and registration identity with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Sources of bibliographic and registration identity must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Paper/registration identity, timing and content material. Identifier strings alone do not establish prospective registration or actual reading. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "Original PMID, PMCID, DOI and PubMed addresses are retained. Evidence-summary registration identifiers or the wording unconfirmed are preserved separately from absent registration wording in citations. No new registry address is inferred from an identifier.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Paper/registration identity, timing and content material. Identifier strings alone do not establish prospective registration or actual reading.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Paper/registration identity, timing and content material. Identifier strings alone do not establish prospective registration or actual reading." }, { "item_id": "N19", "question_type": "Evidence condition", "question": "Were original bilingual and historical-verification statements kept distinct from current review?", "needed": "Scope of original text, translation and historical verification", "role": "Required", "role_reason": "This condition connects Scope of original text, translation and historical verification with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Scope of original text, translation and historical verification must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Original text, translations, correction material and review records. Historical verification is not labeled as passing current review. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "Preserve the selected claim/note, parent Korean/English wording and historical cross-check/verification statements. This work transfers preserved material into a reader view; it does not establish completed content/model/boundary review or independent clinical validation.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Original text, translations, correction material and review records. Historical verification is not labeled as passing current review.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Original text, translations, correction material and review records. Historical verification is not labeled as passing current review." }, { "item_id": "N20", "question_type": "Evidence condition", "question": "Are subclaim originals distinct from parent scores and axes?", "needed": "Selected subclaim D and parent pain context", "role": "Required", "role_reason": "This condition connects Selected subclaim D and parent pain context with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Selected subclaim D and parent pain context must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Selected-question, original-value and parent-boundary review material. No new scores, axes, efficacy grades, independence certification or verdict changes are created. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "Preserve original subclaim grade D/note and absent score/status. Parent pain C50/Caution and all axes are parent context; they do not fill absent labor-duration/cesarean subclaim values or provide new certification.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Selected-question, original-value and parent-boundary review material. No new scores, axes, efficacy grades, independence certification or verdict changes are created.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Selected-question, original-value and parent-boundary review material. No new scores, axes, efficacy grades, independence certification or verdict changes are created." }, { "item_id": "N21", "question_type": "Evidence condition", "question": "What are the original evidence date and empty correction history?", "needed": "Evidence date, production date and change records", "role": "Required", "role_reason": "This condition connects Evidence date, production date and change records with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Evidence date, production date and change records must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Actual corrections, follow-up material, complete prior originals and change history. Existing original text/dates are preserved. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "The original evidence date is 2026-09-07, the correction array is empty and the deliberation note is an empty string. These are distinct from production/review dates and do not certify the absence of external corrections.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Actual corrections, follow-up material, complete prior originals and change history. Existing original text/dates are preserved.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Actual corrections, follow-up material, complete prior originals and change history. Existing original text/dates are preserved." }, { "item_id": "N22", "question_type": "Evidence condition", "question": "Are funding, product support and company involvement distinguished?", "needed": "Report-specific support, affiliations and analysis/publication roles", "role": "Required", "role_reason": "This condition connects Report-specific support, affiliations and analysis/publication roles with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Report-specific support, affiliations and analysis/publication roles must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Original funding, product/device support, author affiliations and analysis/publication roles. Parent independence axes are not treated as new certification. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "Specific funding is unverified for all three reports. This does not establish no industry/product support, no company-employed authors or no company involvement in analysis/reporting.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Original funding, product/device support, author affiliations and analysis/publication roles. Parent independence axes are not treated as new certification.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Original funding, product/device support, author affiliations and analysis/publication roles. Parent independence axes are not treated as new certification." }, { "item_id": "N23", "question_type": "Evidence condition", "question": "Are allocation, blinding, measurement and selective-reporting conditions known?", "needed": "Design labels and actual bias conditions", "role": "Required", "role_reason": "This condition connects Design labels and actual bias conditions with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Design labels and actual bias conditions must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Methods, registration, protocols, SAPs, original analysis tables and change history. Design names alone do not establish official bias-tool/evidence-grade assessments or passing review. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "The original records limitations of small unblinded trials, different controls and combined movement. Allocation concealment, time origins, maternal/clinician analgesic/surgical decisions, assessors and attrition details are unverified.", "condition_status": "Unverified", "status_reason": "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.", "missingness": "Methods, registration, protocols, SAPs, original analysis tables and change history. Design names alone do not establish official bias-tool/evidence-grade assessments or passing review.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Methods, registration, protocols, SAPs, original analysis tables and change history. Design names alone do not establish official bias-tool/evidence-grade assessments or passing review." }, { "item_id": "N24", "question_type": "Evidence condition", "question": "Are adherence, accompanying interventions and actual exposure preserved?", "needed": "Actual programs, controls and labor management", "role": "Required", "role_reason": "This condition connects Actual programs, controls and labor management with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Actual programs, controls and labor management must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Original accompanying-intervention, adherence, exposure and intervention-deviation data. No new totals, repetitions, cumulative exposures or implementation/delivery methods are created. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "Preserve original context concerning ball shape, epidural conditions, positioning/pelvic movement and standard care. Report-specific actual exposure, accompanying analgesic/labor management and adherence details are unverified.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Original accompanying-intervention, adherence, exposure and intervention-deviation data. No new totals, repetitions, cumulative exposures or implementation/delivery methods are created.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Original accompanying-intervention, adherence, exposure and intervention-deviation data. No new totals, repetitions, cumulative exposures or implementation/delivery methods are created." }, { "item_id": "N25", "question_type": "Evidence condition", "question": "Are safety statements distinct from actual harm collection?", "needed": "Harm definitions, collection, comparators and exposure denominators", "role": "Supplementary", "role_reason": "This condition connects Harm definitions, collection, controls and exposure denominators with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Harm definitions, collection, comparators and exposure denominators must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Report-specific harm definitions, collection, severity, exposure/denominators, withdrawals and accompanying management. Cautions do not establish no harm, new safety certification or treatment instructions. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "Parent cautions concerning falls, postural instability and maternal/fetal status are original context. Actual harm collection, fall/maternal/fetal event counts, exposure denominators and between-group CIs are unverified.", "condition_status": "Unverified", "status_reason": "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.", "missingness": "Report-specific harm definitions, collection, severity, exposure/denominators, withdrawals and accompanying management. Cautions do not establish no harm, new safety certification or treatment instructions.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Report-specific harm definitions, collection, severity, exposure/denominators, withdrawals and accompanying management. Cautions do not establish no harm, new safety certification or treatment instructions." }, { "item_id": "N26", "question_type": "Evidence condition", "question": "Are long-term/rare harms and post-intervention outcomes available?", "needed": "Direct follow-up of long-term and rare harms", "role": "Supplementary", "role_reason": "This condition connects Direct follow-up of long-term and rare harms with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Direct follow-up of long-term and rare harms must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Actual long-term/harm follow-up, exposure duration, endpoint denominators and report linkage. Unread/unverified material does not mean 0 events or safety. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "Brief pain/duration data during the index labor do not establish rare maternal/fetal harms, long-term recovery or subsequent-delivery outcomes.", "condition_status": "Unverified", "status_reason": "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.", "missingness": "Actual long-term/harm follow-up, exposure duration, endpoint denominators and report linkage. Unread/unverified material does not mean 0 events or safety.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Actual long-term/harm follow-up, exposure duration, endpoint denominators and report linkage. Unread/unverified material does not mean 0 events or safety." }, { "item_id": "N27", "question_type": "Evidence condition", "question": "Which new materials would prompt an update to this table?", "needed": "Changes in material, conditions, observations and verdicts", "role": "Required", "role_reason": "This condition connects Changes in material, conditions, observations and verdicts with labor duration and cesarean prevention, time intervals, subgroups, event denominators, ball and movement components, anesthesia, controls, co-primary outcomes, support and harms.", "application_exception": "Preserve selected subclaim D and its note that overall duration and operative events were not consistently established. Distinguish absent subclaim score, status and axes from parent pain C50. Positive pain, a primiparous interaction and vaginal delivery among completers do not establish shorter overall labor or cesarean prevention. Create no new effects, CIs, attrition counts/rates, totals, grades, independence/safety certification or labor-ball, delivery or treatment instructions.", "criterion": "Material for Changes in material, conditions, observations and verdicts must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.", "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.", "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.", "proposed_research": "Material needed: Complete prior originals, new material, condition versions, separate application and review records. Material additions, condition revisions and verdict changes remain separate events. This records needed materials; no new research was executed.", "current_reports": [ "R01", "R02", "R03" ], "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "observation": "This is a production sheet of preserved labor-duration/cesarean material. Relevant rows and links can be updated after reviewing originals, endpoints/timing, denominators, actual controls, shared reports and support/harm material.", "condition_status": "Partly verified", "status_reason": "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.", "missingness": "Complete prior originals, new material, condition versions, separate application and review records. Material additions, condition revisions and verdict changes remain separate events.", "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.", "review_date": null, "reading_status": "Full text not read · Stored summary read", "additional_material": "Complete prior originals, new material, condition versions, separate application and review records. Material additions, condition revisions and verdict changes remain separate events." } ], "reports": [ { "report_id": "R01", "title": "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.", "url": "https://pubmed.ncbi.nlm.nih.gov/26859467/", "report_type": "Randomized epidural peanut-ball trial", "existence": "Report linked in the original parent stored summary evidence/citation lists. External public availability, access and current acquisition of the original are unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "study_family": "Original report R01; unique counts and independent replication unverified", "independent_replication": "Parent 2998 and the pain/duration-operative subclaim sheets share the same three reports. First-stage/pushing, total duration, active-labor duration and pain are different outcomes. Randomized/analyzed populations, subgroups, repeated measurements, sheets and reports are not summed into new participant, unique-trial or independent-replication totals. Cohort relationships, confirmed totals and independence are unverified.", "observed_result": "Primiparous interaction P=.018; multiparous P=.057; pushing null", "result_level": "Directly linked epidural labor-duration summary. Distinguish first-stage primiparous interaction P=.018, multiparous P=.057 and null pushing time. Numeric sample size, subgroup denominators/models, prospective plans and between-group duration effects/CIs are unverified. These findings are not transferred into the same benefit for all women or other intervals.", "source_evidence_date": "2026-09-07", "materials": [ { "material_type": "Stored existing review summary", "public_status": "Preserved copy of the complete parent-verdict stored summary", "access_status": "Stored summary", "acquired": true, "actually_read": "Summary read", "as_of": "2026-09-07", "qualification": "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." }, { "material_type": "External abstract", "public_status": "Original bibliographic link or needed material; external public availability/access status unverified", "access_status": "Unread; access not attempted", "acquired": false, "actually_read": "Not read", "as_of": null, "qualification": "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." }, { "material_type": "External full text", "public_status": "Original bibliographic link or needed material; external public availability/access status unverified", "access_status": "Unread; access not attempted", "acquired": false, "actually_read": "Not read", "as_of": null, "qualification": "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." }, { "material_type": "Registration material", "public_status": "Original bibliographic link or needed material; external public availability/access status unverified", "access_status": "Unread; access not attempted", "acquired": false, "actually_read": "Not read", "as_of": null, "qualification": "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." }, { "material_type": "Protocol and analysis plan", "public_status": "Original bibliographic link or needed material; external public availability/access status unverified", "access_status": "Unread; access not attempted", "acquired": false, "actually_read": "Not read", "as_of": null, "qualification": "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." } ], "links": [ { "label": "PubMed", "url": "https://pubmed.ncbi.nlm.nih.gov/26859467/" } ] }, { "report_id": "R02", "title": "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.", "url": "https://pubmed.ncbi.nlm.nih.gov/39103620/", "report_type": "Randomized acute pain and fatigue trial", "existence": "Report linked in the original parent stored summary evidence/citation lists. External public availability, access and current acquisition of the original are unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "study_family": "Original report R02; unique counts and independent replication unverified", "independent_replication": "Parent 2998 and the pain/duration-operative subclaim sheets share the same three reports. First-stage/pushing, total duration, active-labor duration and pain are different outcomes. Randomized/analyzed populations, subgroups, repeated measurements, sheets and reports are not summed into new participant, unique-trial or independent-replication totals. Cohort relationships, confirmed totals and independence are unverified.", "observed_result": "Pain and fatigue positive; total labor duration P=.177", "result_level": "Distinguish 90 participants and positive pain/fatigue after 15 minutes from null total labor duration P=.177. Exact total-duration definitions, arm values, between-group effects/CIs, endpoint denominators and analysis models are unverified. A null result does not establish an effect of 0 or equivalence and is not replaced by the pain signal.", "source_evidence_date": "2026-09-07", "materials": [ { "material_type": "Stored existing review summary", "public_status": "Preserved copy of the complete parent-verdict stored summary", "access_status": "Stored summary", "acquired": true, "actually_read": "Summary read", "as_of": "2026-09-07", "qualification": "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." }, { "material_type": "External abstract", "public_status": "Original bibliographic link or needed material; external public availability/access status unverified", "access_status": "Unread; access not attempted", "acquired": false, "actually_read": "Not read", "as_of": null, "qualification": "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." }, { "material_type": "External full text", "public_status": "Original bibliographic link or needed material; external public availability/access status unverified", "access_status": "Unread; access not attempted", "acquired": false, "actually_read": "Not read", "as_of": null, "qualification": "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." }, { "material_type": "Registration material", "public_status": "Original bibliographic link or needed material; external public availability/access status unverified", "access_status": "Unread; access not attempted", "acquired": false, "actually_read": "Not read", "as_of": null, "qualification": "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." }, { "material_type": "Protocol and analysis plan", "public_status": "Original bibliographic link or needed material; external public availability/access status unverified", "access_status": "Unread; access not attempted", "acquired": false, "actually_read": "Not read", "as_of": null, "qualification": "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." } ], "links": [ { "label": "PubMed", "url": "https://pubmed.ncbi.nlm.nih.gov/39103620/" } ] }, { "report_id": "R03", "title": "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.", "url": "https://pubmed.ncbi.nlm.nih.gov/42026814/", "report_type": "Randomized co-primary trial in high-BMI participants", "existence": "Report linked in the original parent stored summary evidence/citation lists. External public availability, access and current acquisition of the original are unverified.", "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread", "study_family": "Original report R03; unique counts and independent replication unverified", "independent_replication": "Parent 2998 and the pain/duration-operative subclaim sheets share the same three reports. First-stage/pushing, total duration, active-labor duration and pain are different outcomes. Randomized/analyzed populations, subgroups, repeated measurements, sheets and reports are not summed into new participant, unique-trial or independent-replication totals. Cohort relationships, confirmed totals and independence are unverified.", "observed_result": "Pain P=.001; duration 202.9±59.5 vs 213.6±67.5 min, P=.522", "result_level": "High-BMI co-primary report. 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