Objective Compare the effectiveness of a problem-solving, individualised, home-based occupational therapy intervention (ABLE 2.0), to usual occupational therapy, on activities of daily living (ADL) ability in persons with chronic conditions. Design A single-centre, double-blinded, randomised controlled trial with 10- and 26-week follow-up. Setting A Danish municipality. Subjects Persons with chronic conditions experiencing problems performing ADL tasks (n = 80). Interventions ABLE 2.0 was compared with usual occupational therapy. Main measures Coprimary outcomes were self-reported ADL ability (ADL-Interview Performance) and observed ADL motor ability (Assessment of Motor and Process Skills) at Week 10. Secondary outcomes were self-reported ADL ability (ADL-Interview Performance) and observed ADL motor ability (Assessment of Motor and Process Skills) at Week 26, and perceived satisfaction with ADL ability (ADL-Interview Satisfaction) and observed ADL process ability (Assessment of Motor and Process Skills) at Weeks 10 and 26. Results In total, 78 persons were randomly assigned: 40 to usual occupational therapy and 38 to ABLE 2.0. No statistically significant nor clinically relevant difference between group mean changes in primary outcomes was identified from baseline to Week 10 (ADL-Interview Performance −0.16; 95% CI: −0.38 to 0.06 and Assessment of Motor and Process Skills ADL motor ability −0.1; 95% CI: −0.3 to 0.1). At Week 26, a statistically significant and clinically relevant difference was found in Assessment of Motor and Process Skills ADL motor ability (LS mean change: −0.3; 95% CI: −0.5 to −0.1) between groups. Conclusion ABLE 2.0 was effective in improving observed ADL motor ability at 26 weeks.