Background <p>For people in old age, the risk of limitations in activities of daily living (ADL), low physical performance, and chronic diseases increases. Home rehabilitation targeting physical performance is a common intervention for older people with multimorbidity. Still research on home rehabilitation is mainly diagnosis specific. The objectives of this study were to summarize intervention components and evaluate the effects of home rehabilitation on ADL and physical performance in community-dwelling older people (65 years or older) with low physical performance and/or ADL difficulties.</p> Methods <p>The databases MEDLINE, Web of Science, and CINAHL (January 2006–September 2025), plus references were screened, using keywords related to aging, home rehabilitation, ADL, and physical performance in randomized controlled trials (RCTs).</p> <p>Inclusion criteria: RCTs of supervised home rehabilitation, targeting physical performance and/or basic and/or instrumental ADL (BADL/IADL) in community-dwelling people 65 years of age or older with low physical performance and/or ADL difficulties.</p> <p>Exclusion criteria: scope of specific diagnoses, assisted living settings, centre-based, interventions areas outside the occupational therapy or physiotherapy disciplines, mainly delivered by home help service staff, exclusively outcomes outside the scope of ADL and physical performance conducted at home or non-English publications. 3,360 records were screened independently by two reviewers.</p> <p>Data extraction followed the PROSPERO protocol. Methodological quality was assessed using the Joanna Briggs Institute RCT checklist (2020) (JBI), and certainty of evidence using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Random effects models generated pooled effects.</p> Results <p>The review included 27 RCTs (<i>n</i> = 4,948), which were grouped into three intervention approaches. Twenty-three studies were graded as having low risk of bias, three as moderate risk of bias, and one of high risk of bias, using the JBI tool. The age of the participants ranged from 74 to 87 years of age.</p> <p>Activity-based interventions improved BADL (<i>n</i> = 1,048, SMD 0.29, 95% CI 0.17 to 0.41, <i>P</i>&lt;.001; moderate evidence) but not IADL (<i>n</i> = 603, SMD − 0.15, 95% CI − 0.31 to 0.01) or selected ADL tasks (<i>n</i> = 158, non-significant).</p> <p>Exercise-based interventions improved BADL and physical performance (<i>n</i> = 310, SMD 0.43, 95% CI 0.21 to 0.66, <i>P</i>&lt;.001; <i>n</i> = 1,472, SMD 0.20, 95% CI 0.10 to 0.30, <i>P</i>&lt;.001), with low evidence due to imprecision and risk of bias according to GRADE.</p> <p>Reablement-based interventions showed no significant effects on selected ADL tasks measured with Canadian Occupational Performance Measure (COPM) (<i>n</i> = 291, COPM performance MD 0.30, 95% CI − 0.25 to 0.86; COPM satisfaction MD 0.19, 95% CI − 0.04 to 0.42) or physical performance (<i>n</i> = 555, SMD 0.12, 95% CI − 0.05 to 0.28), with low to very low evidence according to GRADE.</p> Conclusion <p>Home rehabilitation comprises three main intervention approaches. The Activity-based and Exercise-based yield small improvements in BADL and physical performance. Evidence for other ADL outcomes and the Reablement-based remains limited.</p> Trial registration <p>PROSPERO (CRD42023488726).</p>