RTW-SE: Return-to-Work Self-Efficacy Questionnaire
An 11-item self-report measure assessing a worker's confidence in their ability to return to work while managing health-related symptoms. Used in occupational rehabilitation and sick-leave management for anxiety, depression, and chronic pain.
About the RTW-SE
The Return-to-Work Self-Efficacy (RTW-SE) questionnaire was developed to assess an individual's confidence in their capacity to resume work while managing ongoing health or mental health challenges. Self-efficacy, the belief in one's own ability to perform specific tasks, is a robust predictor of return-to-work (RTW) outcomes across conditions including depression, anxiety, chronic pain, and musculoskeletal disorders.
The RTW-SE was developed based on Bandura's Social Cognitive Theory and has been validated in occupational rehabilitation and sick-leave populations in multiple countries. It is used both as a prognostic tool to identify individuals at higher risk of prolonged sick leave and as an outcome measure in vocational rehabilitation interventions.
What the Assessment Measures
The RTW-SE measures the degree of confidence a person has in their ability to:
- Manage work demands despite ongoing symptoms
- Cope with work stress without symptom worsening
- Communicate with employers and colleagues about limitations
- Gradually increase work hours or responsibilities
- Return to their previous role or a modified role
Items are rated on a 0–10 scale (Not at all confident to Completely confident), yielding a continuous score.
Scoring
Total score range: 0–110 (sum of 11 items, each 0–10)
Higher scores indicate greater self-efficacy for return to work.
Cutoff for clinical prediction (Gjengedal et al., 2021):
- Score ≤54: Low self-efficacy; high risk for prolonged sick leave
- Score >54: Higher self-efficacy; more favorable RTW prognosis
A score of ≤54 identifies patients on sick leave due to anxiety or depression who are at elevated risk of remaining absent for ≥6 months.
Administration
- Format: Self-report
- Items: 11
- Time: Approximately 5 minutes
- Population: Adults currently on sick leave or at risk of work absence due to physical or mental health conditions
Clinical Applications
The RTW-SE is used in:
- Occupational rehabilitation programs: To assess readiness and guide pacing of return to work
- Psychological treatment for anxiety/depression: As a functional outcome measure alongside symptom measures
- Sick leave case management: To triage individuals needing additional vocational support
- Research: As a predictor variable in RTW cohort studies
Psychometric Properties
- Good internal consistency (Cronbach's α ≈ 0.92–0.96)
- Test-retest reliability: ICC ≈ 0.80–0.90
- Predictive validity for RTW outcomes across anxiety, depression, and musculoskeletal conditions
- Validated in Norwegian (original), Chinese (Wang et al., 2023; Liu et al., 2022), and other languages
Clinical Considerations
- Low RTW-SE is a modifiable risk factor: cognitive-behavioural interventions targeting self-efficacy beliefs can improve RTW outcomes
- RTW-SE should be interpreted alongside functional capacity, employer accommodation availability, and symptom severity
- In clients with both psychiatric and occupational stressors, workplace-specific barriers (e.g., harassment, role conflict) may suppress scores independently of clinical progress
References
- Lagerveld SE, Blonk RWB, Brenninkmeijer V, Schaufeli WB. (2010). Return to work in the context of psychiatric disorders: a review of predictors. Journal of Occupational Rehabilitation, 20(2), 189–202.
- Gjengedal RGH, Lagerveld SE, Reme SE, et al. (2021). The Return-to-Work Self-efficacy Questionnaire (RTW-SE): A Validation Study of Predictive Abilities and Cut-off Values for Patients on Sick Leave Due to Anxiety or Depression. Journal of Occupational Rehabilitation, 31(3), 589–600. PMID: 33630238
- Wang T, Jin M, Zhu R, et al. (2023). Return-to-work self-efficacy questionnaire: Cross-cultural adaptation and validation in China. Nursing Open, 10(9), 6387–6397. PMID: 37317045
- Liu F, Zhang Z, Lin B, et al. (2022). Assessing the psychometric properties of the Chinese return-to-work self-efficacy questionnaire using Rasch model analysis. Health and Quality of Life Outcomes, 20(1), 31. PMID: 35172850
Frequently Asked Questions
What does the RTW-SE measure?
The RTW-SE measures a worker's confidence in their ability to resume employment while managing ongoing health symptoms — covering work performance, stress tolerance, boundary-setting, and communication with employers. It is a self-report, not a clinician-administered instrument. Higher scores indicate greater self-efficacy for return to work.
How is the RTW-SE scored?
Scores are computed as a mean across the 11 items. Gjengedal et al. (2021) derived three clinically meaningful bands from ROC analysis in a Norwegian sick-leave sample: a mean score below 3.7 indicates low self-efficacy (associated with no return to work); 3.7 to 4.6 indicates moderate self-efficacy (associated with partial return); and 4.6 or above indicates high self-efficacy (associated with full return to work). These cut-offs were derived post-treatment and may not transfer directly to all populations or time points.
Can the RTW-SE diagnose a mental health condition?
No. The RTW-SE is a prognostic and outcome measure, not a diagnostic tool. It assesses occupational self-efficacy — a person's confidence in resuming work — and is used alongside symptom measures and functional assessments, not as a substitute for clinical diagnosis.
Is RTW-SE self-efficacy a fixed trait or can it change with treatment?
RTW-SE is a modifiable state. Studies show significant increases in RTW-SE scores following work-focused cognitive-behavioural treatment, and improvements in self-efficacy predict earlier full return to work even after controlling for depression and anxiety symptoms. This sensitivity to change makes it useful both as an outcome measure and as a target for intervention.
Bill this assessment
The RTW-SE: Return-to-Work Self-Efficacy Questionnaire qualifies for reimbursement under these CPT codes (US).
Using this assessment in practice
For clinicians
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For individuals
This page is a clinical reference, not a diagnostic tool. If you have concerns about your own symptoms, bring this information to a qualified mental health professional.
Last reviewed: Jun 3, 2026
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