Intensive land use alters hydrology and water quality, threatening freshwater benthic macroinvertebrates. Over 200,000 management practices (MPs) have been implemented across the Chesapeake Bay watershed since the 1980s, yet biological responses remain inconsistent. We synthesized 29 studies from 4 physiographic provinces covering 8 MP categories and evaluated macroinvertebrate responses along MP gradients using structural (richness), functional (biomass), tolerance, and biotic metrics. We hypothesized that MPs enhancing habitat complexity or restoring flow regimes would benefit taxa sensitive to sediment, hydrologic instability and organic pollution, with outcomes shaped by regional context, land use, and chosen metrics. Four themes emerged. (i) Agricultural Riparian Forest Buffers (RFBs) consistently improved sensitive metrics related to abundance, biomass and richness. (ii) Urban streams with Stream Habitat Improvement and Management (SHIM) showed improved richness and diversity, but biomass and tolerance metrics declined or remained neutral, indicating unresolved hydrologic and pollutant stress. (iii) Structural and functional responses diverged: effect sizes for total and feeding-group biomasses (functional metrics) were negative, whereas genus-level Ephemeroptera-Plecoptera-Trichoptera (EPT) richness (structural metric) was positive, indicating that structural shifts may not track underlying production changes. (iv) Physiographic comparisons showed counterintuitive patterns, as RFBs improved EPT richness in Piedmont streams but had negative effects in the Coastal Plain. Evaluating MP effectiveness requires distinguishing a no-MP pathway (stressors → instream conditions → assemblages → responses) from an MP-mediated pathway (practice regime → modified stressors → instream conditions → assemblages → responses), underscoring the need for region-specific, multi-metric monitoring and improved understanding of MP density thresholds and recovery lags.