{
  "schema_version": "chamgap-public-evidence-check-1.0",
  "public_id": "v3004-s0",
  "verdict_number": "3004",
  "title": "Labor VR × immediate pain before analgesia: change signal and missing CI",
  "view_version": "1.0",
  "view_created_date": "2026-10-19",
  "criteria_version": "1.0",
  "criteria_date": "2026-10-06",
  "review_date": null,
  "legacy_evidence_date": "2026-09-07",
  "review_scope": {
    "materials_read": "Existing review summaries and stored records of methodological application",
    "clinical_papers_directly_read": false,
    "new_clinical_search": false,
    "limitation": "Existing stored summary and preserved methodology application records. External papers, abstracts, registration, protocols, SAPs, original result tables and support disclosures are unread, and review of existing content remains incomplete.",
    "date_meaning": "This is the date the stored materials were checked, not the date of a new search of the clinical literature."
  },
  "claim_context": {
    "population": "The key Wong trial involved 40 term nulliparous women before pharmacologic/neuraxial analgesia, with 21 VR and 19 control participants. Do not extend this to all laboring women, multiparous women, high-risk pregnancy, post-epidural use or all labor stages. Original eligibility, baseline pain, stages and endpoint/time-specific denominators are unverified.",
    "intervention": "Immersive VR combined nature scenes, distraction and labor-specific audio guidance. This does not establish an isolated device/immersion effect or identical effects across headsets/content. Keep report-specific devices, content, contact and actual exposure conditions separate.",
    "dose": "Study exposures were up to 30 minutes in the key trial and about 10 minutes in the acute crossover. Do not turn key-trial exposure into post-exposure persistence or copy it to every report. Calculate no total exposure and create no VR setup, labor, analgesic or treatment instructions.",
    "comparator": "Original records use no added intervention and standard care, describing no active comparator to isolate attention effects. Non-VR contractions in the crossover and epidural status in other trials are separate. Shared care, guidance, contact, expectancy and exact original contrasts are unverified.",
    "endpoint": "The selection is immediate pain before analgesia. Original Wong values are control +0.58, VR -0.52 and between-group change difference -1.10, P=.03; the direct 95% CI is unverified. MCID responses of 0% versus 23.8%, P=.049 are a separate record with unverified threshold validation and CI. Calculate no new change difference, CI or responder count.",
    "duration": "Up to 30 minutes is key-trial exposure. Distinguish another report’s during-use signal from nonpersistence 30 minutes later; exact time origins, concurrent analgesia and denominators are unverified. Do not transfer immediate score signals to sustained whole-labor effects or reduced medication/obstetric events.",
    "excluded_extensions": [
      "Back-calculating CI/SE or standardized effects from original change differences/P, or calculating new MCID responder counts",
      "Combining primary pain with secondary pain, satisfaction, anxiety or medication/obstetric events as one effect",
      "Interchanging within-group reduction, pre/post-epidural and during/immediately-after/30-minutes-later results",
      "Using representative populations, maximum exposure, standard care or total samples as every report/endpoint’s conditions or denominators",
      "Counting same-cohort qualitative reports, shared bibliography or the three questions as new independent trials or participant totals",
      "Certifying in-kind support, reported noninvolvement in analysis or public funding as complete independence/support verification",
      "Inheriting parent C with 50 points, Caution or historical verification as subclaim scores or new clinical/safety certification",
      "Creating new VR use/setup, labor, analgesic or treatment instructions, or medication/surgery replacement recommendations"
    ]
  },
  "requirements": [
    {
      "item_id": "N01",
      "question_type": "Evidence condition",
      "question": "Which immediate-pain claim is selected?",
      "needed": "Subclaim of immediate labor pain before pharmacologic analgesia",
      "role": "Required",
      "role_reason": "This condition connects Subclaim of immediate labor pain before pharmacologic analgesia with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Subclaim of immediate labor pain before pharmacologic analgesia must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Materials are needed for populations, medication status, comparator, scale, timing, denominators and original effects/CIs. Create no new question or independence certification. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The selection is immediate labor-pain reduction before pharmacologic analgesia. The original grade C note records a 40-person primary pain result and a brief signal from a small independent crossover. Persistence and analgesic/operative events are separate.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Materials are needed for populations, medication status, comparator, scale, timing, denominators and original effects/CIs. Create no new question or independence certification.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Materials are needed for populations, medication status, comparator, scale, timing, denominators and original effects/CIs. Create no new question or independence certification."
    },
    {
      "item_id": "N02",
      "question_type": "Evidence condition",
      "question": "What is Wong's between-group pain-change difference?",
      "needed": "Direct between-group pre-post effects and original analysis",
      "role": "Required",
      "role_reason": "This condition connects Direct between-group pre-post effects and original analysis with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Direct between-group pre-post effects and original analysis must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original pain scale/direction, baseline/measurement windows, model, arm denominators, direct 95% CI and adjustment are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Original results are control +0.58, VR -0.52 and between-group change difference -1.10, P=.03. The difference was already recorded; it was not calculated by subtracting arms now.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original pain scale/direction, baseline/measurement windows, model, arm denominators, direct 95% CI and adjustment are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original pain scale/direction, baseline/measurement windows, model, arm denominators, direct 95% CI and adjustment are unverified."
    },
    {
      "item_id": "N03",
      "question_type": "Evidence condition",
      "question": "Were precision and importance of the original difference verified?",
      "needed": "Original effect, direct interval and patient-important difference",
      "role": "Required",
      "role_reason": "This condition connects Original effect, direct interval and patient-important difference with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Original effect, direct interval and patient-important difference must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original between-group intervals, variation/model, denominators, scales and patient-importance criteria are needed. Do not back-calculate CI, SE or standardized effects. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The parent retains -1.10 points, P=.03 and an unverified 95% CI together. Do not turn this into a large or established whole-labor effect.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original between-group intervals, variation/model, denominators, scales and patient-importance criteria are needed. Do not back-calculate CI, SE or standardized effects.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original between-group intervals, variation/model, denominators, scales and patient-importance criteria are needed. Do not back-calculate CI, SE or standardized effects."
    },
    {
      "item_id": "N04",
      "question_type": "Evidence condition",
      "question": "What do allocation and all analyzed mean?",
      "needed": "Allocation, analysis and endpoint/time-specific data/exposure denominators",
      "role": "Required",
      "role_reason": "This condition connects Allocation, analysis and endpoint/time-specific data/exposure denominators with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Allocation, analysis and endpoint/time-specific data/exposure denominators must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original flow, missingness/stopping, endpoint/time-specific denominators, ITT/analysis definitions and harm exposure are needed. Calculate no new arm data or events. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Wong records 40 participants, 21 VR/19 control, and the text says all 40 were analyzed. This does not establish complete data for every endpoint, time or harm, or adequate power.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original flow, missingness/stopping, endpoint/time-specific denominators, ITT/analysis definitions and harm exposure are needed. Calculate no new arm data or events.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original flow, missingness/stopping, endpoint/time-specific denominators, ITT/analysis definitions and harm exposure are needed. Calculate no new arm data or events."
    },
    {
      "item_id": "N05",
      "question_type": "Evidence condition",
      "question": "Who was studied before pharmacologic or neuraxial analgesia?",
      "needed": "Term/nulliparous eligibility, labor status and pre-analgesia scope",
      "role": "Required",
      "role_reason": "This condition connects Term/nulliparous eligibility, labor status and pre-analgesia scope with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Term/nulliparous eligibility, labor status and pre-analgesia scope must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original pregnancy/labor stages, baseline pain, parity/term status, analgesia/cointerventions, high-risk/exclusion criteria and denominators are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The parent describes 40 term nulliparous women before pharmacologic/neuraxial analgesia in the key trial. Do not copy effects to all laboring women, post-epidural use or other labor stages.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original pregnancy/labor stages, baseline pain, parity/term status, analgesia/cointerventions, high-risk/exclusion criteria and denominators are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original pregnancy/labor stages, baseline pain, parity/term status, analgesia/cointerventions, high-risk/exclusion criteria and denominators are unverified."
    },
    {
      "item_id": "N06",
      "question_type": "Evidence condition",
      "question": "Were nature scenes, audio and distraction separated?",
      "needed": "Attribution of combined content and immersive devices",
      "role": "Required",
      "role_reason": "This condition connects Attribution of combined content and immersive devices with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Attribution of combined content and immersive devices must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Materials distinguishing devices, content, audio/contact, exposure and comparator components, including active controls, are needed. Create no new VR setup, labor or analgesia instructions. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The key trial combined nature scenes, distraction and labor-specific audio. Do not establish an isolated device/immersion effect or identical effects across all content.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Materials distinguishing devices, content, audio/contact, exposure and comparator components, including active controls, are needed. Create no new VR setup, labor or analgesia instructions.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Materials distinguishing devices, content, audio/contact, exposure and comparator components, including active controls, are needed. Create no new VR setup, labor or analgesia instructions."
    },
    {
      "item_id": "N07",
      "question_type": "Evidence condition",
      "question": "Are original and active attention controls the same?",
      "needed": "Original comparator versus attention, contact and expectancy",
      "role": "Required",
      "role_reason": "This condition connects Original comparator versus attention, contact and expectancy with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Original comparator versus attention, contact and expectancy must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Shared care, contact/guidance, active attention controls, expectancy/blinding, exact original contrasts and denominators are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Original records describe up to 30 minutes of VR versus no added intervention and standard care. They describe no active control to isolate attention effects.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Shared care, contact/guidance, active attention controls, expectancy/blinding, exact original contrasts and denominators are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Shared care, contact/guidance, active attention controls, expectancy/blinding, exact original contrasts and denominators are unverified."
    },
    {
      "item_id": "N08",
      "question_type": "Evidence condition",
      "question": "What are pain and anxiety in the Frey crossover?",
      "needed": "Separate acute crossover endpoints, intervals and analysis",
      "role": "Required",
      "role_reason": "This condition connects Separate acute crossover endpoints, intervals and analysis with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Separate acute crossover endpoints, intervals and analysis must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original scales, contraction/assessment windows, order/periods/carryover, paired denominators, crossover estimation and hierarchy are unverified. Do not convert scales or newly assign an interval level to anxiety. This records needed materials; no new research was executed.",
      "current_reports": [
        "R02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Frey records an order-randomized acute crossover of 27 participants, about 10 minutes of VR/non-VR contractions. Distinguish sensory pain -1.5 (95% CI -2.2 to -0.8) from anxiety -1.5 (-2.3 to -0.8).",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original scales, contraction/assessment windows, order/periods/carryover, paired denominators, crossover estimation and hierarchy are unverified. Do not convert scales or newly assign an interval level to anxiety.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original scales, contraction/assessment windows, order/periods/carryover, paired denominators, crossover estimation and hierarchy are unverified. Do not convert scales or newly assign an interval level to anxiety."
    },
    {
      "item_id": "N09",
      "question_type": "Evidence condition",
      "question": "Is crossover support replication under identical conditions?",
      "needed": "Content, scales, within-person correlation and independence wording",
      "role": "Required",
      "role_reason": "This condition connects Content, scales, within-person correlation and independence wording with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Content, scales, within-person correlation and independence wording must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Links among institutions, recruitment, registration/support, content/scales, order/carryover, paired denominators and original effects/CIs are needed. Create no new independence certification or totals. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The parent distinguishes brief pain/anxiety signals from an independent acute crossover with different content/scales. Do not count repeated contractions as new participants or combine them as the same effect as the key trial's -1.10 points.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Links among institutions, recruitment, registration/support, content/scales, order/carryover, paired denominators and original effects/CIs are needed. Create no new independence certification or totals.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Links among institutions, recruitment, registration/support, content/scales, order/carryover, paired denominators and original effects/CIs are needed. Create no new independence certification or totals."
    },
    {
      "item_id": "N10",
      "question_type": "Evidence condition",
      "question": "Are MCID responses separate confirmation?",
      "needed": "Response criteria, denominators, external validation and intervals",
      "role": "Required",
      "role_reason": "This condition connects Response criteria, denominators, external validation and intervals with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Response criteria, denominators, external validation and intervals must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Criterion source/prespecification, arm order, responders/denominators, direct effects/CIs and multiplicity are needed. Calculate no new responder counts from allocation sizes. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The parent retains minimum-clinically-important-difference responses of 0% versus 23.8%, P=.049 with unverified external threshold validation and CI, without adding another strength.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Criterion source/prespecification, arm order, responders/denominators, direct effects/CIs and multiplicity are needed. Calculate no new responder counts from allocation sizes.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Criterion source/prespecification, arm order, responders/denominators, direct effects/CIs and multiplicity are needed. Calculate no new responder counts from allocation sizes."
    },
    {
      "item_id": "N11",
      "question_type": "Evidence condition",
      "question": "Are Carus satisfaction and pain distinguished?",
      "needed": "Primary satisfaction, secondary pain and pre/post-epidural results",
      "role": "Required",
      "role_reason": "This condition connects Primary satisfaction, secondary pain and pre/post-epidural results with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Primary satisfaction, secondary pain and pre/post-epidural results must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Do not turn satisfaction P or within-group pain into direct between-group primary pain effects. Original scales, time-specific denominators, medication status, between-group effects/CIs and hierarchy are needed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R03"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Carus records 42 participants, 21 versus 21, primary satisfaction P=.04 and secondary pain. Early within-group pain reduction and no post-epidural change are separate findings.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Do not turn satisfaction P or within-group pain into direct between-group primary pain effects. Original scales, time-specific denominators, medication status, between-group effects/CIs and hierarchy are needed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not turn satisfaction P or within-group pain into direct between-group primary pain effects. Original scales, time-specific denominators, medication status, between-group effects/CIs and hierarchy are needed."
    },
    {
      "item_id": "N12",
      "question_type": "Evidence condition",
      "question": "Are immediate signals transferred to persistent effects?",
      "needed": "Exposure duration versus during, immediate and post-exposure assessment",
      "role": "Required",
      "role_reason": "This condition connects Exposure duration versus during, immediate and post-exposure assessment with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Exposure duration versus during, immediate and post-exposure assessment must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Time origins for exposure end, baseline/during/immediate/follow-up, original between-group effects/CIs, denominators and concurrent analgesia are unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Up to 30 minutes is key-trial exposure. Correia records that the during-use signal was not maintained 30 minutes later. Do not turn immediate/during-use findings into persistent effects.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Time origins for exposure end, baseline/during/immediate/follow-up, original between-group effects/CIs, denominators and concurrent analgesia are unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Time origins for exposure end, baseline/during/immediate/follow-up, original between-group effects/CIs, denominators and concurrent analgesia are unverified."
    },
    {
      "item_id": "N13",
      "question_type": "Evidence condition",
      "question": "Does a pain signal mean less analgesia or operative birth?",
      "needed": "Subjective pain versus epidural, cesarean and instrumental-delivery events",
      "role": "Required",
      "role_reason": "This condition connects Subjective pain versus epidural, cesarean and instrumental-delivery events with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Subjective pain versus epidural, cesarean and instrumental-delivery events must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original event definitions, medication/timing, denominators, direct effects/CIs, prespecified sample/power and clinical plans are needed. Create no new labor or analgesia instructions. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The original text and separate event subclaim describe unestablished precise effects and power for analgesic/obstetric events. Do not turn pain/satisfaction signals into confirmation of medication replacement or surgery prevention.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original event definitions, medication/timing, denominators, direct effects/CIs, prespecified sample/power and clinical plans are needed. Create no new labor or analgesia instructions.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original event definitions, medication/timing, denominators, direct effects/CIs, prespecified sample/power and clinical plans are needed. Create no new labor or analgesia instructions."
    },
    {
      "item_id": "N14",
      "question_type": "Evidence condition",
      "question": "Are brief self-report and unblinded limitations retained?",
      "needed": "Pain measurement, expectancy, prespecified endpoints and selective reporting",
      "role": "Required",
      "role_reason": "This condition connects Pain measurement, expectancy, prespecified endpoints and selective reporting with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Pain measurement, expectancy, prespecified endpoints and selective reporting must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Allocation/concealment, assessors/participants, measurement/baseline adjustment, prespecified endpoints/registration/plans, missingness and selected times are unverified. Create no new formal bias assessment or grade. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The key trial is open randomized; the text retains patient-reported, small acute unblinded-trial limitations. A primary signal does not resolve every bias or selection issue.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Allocation/concealment, assessors/participants, measurement/baseline adjustment, prespecified endpoints/registration/plans, missingness and selected times are unverified. Create no new formal bias assessment or grade.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Allocation/concealment, assessors/participants, measurement/baseline adjustment, prespecified endpoints/registration/plans, missingness and selected times are unverified. Create no new formal bias assessment or grade."
    },
    {
      "item_id": "N15",
      "question_type": "Evidence condition",
      "question": "Are brief pain and maternal/neonatal harms separated?",
      "needed": "Harms collection, events, denominators, timing and observation conditions",
      "role": "Supplementary",
      "role_reason": "This condition connects Harms collection, events, denominators, timing and observation conditions with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Harms collection, events, denominators, timing and observation conditions must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original harm counts, denominators, active collection, severity/timing, stopping/cointerventions and vulnerable-population data are needed. Absence of numbers does not establish safety or justify new use/treatment instructions. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The parent describes dizziness, motion sickness, discomfort/visual obstruction and monitoring/communication boundaries, noting that 40 participants are too few for rare maternal/neonatal harms.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original harm counts, denominators, active collection, severity/timing, stopping/cointerventions and vulnerable-population data are needed. Absence of numbers does not establish safety or justify new use/treatment instructions.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original harm counts, denominators, active collection, severity/timing, stopping/cointerventions and vulnerable-population data are needed. Absence of numbers does not establish safety or justify new use/treatment instructions."
    },
    {
      "item_id": "N16",
      "question_type": "Evidence condition",
      "question": "What is the scope of AppliedVR support and analysis noninvolvement?",
      "needed": "Same-cohort product support and analysis roles",
      "role": "Required",
      "role_reason": "This condition connects Same-cohort product support and analysis roles with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Same-cohort product support and analysis roles must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Money/in-kind support, author affiliations/COI, design/analysis/publication roles and same-cohort original-report identification are needed. Do not extend reported analysis noninvolvement to every role. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Wong's funding wording preserves AppliedVR device/software in-kind support and reported noninvolvement in analysis in a same-cohort report. Do not add a same-cohort qualitative study as a new trial.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Money/in-kind support, author affiliations/COI, design/analysis/publication roles and same-cohort original-report identification are needed. Do not extend reported analysis noninvolvement to every role.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Money/in-kind support, author affiliations/COI, design/analysis/publication roles and same-cohort original-report identification are needed. Do not extend reported analysis noninvolvement to every role."
    },
    {
      "item_id": "N17",
      "question_type": "Evidence condition",
      "question": "What are funding and COI in other reports?",
      "needed": "Public funding, no-funding declarations, unverified support and company roles",
      "role": "Required",
      "role_reason": "This condition connects Public funding, no-funding declarations, unverified support and company roles with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Public funding, no-funding declarations, unverified support and company roles must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original money, device support, affiliations/COI, design/analysis/publication roles and company relationships are unverified. Do not promote these to complete support verification. This records needed materials; no new research was executed.",
      "current_reports": [
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve Frey's NIH AR054115 and GM042725, Carus's reported no applicable funding/no conflicts and Correia's unverified support.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original money, device support, affiliations/COI, design/analysis/publication roles and company relationships are unverified. Do not promote these to complete support verification.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original money, device support, affiliations/COI, design/analysis/publication roles and company relationships are unverified. Do not promote these to complete support verification."
    },
    {
      "item_id": "N18",
      "question_type": "Evidence condition",
      "question": "Do identifiers verify prespecified hierarchy?",
      "needed": "Paper-registration linkage, original identifiers and registration/plan reading",
      "role": "Required",
      "role_reason": "This condition connects Paper-registration linkage, original identifiers and registration/plan reading with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Paper-registration linkage, original identifiers and registration/plan reading must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original registration/change history, protocols/SAPs, paper linkage and prespecified endpoints/denominators/success rules are needed. Infer no new URLs and perform no clinical link checks. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve unverified Wong paper–official-registration linkage, Frey NCT02926469, Carus NCT05032456 and unverified Correia registration. Identifiers/PMCID do not establish current reading or prospective prespecification.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original registration/change history, protocols/SAPs, paper linkage and prespecified endpoints/denominators/success rules are needed. Infer no new URLs and perform no clinical link checks.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original registration/change history, protocols/SAPs, paper linkage and prespecified endpoints/denominators/success rules are needed. Infer no new URLs and perform no clinical link checks."
    },
    {
      "item_id": "N19",
      "question_type": "Evidence condition",
      "question": "Can shared reports be counted as new independent trials?",
      "needed": "Parent/subclaims and same-cohort report relationships",
      "role": "Required",
      "role_reason": "This condition connects Parent/subclaims and same-cohort report relationships with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Parent/subclaims and same-cohort report relationships must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Registration, institutions, recruitment, participants, reports/support and qualitative/quantitative cohort relationships are needed. Do not sum reports, years or sheets as new unique-trial/participant totals. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The parent and three subclaims share four reports. Preserve the original rule against counting same-cohort qualitative material as replication.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Registration, institutions, recruitment, participants, reports/support and qualitative/quantitative cohort relationships are needed. Do not sum reports, years or sheets as new unique-trial/participant totals.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Registration, institutions, recruitment, participants, reports/support and qualitative/quantitative cohort relationships are needed. Do not sum reports, years or sheets as new unique-trial/participant totals."
    },
    {
      "item_id": "N20",
      "question_type": "Evidence condition",
      "question": "Are total samples every endpoint's denominators?",
      "needed": "Report-specific allocation, analysis and endpoint/time denominators",
      "role": "Required",
      "role_reason": "This condition connects Report-specific allocation, analysis and endpoint/time denominators with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Report-specific allocation, analysis and endpoint/time denominators must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: All analyzed is key-trial context and is not copied to other reports. Original flow, missingness/stopping, cointerventions, analysis populations and sensitivity are needed; calculate no new totals, rates, responder counts or effects. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve original sizes separately: 40 participants (21/19), 27, 42 (21/21) and 61 (32/29). Identical crossover, satisfaction, pain, medication, event, time and harm denominators have not been verified.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "All analyzed is key-trial context and is not copied to other reports. Original flow, missingness/stopping, cointerventions, analysis populations and sensitivity are needed; calculate no new totals, rates, responder counts or effects.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "All analyzed is key-trial context and is not copied to other reports. Original flow, missingness/stopping, cointerventions, analysis populations and sensitivity are needed; calculate no new totals, rates, responder counts or effects."
    },
    {
      "item_id": "N21",
      "question_type": "Evidence condition",
      "question": "Are research records turned into use or analgesia instructions?",
      "needed": "Original exposure/safety wording versus operational guidance",
      "role": "Supplementary",
      "role_reason": "This condition connects Original exposure/safety wording versus operational guidance with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Original exposure/safety wording versus operational guidance must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Actual treatment/use decisions are separate. Create no methods or medication-change recommendations beyond the original text. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "This work preserves devices, content, comparisons and safety boundaries in an evidence table. Create no new VR use/setup steps, labor, analgesic or treatment instructions, or replacement guidance.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Actual treatment/use decisions are separate. Create no methods or medication-change recommendations beyond the original text.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Actual treatment/use decisions are separate. Create no methods or medication-change recommendations beyond the original text."
    },
    {
      "item_id": "N22",
      "question_type": "Evidence condition",
      "question": "Are subclaim grades distinguished from parent scores and axes?",
      "needed": "Subclaim grades, absent score/status/axes and parent context",
      "role": "Required",
      "role_reason": "This condition connects Subclaim grades, absent score/status/axes and parent context with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Subclaim grades, absent score/status/axes and parent context must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Do not fill absent subclaim fields from parent values or turn unrecorded/? into definite values. Create no new grades, scores or independence certification. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve immediate-pain C, persistence D and event ?. Subclaim scores/status/axes are absent; parent C with 50 points, Caution, original axes and unrecorded precision concern immediate-pain context.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Do not fill absent subclaim fields from parent values or turn unrecorded/? into definite values. Create no new grades, scores or independence certification.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not fill absent subclaim fields from parent values or turn unrecorded/? into definite values. Create no new grades, scores or independence certification."
    },
    {
      "item_id": "N23",
      "question_type": "Evidence condition",
      "question": "Are representative conditions copied to every report?",
      "needed": "Both languages, devices/content, population, timing and denominators",
      "role": "Required",
      "role_reason": "This condition connects Both languages, devices/content, population, timing and denominators with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Both languages, devices/content, population, timing and denominators must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Original report-specific populations, devices/content, comparators, denominators, endpoints/times and English correspondence are needed. No external English comparison or clinical correction review was performed now. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve parent bilingual text and representative conditions. Do not apply 40 participants, up to 30 minutes, standard care or pre-post differences as identical conditions for the 27-person crossover, 42-person satisfaction trial or 61-person persistence trial.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Original report-specific populations, devices/content, comparators, denominators, endpoints/times and English correspondence are needed. No external English comparison or clinical correction review was performed now.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Original report-specific populations, devices/content, comparators, denominators, endpoints/times and English correspondence are needed. No external English comparison or clinical correction review was performed now."
    },
    {
      "item_id": "N24",
      "question_type": "Evidence condition",
      "question": "Are stored-summary and external-material reading distinguished?",
      "needed": "Material-specific existence, acquisition and actual reading",
      "role": "Required",
      "role_reason": "This condition connects Material-specific existence, acquisition and actual reading with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Material-specific existence, acquisition and actual reading must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: URLs, PMCID or identifiers do not establish acquisition, accessibility, reading or completed review. Actual material acquisition and review are separate events. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The complete stored parent summary was read for production. Historical verification, incorporation, cross-checks and same-cohort support wording are retained as history; external abstracts, full texts, registration and protocols/SAPs are unread.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "URLs, PMCID or identifiers do not establish acquisition, accessibility, reading or completed review. Actual material acquisition and review are separate events.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "URLs, PMCID or identifiers do not establish acquisition, accessibility, reading or completed review. Actual material acquisition and review are separate events."
    },
    {
      "item_id": "N25",
      "question_type": "Evidence condition",
      "question": "How are evidence date, empty histories and production date distinguished?",
      "needed": "Original evidence date, correction/deliberation records and date roles",
      "role": "Required",
      "role_reason": "This condition connects Original evidence date, correction/deliberation records and date roles with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Original evidence date, correction/deliberation records and date roles must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Link complete originals, versions and events when new material/corrections are obtained. No new external lookup or original-verdict change was performed. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve original evidence date 2026-09-07, empty corrections and empty deliberation. Retain the original 2026 report bibliography and periods; production date does not become a new evidence-verification date.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Link complete originals, versions and events when new material/corrections are obtained. No new external lookup or original-verdict change was performed.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Link complete originals, versions and events when new material/corrections are obtained. No new external lookup or original-verdict change was performed."
    },
    {
      "item_id": "N26",
      "question_type": "Evidence condition",
      "question": "Are material slots quality or independent-trial counts?",
      "needed": "Production structure versus unique clinical units and actual acquisition",
      "role": "Required",
      "role_reason": "This condition connects Production structure versus unique clinical units and actual acquisition with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Production structure versus unique clinical units and actual acquisition must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Do not double-count sharing across parent/subclaims. Distinguish original trials/cohorts and actual acquisition/reading; unique-trial/participant totals remain unverified. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "The 20 material slots comprise 4 stored summaries and 16 unread external slots. They are not acquired papers, unique trials, participants, independent replications or quality scores.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Do not double-count sharing across parent/subclaims. Distinguish original trials/cohorts and actual acquisition/reading; unique-trial/participant totals remain unverified.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Do not double-count sharing across parent/subclaims. Distinguish original trials/cohorts and actual acquisition/reading; unique-trial/participant totals remain unverified."
    },
    {
      "item_id": "N27",
      "question_type": "Evidence condition",
      "question": "How are new materials or changed questions updated?",
      "needed": "Separating criteria revisions, evidence updates and verdict-change events",
      "role": "Required",
      "role_reason": "This condition connects Separating criteria revisions, evidence updates and verdict-change events with populations, combined content, actual comparators, scales, between-group pre-post change, denominators, timing, precision and harms for immediate pain before analgesia, distinguishing persistence, satisfaction and medication/obstetric events.",
      "application_exception": "Preserve selected C and the original brief signal. Distinguish absent subclaim score/status/axes from parent C with 50 points, Caution and unrecorded precision. Do not recalculate change differences, intervals, P or MCID responses, or combine within/between-group, primary/secondary, pre/post-epidural, immediate/persistent, pain/anxiety/event outcomes. Create no new effects, CIs, responder counts, totals, independence/safety certification or VR, labor, analgesic or treatment instructions.",
      "criterion": "Material for Separating criteria revisions, evidence updates and verdict-change events must be linked to the selected subclaim, parent context, same report/trial, outcome units, times, actual comparator and denominators, distinguishing unread external material.",
      "basis": "Preserved C/E/H application conditions concerning questions, populations, interventions, comparators, reports versus studies, endpoints, denominators and harms were referenced.",
      "condition_origin": "Internally applied conditions preserved for the existing subclaim. They do not establish preregistration, official-tool certification or completed content review.",
      "proposed_research": "Material needed: Record complete originals, criterion versions, events and reasons for change. Do not invent effects, CIs, independence or VR, labor, analgesic or treatment instructions. This records needed materials; no new research was executed.",
      "current_reports": [
        "R01",
        "R02",
        "R03",
        "R04"
      ],
      "existence": "Display information in the original parent stored summary is preserved. Public availability, acquisition and actual reading of detailed external material are separately unverified.",
      "acquired_read": "Stored summary read; external abstracts, full texts, registration, protocols, SAPs and support disclosures unread",
      "observation": "Preserve original material and production conditions/observations. Link additions or question changes to relevant comparisons, denominators, endpoints/times, reports and subclaim boundaries; no new lookup, calculation or regrading occurred now.",
      "condition_status": "Partly verified",
      "status_reason": "The selected claim, parent material and reports are distinguished and transferred from the stored summary. Detailed original material is unverified and review of existing content remains incomplete. This does not establish completed clinical review or certification.",
      "missingness": "Record complete originals, criterion versions, events and reasons for change. Do not invent effects, CIs, independence or VR, labor, analgesic or treatment instructions.",
      "uncertainty": "External original material is unread and review of existing content remains incomplete. Original grades, scores, axes, historical verification and independence statements are not treated as new verdicts or certification.",
      "review_date": null,
      "reading_status": "Full text not read · Stored summary read",
      "additional_material": "Record complete originals, criterion versions, events and reasons for change. Do not invent effects, CIs, independence or VR, labor, analgesic or treatment instructions."
    }
  ],
  "reports": [
    {
      "report_id": "R01",
      "title": "Wong MS, Spiegel BMR, Gregory KD. Virtual Reality Reduces Pain in Laboring Women: A Randomized Controlled Trial. Am J Perinatol. 2021;38(S01):e167-e172. PMID: 32485759. DOI: 10.1055/s-0040-1708851.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/32485759/",
      "report_type": "Open randomized controlled trial",
      "existence": "The stored summary contains a bibliography; acquisition and reading of external originals are unverified.",
      "acquired_read": "Stored summary read; external materials unread",
      "study_family": "Report shared across parent/subclaims; unique counts and independence unverified",
      "independent_replication": "The parent and three subclaims share the four Wong, Frey, Carus and Correia references. Preserve the original rule against adding same-cohort qualitative material as replication. Do not count reports, years, repeated contractions or separate sheets as new unique trials or independent participant totals; unique-trial/participant totals are unverified.",
      "observed_result": "Control +0.58, VR -0.52; difference in change -1.10, P=.03",
      "result_level": "Primary between-group pre-post pain change from 40 participants, 21 VR/19 control. Direct intervals, scales/models and endpoint-specific denominators are unverified. All analyzed and MCID-response statements do not establish complete data at all times/for harms or separate confirmation.",
      "source_evidence_date": "2026-09-07",
      "materials": [
        {
          "material_type": "Stored existing review summary",
          "public_status": "Preserved copy of the complete parent-verdict stored summary",
          "access_status": "Stored summary",
          "acquired": true,
          "actually_read": "Summary read",
          "as_of": "2026-09-07",
          "qualification": "Preserve original PMID 32485759, DOI 10.1055/s-0040-1708851 and unverified paper–official-registration linkage. PMCID and case/citation registration annotations are unrecorded. Same-cohort in-kind-support/noninvolvement-in-analysis statements do not become new reading or independence certification."
        },
        {
          "material_type": "External abstract",
          "public_status": "Original bibliographic link or needed material; external public availability/access status unverified",
          "access_status": "Unread; access not attempted",
          "acquired": false,
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        {
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        {
          "label": "PubMed",
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    {
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      "title": "Frey DP, et al. Virtual Reality Analgesia in Labor: The VRAIL Pilot Study-A Preliminary Randomized Controlled Trial Suggesting Benefit of Immersive Virtual Reality Analgesia in Unmedicated Laboring Women. Anesth Analg. 2019;128:e93-e96. PMID: 31094789. DOI: 10.1213/ANE.0000000000003649.",
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      "independent_replication": "The parent and three subclaims share the four Wong, Frey, Carus and Correia references. Preserve the original rule against adding same-cohort qualitative material as replication. Do not count reports, years, repeated contractions or separate sheets as new unique trials or independent participant totals; unique-trial/participant totals are unverified.",
      "observed_result": "Sensory pain -1.5 (95% CI -2.2 to -0.8); anxiety -1.5 (-2.3 to -0.8)",
      "result_level": "Order-randomized acute crossover context with 27 participants. Keep original sensory-pain and anxiety values separate without newly assigning an interval level to anxiety. Order, periods, carryover, paired denominators and differing content/scales are unverified.",
      "source_evidence_date": "2026-09-07",
      "materials": [
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        },
        {
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        },
        {
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        },
        {
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        },
        {
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        }
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        {
          "label": "PubMed",
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    {
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      "title": "Carus EG, Albayrak N, Bildirici HM, Gur Ozmen S. Immersive virtual reality on childbirth experience for women: a randomized controlled trial. BMC Pregnancy Childbirth. 2022;22:354. PMID: 35461248. PMCID: PMC9034564. DOI: 10.1186/s12884-022-04598-y.",
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      "observed_result": "Satisfaction P=.04; within-group early-pain reduction and no post-epidural change",
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      "source_evidence_date": "2026-09-07",
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        {
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    {
      "report_id": "R04",
      "title": "Correia MCG, et al. Virtual Reality in Labor Pain Management: A Randomized Controlled Trial. Pain Manag Nurs. 2026;27:e708-e714. PMID: 41896140. DOI: 10.1016/j.pmn.2026.02.005.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/41896140/",
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      "observed_result": "The during-use signal was not sustained 30 minutes later",
      "result_level": "During-use and 30-minutes-later results from 61 participants, 32 versus 29. Nonpersistence does not establish exact effect 0 or equivalence. Exact effects/CIs, time origins, denominators, registration and support are unverified.",
      "source_evidence_date": "2026-09-07",
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        },
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        },
        {
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        {
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        }
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      "links": [
        {
          "label": "PubMed",
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      "review_level": "Existing methodological links were reused for production. External originals were not reread and methodological content was not reassessed."
    }
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    "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",
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    "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"
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    "reason": "The parent and three subclaims share the four Wong, Frey, Carus and Correia references. Preserve the original rule against adding same-cohort qualitative material as replication. Do not count reports, years, repeated contractions or separate sheets as new unique trials or independent participant totals; unique-trial/participant totals are unverified."
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      "date": "2026-10-19",
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  "language": "en",
  "translation_date": "2026-10-19"
}