# Birth and peanut balls × labor duration or cesarean prevention Verdict 2998 · Evidence Check Stored-material review date: Not recorded Original evidence cut-off: 2026-09-07 Review-criteria version: 1.0 Public page/material preparation date: 2026-10-16 Clinical papers were not read directly; existing review summaries were checked. No new clinical-literature search was performed. Unverified does not mean that research is absent or that there is no effect. ## Assessment scope - 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. - Ingredient, formulation and route: 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. - Measured outcome: 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. - Questions outside this scope: 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 ## Checklist items ### N01 · Which labor-duration and cesarean claim is being checked? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Direct results by duration endpoint, original cesarean material and selected-question boundaries. Parent scores or pain efficacy do not fill absent subclaim values. - Required materials and conditions: Selected subclaim and original grade/note - Materials to obtain first: Direct results by duration endpoint, original cesarean material and selected-question boundaries. Parent scores or pain efficacy do not fill absent subclaim values. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N02 · What was total labor duration in the trial of 90 participants? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Total-duration definition, arm values, between-group effects/95% CIs, denominators and analysis model. P=.177 does not certify zero duration effect or equivalence. - Required materials and conditions: Direct total-labor-duration results - Materials to obtain first: Total-duration definition, arm values, between-group effects/95% CIs, denominators and analysis model. P=.177 does not certify zero duration effect or equivalence. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R02 ### N03 · What was active-labor duration in the high-BMI trial? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Active-labor start/end criteria, arm-specific analysis denominators, statistical meaning of ±, between-group effects/CIs and joint pain/duration hierarchy. - Required materials and conditions: Active-labor duration and pain as joint outcomes - Materials to obtain first: Active-labor start/end criteria, arm-specific analysis denominators, statistical meaning of ±, between-group effects/CIs and joint pain/duration hierarchy. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R03 ### N04 · Whose first-stage results are reported in the epidural trial? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Exact interaction and between-group test comparisons, parity-specific denominators, effects/CIs and prospective subgroup plans. Subgroups are not counted as new independent replications. - Required materials and conditions: Duration outcomes by parity subgroup - Materials to obtain first: Exact interaction and between-group test comparisons, parity-specific denominators, effects/CIs and prospective subgroup plans. Subgroups are not counted as new independent replications. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01 ### N05 · Were pushing time and the first stage distinguished? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: 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. - Required materials and conditions: Direct pushing-time results - Materials to obtain first: 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. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01 ### N06 · Were different labor-duration intervals distinguished? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Interval-specific clinical definitions, time origins, labor stages, time-specific denominators and direct comparison tables. No new pooled duration effect is calculated. - Required materials and conditions: Correspondence of time intervals, origins and endpoints - Materials to obtain first: Interval-specific clinical definitions, time origins, labor stages, time-specific denominators and direct comparison tables. No new pooled duration effect is calculated. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N07 · Are direct cesarean-prevention event data available? Verification status: Unverified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Arm-specific 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. - Required materials and conditions: Cesarean events by arm and direct comparisons - Materials to obtain first: 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. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N08 · Does vaginal delivery among completers establish operative prevention? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: 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. - Required materials and conditions: Delivery route and missingness for all randomized participants - Materials to obtain first: 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. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N09 · Are the ball itself and positioning/movement packages separated? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Report-specific 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. - Required materials and conditions: Ball shape and combined-program components - Materials to obtain first: 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. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N10 · Are epidural, parity and high-BMI populations the same? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Report-specific eligibility, parity, BMI thresholds, epidural/analgesic use, fetal/maternal status and arm-specific baselines. Details absent from the summary remain unverified. - Required materials and conditions: Report-specific populations and baseline conditions - Materials to obtain first: Report-specific eligibility, parity, BMI thresholds, epidural/analgesic use, fetal/maternal status and arm-specific baselines. Details absent from the summary remain unverified. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N11 · What are the original randomized, analysis and endpoint denominators? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Arm-specific 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. - Required materials and conditions: Participant flow and endpoint denominators by report - Materials to obtain first: 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. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N12 · Are positive pain, null duration and the co-primary hierarchy distinguished? Verification status: Unverified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Registration, protocol, SAP, joint-outcome success criteria, multiplicity, subgroup plans and change history. Original parent axes are preserved without regrading. - Required materials and conditions: Prospective joint-outcome, multiplicity and subgroup plans - Materials to obtain first: Registration, protocol, SAP, joint-outcome success criteria, multiplicity, subgroup plans and change history. Original parent axes are preserved without regrading. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N13 · Do analgesic use and instrumental delivery support the same conclusion? Verification status: Unverified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Outcome-specific definitions, original values, arm denominators, effects/CIs and clinical decision criteria. Unverified outcomes are distinguished from the selected question. - Required materials and conditions: Clinical events and directness by outcome - Materials to obtain first: Outcome-specific definitions, original values, arm denominators, effects/CIs and clinical decision criteria. Unverified outcomes are distinguished from the selected question. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N14 · Are the size and clinical importance of duration signals known? Verification status: Unverified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Between-group estimands, models, variance definitions, prospective importance thresholds and stage-specific analysis tables. No new differences, CIs, effects or grades are calculated. - Required materials and conditions: Between-group duration estimates and uncertainty - Materials to obtain first: Between-group estimands, models, variance definitions, prospective importance thresholds and stage-specific analysis tables. No new differences, CIs, effects or grades are calculated. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N15 · Can findings extend to other deliveries or later outcomes? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Measurement timing, recovery follow-up, care settings, accompanying management and direct results. No labor-ball use, delivery, analgesic or treatment instructions are created. - Required materials and conditions: Index-labor outcomes and subsequent follow-up - Materials to obtain first: Measurement timing, recovery follow-up, care settings, accompanying management and direct results. No labor-ball use, delivery, analgesic or treatment instructions are created. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N16 · Are the same reports or populations counted as new independent trials? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Original study/report identifiers and cohort/analysis-population linkage. Unique-trial counts, unique-participant totals and independent replication are unverified. - Required materials and conditions: Study, report and cohort linkage - Materials to obtain first: Original study/report identifiers and cohort/analysis-population linkage. Unique-trial counts, unique-participant totals and independent replication are unverified. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N17 · Which materials were actually read? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Actual originals, appendices, registration/planning materials and reading records. No new clinical material was searched and no external access was verified in this work. - Required materials and conditions: Reading scope of stored summaries and external originals - Materials to obtain first: Actual originals, appendices, registration/planning materials and reading records. No new clinical material was searched and no external access was verified in this work. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N18 · Where do the original bibliography and registration identifiers appear? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Paper/registration identity, timing and content material. Identifier strings alone do not establish prospective registration or actual reading. - Required materials and conditions: Sources of bibliographic and registration identity - Materials to obtain first: Paper/registration identity, timing and content material. Identifier strings alone do not establish prospective registration or actual reading. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N19 · Were original bilingual and historical-verification statements kept distinct from current review? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Original text, translations, correction material and review records. Historical verification is not labeled as passing current review. - Required materials and conditions: Scope of original text, translation and historical verification - Materials to obtain first: Original text, translations, correction material and review records. Historical verification is not labeled as passing current review. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N20 · Are subclaim originals distinct from parent scores and axes? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Selected-question, original-value and parent-boundary review material. No new scores, axes, efficacy grades, independence certification or verdict changes are created. - Required materials and conditions: Selected subclaim D and parent pain context - Materials to obtain first: Selected-question, original-value and parent-boundary review material. No new scores, axes, efficacy grades, independence certification or verdict changes are created. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N21 · What are the original evidence date and empty correction history? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Actual corrections, follow-up material, complete prior originals and change history. Existing original text/dates are preserved. - Required materials and conditions: Evidence date, production date and change records - Materials to obtain first: Actual corrections, follow-up material, complete prior originals and change history. Existing original text/dates are preserved. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N22 · Are funding, product support and company involvement distinguished? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Original funding, product/device support, author affiliations and analysis/publication roles. Parent independence axes are not treated as new certification. - Required materials and conditions: Report-specific support, affiliations and analysis/publication roles - Materials to obtain first: Original funding, product/device support, author affiliations and analysis/publication roles. Parent independence axes are not treated as new certification. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N23 · Are allocation, blinding, measurement and selective-reporting conditions known? Verification status: Unverified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: 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. - Required materials and conditions: Design labels and actual bias conditions - Materials to obtain first: 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. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N24 · Are adherence, accompanying interventions and actual exposure preserved? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Original accompanying-intervention, adherence, exposure and intervention-deviation data. No new totals, repetitions, cumulative exposures or implementation/delivery methods are created. - Required materials and conditions: Actual programs, controls and labor management - Materials to obtain first: Original accompanying-intervention, adherence, exposure and intervention-deviation data. No new totals, repetitions, cumulative exposures or implementation/delivery methods are created. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N25 · Are safety statements distinct from actual harm collection? Verification status: Unverified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Report-specific harm definitions, collection, severity, exposure/denominators, withdrawals and accompanying management. Cautions do not establish no harm, new safety certification or treatment instructions. - Required materials and conditions: Harm definitions, collection, comparators and exposure denominators - Materials to obtain first: Report-specific harm definitions, collection, severity, exposure/denominators, withdrawals and accompanying management. Cautions do not establish no harm, new safety certification or treatment instructions. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N26 · Are long-term/rare harms and post-intervention outcomes available? Verification status: Unverified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: Brief pain/duration data during the index labor do not establish rare maternal/fetal harms, long-term recovery or subsequent-delivery outcomes. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Actual long-term/harm follow-up, exposure duration, endpoint denominators and report linkage. Unread/unverified material does not mean 0 events or safety. - Required materials and conditions: Direct follow-up of long-term and rare harms - Materials to obtain first: Actual long-term/harm follow-up, exposure duration, endpoint denominators and report linkage. Unread/unverified material does not mean 0 events or safety. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ### N27 · Which new materials would prompt an update to this table? Verification status: Partly verified Reading scope: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread - Current findings: 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. - Why unverified: The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification. - Reason for missing information: Complete prior originals, new material, condition versions, separate application and review records. Material additions, condition revisions and verdict changes remain separate events. - Required materials and conditions: Changes in material, conditions, observations and verdicts - Materials to obtain first: Complete prior originals, new material, condition versions, separate application and review records. Material additions, condition revisions and verdict changes remain separate events. - Further 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. - Conditions for verification: 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. - Why this condition is needed: 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 exceptions: 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. - Remaining uncertainty: External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification. - Referenced methods: Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced. - Related sources: R01, R02, R03 ## Evidence and sources ### R01 Payton CL, et al. Randomized Controlled Trial of Use of the Peanut Ball During Labor. Nurs Womens Health. 2016. PMID: 26859467. DOI: 10.1097/NMC.0000000000000232. [PubMed](https://pubmed.ncbi.nlm.nih.gov/26859467/) Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread Findings recorded in the summary: Primiparous interaction P=.018; multiparous P=.057; pushing null Record 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. 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. | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Stored existing review summary | Preserved copy of the complete parent-verdict stored summary | Stored summary | Summary read | Preserve original PubMed URL, PMID 26859467, DOI 10.1097/NMC.0000000000000232, PMCID unrecorded and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred. | | External abstract | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PubMed URL, PMID 26859467, DOI 10.1097/NMC.0000000000000232, PMCID unrecorded and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred. | | External full text | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PubMed URL, PMID 26859467, DOI 10.1097/NMC.0000000000000232, PMCID unrecorded and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred. | | Registration material | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PubMed URL, PMID 26859467, DOI 10.1097/NMC.0000000000000232, PMCID unrecorded and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred. | | Protocol and analysis plan | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PubMed URL, PMID 26859467, DOI 10.1097/NMC.0000000000000232, PMCID unrecorded and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred. | ### R02 Alan Dikmen H, et al. Effects of peanut ball use on perceived labor pain, fatigue, and mother's perception of childbirth: a randomized controlled trial. Arch Gynecol Obstet. 2025;311. PMID: 39103620. PMCID: PMC12055654. DOI: 10.1007/s00404-024-07656-2. [PubMed](https://pubmed.ncbi.nlm.nih.gov/39103620/) Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread Findings recorded in the summary: Pain and fatigue positive; total labor duration P=.177 Record 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. 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. | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Stored existing review summary | Preserved copy of the complete parent-verdict stored summary | Stored summary | Summary read | Preserve original PubMed URL, PMID 39103620, DOI 10.1007/s00404-024-07656-2, PMCID PMC12055654 and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred. | | External abstract | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PubMed URL, PMID 39103620, DOI 10.1007/s00404-024-07656-2, PMCID PMC12055654 and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred. | | External full text | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PubMed URL, PMID 39103620, DOI 10.1007/s00404-024-07656-2, PMCID PMC12055654 and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred. | | Registration material | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PubMed URL, PMID 39103620, DOI 10.1007/s00404-024-07656-2, PMCID PMC12055654 and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred. | | Protocol and analysis plan | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PubMed URL, PMID 39103620, DOI 10.1007/s00404-024-07656-2, PMCID PMC12055654 and bibliographic wording unchanged. The original evidence registration field exists and reads unconfirmed. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred. | ### R03 Ozkececi F, et al. The Effect of Peanut Ball Use on the Labour Process and Maternal-Neonatal Outcomes in Parturient Women With High Maternal Body Mass Index: A Randomized Controlled Trial. Int J Nurs Pract. 2026;32:e70144. PMID: 42026814. PMCID: PMC13106928. DOI: 10.1111/ijn.70144. [PubMed](https://pubmed.ncbi.nlm.nih.gov/42026814/) Materials actually read: Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread Findings recorded in the summary: Pain P=.001; duration 202.9±59.5 vs 213.6±67.5 min, P=.522 Record level: High-BMI co-primary report. Distinguish 70 randomized/59 analyzed, pain P=.001 and active-labor duration 202.9±59.5 versus 213.6±67.5 minutes/P=.522. The meaning of ±, group correspondence, interval origins, denominators, effects/CIs and joint success rules are unverified. Active-labor duration is not total duration and completer results do not establish cesarean prevention. 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. | Material | Public availability | Access status | Actually read | Notes | |---|---|---|---|---| | Stored existing review summary | Preserved copy of the complete parent-verdict stored summary | Stored summary | Summary read | Preserve original PubMed URL, PMID 42026814, DOI 10.1111/ijn.70144, PMCID PMC13106928 and bibliographic wording unchanged. The original evidence registration field exists and reads NCT05276947. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred. | | External abstract | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PubMed URL, PMID 42026814, DOI 10.1111/ijn.70144, PMCID PMC13106928 and bibliographic wording unchanged. The original evidence registration field exists and reads NCT05276947. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred. | | External full text | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PubMed URL, PMID 42026814, DOI 10.1111/ijn.70144, PMCID PMC13106928 and bibliographic wording unchanged. The original evidence registration field exists and reads NCT05276947. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred. | | Registration material | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PubMed URL, PMID 42026814, DOI 10.1111/ijn.70144, PMCID PMC13106928 and bibliographic wording unchanged. The original evidence registration field exists and reads NCT05276947. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred. | | Protocol and analysis plan | Original bibliographic link or needed material; external public availability/access status unverified | Unread; access not attempted | Not read | Preserve original PubMed URL, PMID 42026814, DOI 10.1111/ijn.70144, PMCID PMC13106928 and bibliographic wording unchanged. The original evidence registration field exists and reads NCT05276947. Registration wording is unrecorded in the citation. Unconfirmed identifiers do not establish no registration; no new registry URL, prospective status or external bibliographic verification is inferred. | ## Review criteria and methods These are Chamgap's own application conditions, informed by the relevant sections of official methodological guidance. They do not constitute official assessment-tool certification or a new efficacy score. - M03 [Cochrane Handbook 6.5 (2024), chapter updated 2023-08](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-03) · §3.1, §3.2.1–3.2.3, MECIR C5/C7/C13 · Clearly record the question, eligibility conditions and reasons for changes, and distinguish variations in interventions. · Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed. - M04 [Cochrane Handbook 6.5.1 (2025), chapter updated 2025-03](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-04) · §4.5, §4.6.1–4.6.3, MECIR C42 · Distinguish studies from reports and link them; do not omit a study solely because results are unreported. · Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed. - M08 [Cochrane Handbook 6.5 (2024), chapter updated 2019-10](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-08) · §8.1–8.2.3, Table 8.2.a · Define the outcome and effect of interest, then examine randomization, deviations, missing data, measurement and selective reporting. · Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed. - M15 [Cochrane Handbook 6.5 (2024), chapter updated 2023-08](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-15) · §15.2.4, §15.3.1–15.3.3 · Distinguish effect estimates, intervals, importance and applicability. Sample size alone does not determine precision. · Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed. - M19 [Cochrane Handbook 6.5 (2024), chapter updated 2019-10](https://www.cochrane.org/authors/handbooks-and-manuals/handbook/current/chapter-19) · §19.1.2, §19.2.1–19.2.4 · Harm questions may require different designs, populations and follow-up from efficacy questions. Case reports do not establish incidence rates. · Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed. ## What the statuses mean - Partly verified: Some information is present in the stored source, with detailed original materials still unverified; this does not mean review passed or clinical efficacy certified - Unverified: Detailed materials for the selected condition could not be established within the stored scope; this does not mean zero effect, zero studies or safety - Review incomplete: Awaiting user review - Met: Use only within the relevant condition's scope after user review; no automatic display in this preparation - Not reported: Distinguish only within materials actually read; do not turn unread external materials into unreported findings - Inaccessible: Not applied during this preparation because actual access was not tested - Not applicable: Use with a reason for non-applicability based on an explicit question boundary - Conflicting data: Judge after actual material comparison; review was not performed during this preparation - Insufficient evidence for the conditions: Do not use as a clinical grade encompassing currently unread materials ## Change history 2026-10-16 · Public page/materials 1.0. Public pages and materials were prepared from the existing 27 items. No new clinical search, verification-status change or scoring was performed.