Summary River rehabilitation schemes are now widespread in the UK and elsewhere, but there have been few systematic assessments of their ecological effect, particularly on target organisms such as fish. Fish populations were therefore assessed in 13 lowland rivers using point abundance measures and depletion electrofishing. Each river was sampled in two reaches, respectively containing a small‐scale rehabilitation scheme (artificial riffles or flow deflectors) and an unrehabilitated control reach. Detailed geomorphological surveys were undertaken for the two study reaches in each river to assess the physical and hydraulic effect of rehabilitation. There were large qualitative and quantitative differences among rivers and some had relatively impoverished fish faunas. Overall, total fish abundance, species richness, diversity and equitability were not significantly different between rehabilitated and control reaches. This was true for both the sampling methods used. Bullhead Cottus gobio and stone loach Barbatula barbatula tended to be more abundant in rehabilitated reaches, but this was significant only for artificial riffles. There was a significant between‐year difference in fish abundance. In general, rehabilitation schemes increased depth and flow heterogeneity, and fish species richness and diversity appeared to respond positively to increased flow velocity in restored reaches. However, there were few significant relationships between the fish fauna and physical variables, indicating that increasing physical (habitat) heterogeneity does not necessarily lead to higher biological diversity. We therefore caution against the use of physical responses to rehabilitation as a surrogate or reliable predictor of ecological response. The weak response of fishes to rehabilitation may have been because the schemes were inappropriate in design and scale for low‐gradient rivers. Furthermore, fish assemblages may have lacked the potential for recovery because of poor water quality and/or because the schemes were isolated within longer sections of degraded river. More extensive and directed biological monitoring is essential to improve understanding and enable future improvements in the design of schemes and the selection of sites with greater potential for successful rehabilitation. Synthesis and applications. From this substantial sample of lowland rivers, there is little evidence of any general benefit to fish of small‐scale instream structures in river rehabilitation. From present ecological knowledge it may be that resources would be better devoted to promoting the development of lateral and off‐channel habitats within the river corridor. Physical restoration will be most effective when used alongside other strategies to augment fish populations such as water quality management.