this study aimed to review published randomized and non-randomized control trials (RCTs and NRCTs) that assessed the effects of unsupervised PFMT programs in comparison with supervised PFMT programs for managing UI symptoms, quality of life (QoL), PFMs function/ strength, the severity of UI and patient's satisfaction outcomes in female adults.

Five databases were searched from inception to December 2021 and the search was updated until June 28, 2022. Randomized and non-randomized control trials (RCTs and NRCTs) comparing supervised and unsupervised PFMT in women with UI and reported urinary symptoms, quality of life (QoL), pelvic floor muscles (PFM) function/ strength, the severity
of UI, and patient satisfaction outcomes, were included. Risk of bias assessment of eligible studies was performed by two authors through Cochrane risk of bias assessment tools. The meta-analysis was conducted using a random effects model with the mean difference or standardized mean difference.

Six RCTs and one NRCT study were included. All RCTs were assessed as "high risk of bias" and the NRCT study was rated as "serious risk of bias" for almost all domains. The results showed that supervised PFMT is better than unsupervised for QoL and PFMs function of women with UI. There was no difference between supervised and unsupervised PFMT for urinary symptoms and improvement of the severity of UI. Results of patient satisfaction were inconclusive due to the sparse literature. However, supervised, and unsupervised PFMT with thorough education and regular reassessment showed better results than unsupervised PFMT without educating patients about correct PFMs contractions.

This study was a systematic review and meta-analysis comparing the effectiveness of the supervised versus unsupervised PFMT for the treatment of women with UI. The findings of the present systematic review and meta-analysis showed that the QoL and PFM function improved significantly in the supervised group compared to the unsupervised. There was not a significant difference in the severity of UI and the results of studies that reported patient satisfaction were inconclusive. This systematic review and meta-analysis differ from the existing Cochrane
review of PFMT for UI which is limited to the comparison of PFMT to no treatment, placebo/sham, or inactive treatment

This systematic review and meta-analysis indicated that both supervised and unsupervised PFMT has positive effects on QoL, PFMs function, urinary symptoms, and the severity of UI. Although supervised PFMT showed better results in most of the included studies compared with unsupervised PFMT, the improvement of urinary symptoms and severity of UI was almost the same between the two groups.